FAT-EMBOLISM SYNDROME - A 10-YEAR REVIEW

Background: The effect of recent advances in critical care and the emp hasis on early fracture fixation in patients with fat embolism syndrom e (FES) are unknown. Objective: To better define FES in current practi ce by conducting a 10-year review of the experiences at our level I tr auma center. Design: The medical records of all patients in whom FES w as diagnosed from July 1, 1985, to July 1, 1995, were reviewed for dem ographics, injury severity and pattern, diagnostic criteria, and manag ement. Setting: A level I trauma center. Results: Twenty-seven patient s with clinically apparent FES were identified. This resulted in an in cidence of 0.9% of all patients with long-bone fractures. The mean inj ury severity score was 9.5 (range, 4-22). The diagnosis of FES was mad e by clinical criteria, including hypoxia, 26 patients (96%); mental s tatus changes, 16 patients (59%); petechiae, 9 patients (33%); tempera ture higher than 39 degrees C, 19 patients (70%); tachycardia (heart r ate >120 beats per minute), 25 patients (93%); thrombocytopenia (plate let count <150x10(9)/L), 10 patients (37%); and unexplained anemia, 18 patients (67%). Thirteen patients (48%) had multiple long-bone fractu res, and 14 patients (52%) had a single long-bone fracture. Seven pati ents (26%) had open fractures, 15 (56%) had closed fractures, and the remaining 5 (18%) had both. Of the total fracture population, the dist ribution was 81% closed, 15% open, and 4% both. Management included ve ntilatory support for 12 (44%) of the patients; early operative fixati on was emphasized, and 74% of the fractures were stabilized within 24 hours of injury. This was comparable with 76% of the total fracture po pulation. There were 2 deaths, for a mortality of 7%. Conclusions: (1) Fat embolism syndrome remains a diagnosis of exclusion and is based o n clinical criteria. (2) Clinically apparent FES is unusual but may be masked by associated injuries in more severely injured patients. (3) No association could be identified between FES and a specific fracture pattern or location. (4) Early intramedullary fixation does not incre ase the incidence or severity of FES. (5) While FES seems to have a di rect effect on survival, the management of FES remains primarily suppo rtive.