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Updated: Jun 18 2021

Fat Embolism Syndrome

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https://upload.orthobullets.com/topic/9055/images/bone marrow em_moved.jpg
  • summary
    • Fat Embolism Syndrome is an acute respiratory disorder caused by an inflammatory response to embolized fat globules that may enter the bloodstream as a result of acute long bone fractures or intramedullary instrumentation. Patients present with hypoxia, changes in mental status, and  petechial rash. 
    • Diagnosis is made clinically with presence of hypoxemia (PaO2 < 60), CNS depression, petechial rash, and pulmonary edema.
    • Treatment is focused on prevention with early stabilization of long bone fractures. Mechanical ventilation with high levels of PEEP is the recommended treatment for acute presentation. 
  • Epidemiology
    • Incidence
      • 3-4% with isolated long bone trauma
      • 10-15% with polytrauma
  • Etiology
    • Pathophysiology
      • fat and marrow elements are embolized into the bloodstream during
        • acute long bone fractures
        • intramedullary instrumentation
          • intramedullary nailing
      • pathophysiology
        • two theories regarding the causes of fat embolism include
          • mechanical theory
            • embolism is caused by droplets of bone marrow fat released into venous system
          • biochemical theory
            • lipoprotein lipase induces free fatty acid production with resultant hyperinflammatory response similar to ARDS
  • Diagnosis Criteria
    • Major (1)
      • hypoxemia (PaO2 < 60)
      • CNS depression (changes in mental status)
      • petechial rash
      • pulmonary edema
    • Minor (4)
      • tachycardia
      • pyrexia
      • retinal emboli
      • fat in urine or sputum
      • thrombocytopenia
      • decreased HCT
    • Additional
      • PCO2 > 55
      • pH < 7.3
      • RR > 35
      • dyspnea
      • anxiety
  • Presentation
    • History
      • symptoms usually present within 24 hours of inciting event
    • Symptoms
      • patient complains of feeling "short of breath"
      • patient appears confused
    • Physical exam
      • tachycardia
      • tachypnea
      • petechiae
        • axillary region
        • conjunctivae
        • oral mucosa
  • Studies
    • ABG
      • hypoxemia (PaO2 < 60 mmHg)
  • Treatment
    • Nonoperative
      • mechanical ventilation with high levels of PEEP (positive end expiratory pressure)
        • indications
          • acute fat emboli syndrome
    • Prevention
      • early fracture stabilization
        • indications
          • early fracture stabilization (within 24 hours) of long bone fracture is most important factor in prevention of FES
        • techniques to reduce the risk of fat emboli
          • overreaming of the femoral canal during a TKA
          • use of reamers with decreased shaft width reduces the risk during femoral reaming for intramedullary fixation
          • use of external fixation for definitive fixation of long bone fractures in medically unstable patients decreases the risk
  • Prognosis
    • Fatal in up to 15% of patients
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Question
1 of 6
In scope icon N/A
QID 219803 (Type "219803" in App Search)
A 52-year-old recreational surfer presents with shoulder pain and weakness after being hit forcefully by a wave while trying to recover his board with his arm in hyperabduction and external rotation. On examination, he has a positive bear hug test, active internal rotation to neutral on the affected side, and passive external rotation of 100 degrees compared to 70 degrees on the unaffected side. He comes to the clinic with an MRI, a representative image of which is shown in Figure A. You are planning to book him for a rotator cuff repair with a suprapectoral arthroscopic biceps tenodesis. Injury to which of the following structures most likely contributed to the findings shown in Figure A?
  • A

Coracoacromial (CA) ligament and superior glenohumeral ligament (SGHL)

4%

25/626

Coracoacromial (CA) ligament and middle glenohumeral ligament (MGHL)

3%

17/626

Coracohumeral ligament (CHL) and inferior glenohumeral ligament (IGHL)

23%

142/626

Coracohumeral ligament (CHL) and middle glenohumeral ligament (MGHL)

41%

258/626

Coracohumeral ligament (CHL) and superior glenohumeral ligament (SGHL)

27%

172/626

  • A

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Basic Science⎪Fat Embolism Syndrome
  • Basic Science
  • - Fat Embolism Syndrome
12:57 min
8/13/2020
928 plays
4.3
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