0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Fat Embolism Syndrome:  A 10-Year Review

Eileen M. Bulger, MD; Douglas G. Smith, MD; Ronald V. Maier, MD; Gregory J. Jurkovich, MD
Arch Surg. 1997;132(4):435-439. doi:10.1001/archsurg.1997.01430280109019.
Text Size: A A A
Published online

Background:  The effect of recent advances in critical care and the emphasis on early fracture fixation in patients with fat embolism syndrome (FES) are unknown.

Objective:  To better define FES in current practice by conducting a 10-year review of the experiences at our level I trauma center.

Design:  The medical records of all patients in whom FES was diagnosed from July 1, 1985, to July 1, 1995, were reviewed for demographics, injury severity and pattern, diagnostic criteria, and management.

Setting:  A level I trauma center.

Results:  Twenty-seven patients with clinically apparent FES were identified. This resulted in an incidence of 0.9% of all patients with long-bone fractures. The mean injury severity score was 9.5 (range, 4-22). The diagnosis of FES was made by clinical criteria, including hypoxia, 26 patients (96%); mental status changes, 16 patients (59%); petechiae, 9 patients (33%); temperature higher than 39°C, 19 patients (70%); tachycardia (heart rate >120 beats per minute), 25 patients (93%); thrombocytopenia (platelet count <150×109/L), 10 patients (37%); and unexplained anemia, 18 patients (67%). Thirteen patients (48%) had multiple long-bone fractures, and 14 patients (52%) had a single long-bone fracture. Seven patients (26%) had open fractures, 15 (56%) had closed fractures, and the remaining 5 (18%) had both. Of the total fracture population, the distribution was 81% closed, 15% open, and 4% both. Management included ventilatory support for 12 (44%) of the patients; early operative fixation was emphasized, and 74% of the fractures were stabilized within 24 hours of injury. This was comparable with 76% of the total fracture population. There were 2 deaths, for a mortality of 7%.

Conclusions:  (1) Fat embolism syndrome remains a diagnosis of exclusion and is based on 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 increase the incidence or severity of FES. (5) While FES seems to have a direct effect on survival, the management of FES remains primarily supportive.Arch Surg. 1997;132:435-439

Topics

Sign in to download this free article PDF

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in to download this free article PDF

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();