embolism (fat)

Last reviewed 05/2021

Fat Embolism Syndrome (FES)

• potentially fatal complication of long bone fractures
  
  
• classically described as the triad of hypoxia, petechiae, and neurological impairment
  
  
• characterized by bone marrow fat entering the systemic circulation and the individual's inflammatory response to it
  • response can result in dysfunction of several organs, most importantly the lungs, brain, and skin
    
    
• although fat embolization occurs in the majority of patients with long bone fractures or during orthopedic procedures, clinical signs and symptoms occur in only 1-10% of these patients
  • most of the reported cases occurred in patients with multiple traumatic injuries that resulted in the systemic inflammatory response syndrome, which causes multi-organ damage via a reaction to free fatty acids
  • non-traumatic causes of FES
    • non-traumatic conditions are very uncommon causes of FES; they are acute pancreatitis, fatty liver, corticosteroid therapy, lymphography, fat emulsion infusion and haemoglobinopathies

Reference:

• Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg (Br) 1974;7:408-416.
• Robinson CM. Current concepts of respiratory insufficiency syndromes after fracture. J Bone Joint Surg (Br) 2001;7:781-791.
• Shaikh N. Emergency management of fat embolism syndrome. J Emerg Trauma Shock. 2009 Jan;2(1):29-33.