Fat Embolism is a complication of closed fracrures. It may lead to Respiratory distress, cerebral dysfunction and rash. It is often very difficult to diagnose.
Causes
1. Fractures – closed fractures
produce more emboli than open fractures. Long bones pelvis and ribs cause more
emboli. Sternum and clavicle furnish less. Multiple fractures produce more
emboli.
2. Orthopedic procedures – most commonly intramedullary nailing of the long
bones hip or knee replacements.
3. Massive soft tissue injury.
4. Severe burns.
5. Bone marrow biopsy
Non – traumatic settings occasionally lead to fat embolism. These include Conditions associated with:
- Liposuction
- Fatty liver.
- Prolonged corticosteroid therapy
- Acute pancreatitis
- Osteomyelitis
- Conditions causing bone infarcts,especially sickle cell disease.
Symptoms
Patients often presents with the following symptoms:
- Breathlessness
- Chest pain
- Fever
- Petechial rash
- Cerebral dysfunction ( disorientation, confusion, seizures)
- Oliguria, haematuria, anuria
- Respiratory failure
Diagnosis
Major Criteria
- Respiratory insufficiency.
- Cerebral involvement
- Petechial rash
Minor Criteria
- Tachycardia
- Pyrexia ( usually > 39 degrees. C)
- Confusion
- Sustained pO2,< 8 kPa.
- Sustained respiratory rate> 35/minute in spite of sedation.
- Retinal changes – cotton wool exudates and small haemorrhages, occasionally fat globules seen in retinal vessels.
- Jaundice
- Renal signs
- Thrombocytopenia
- Anaemia
- High ESR
- Fat macroglobulinemia
- Diffuse alveolar infiltrates ‘snow storm apperance’on CXR.
One study concluded that atleast two symptoms for the major criteria Or one symptom for the major criteria must be present to diagnose the Syndrome.
Investigations
– Chest X-ray
– Blood gas analysis
– Blood investigations
– Urine analysis
– MRI scan study of Brain
– Transoesophageal Echocardiogram
Management
– Sufficient
oxygenation
– Restriction of fluid intake
– Diuretics
– Albumin Infusion
– Mechanical ventilation
– Heparin anti coagulation
Prevention
–
Early immobilisation of fractures
– Heparin anti coagulation