In a consecutive series of 274 patients with isolated femoral shaft fr
actures 11 patients (4%) developed fat embolism syndrome. There were n
o cases of fat embolism syndrome in patients over the age of 35 years.
Of the remaining patients, 60 operated on within 10 h of injury did n
ot develop fat embolism. This left 109 patients who had nailing perfor
med more than 10 h alter initial of whom eleven (10%) developed fat em
bolism syndrome (p<0.027). Patients under the age of 35 years with iso
lated femoral fractures should have nailing performed as early as poss
ible after injury to minimize fat embolism syndrome. (C) 1998 Publishe
d by Elsevier Science Ltd. All rights reserved.