Fat Embolism

Fat Embolism Syndrome is a syndrome that occurs most commonly after long bone fractures.  The old theory is that the marrow fat gains entrance into the bloodstream and embolizes, primarily to the pulmonary circulation.  Most likely, the syndrome results from degradation of the fat globules in plasma to toxic metabolites such as free fatty acids and C-reactive protein.

Some of the findings associated with Fat Embolism are:

• Occurence 24-72 hours after long bone fracture or manipulation
• Classic triad of: hypoxemia, neurologic abnormalities and petechial rash
• Hypoxemia resembles ARDS or ALI and occurs in 50% of patients
• Neurologic abnormalities present as confusion and are transient
• Petechial rash on head, neck and thorax in about 20% of patients - resolves in 5-7 days
• Rarely, lipiduria, retinopathy, fever, DIC, and myocardial depression develop

The diagnosis is usually made based on clinical symptomatology.

Early fixation of long bone fractures helps prevent the syndrome from occurring.

Treatment is supportive, primarily involving ventilator management.  The mortality rate is about 2%.