Rare case of Fat Embolism Syndrome with Multiple Small Pulmonary Emboli After Femur Fracture ORIF: A report

Recently published case report discussed a case report of a 56-year-old female patient who developed Fat Embolism Syndrome (FES) and multiple small pulmonary emboli following open reduction internal fixation (ORIF) of a left femur fracture. FES is a rare but potentially fatal complication of orthopedic injuries, particularly long bone fractures. The syndrome is caused by the release of fat globules into the bloodstream, resulting in the obstruction of blood vessels and subsequent tissue damage. The incidence of FES in patients with long bone fractures has been reported in 0.5-11%, with the highest risk for morbidity and mortality in those with pre-existing respiratory or cardiovascular complications. Diagnostic criteria for FES include respiratory distress, neurological dysfunction, and a petechial rash, or specific criteria proposed by Gurd and Wilson.

Recognition and Treatment of FES and Pulmonary Emboli

The research highlighted that prompt recognition and treatment of FES and pulmonary emboli in patients undergoing orthopedic procedures are critical for improving outcomes and preventing mortality. The treatment for FES primarily involves supportive measures, while pulmonary embolism is typically managed with anticoagulant therapy. However, the decision to administer anticoagulants in patients with FES needs to be carefully weighed against potential bleeding risks. The study emphasized the importance of maintaining a high index of suspicion for FES and pulmonary emboli in patients undergoing orthopedic procedures and called for further research to identify risk factors and devise optimal treatment strategies for these complications. The case report underscored the need for awareness about the possibility of FES and maintaining a high index of suspicion during the intraoperative course.

The paper also noted that the patient was managed with supportive care, including mechanical ventilation, fluid resuscitation, vasopressor support, and heparin administration to prevent further clot propagation. The authors highlighted that management of FES varies on a case-by-case basis, and prompt recognition and treatment are crucial in improving outcomes and preventing patient morbidity and mortality.

Conclusion

In conclusion, the research paper presented a case report of FES and multiple small pulmonary emboli following ORIF of a left femur fracture, emphasizing the need for prompt recognition and treatment to improve outcomes in patients undergoing orthopedic procedures. The study also underscored the importance of maintaining a high index of suspicion for these complications and called for further research to devise optimal treatment strategies for FES and pulmonary emboli in this patient population.

Reference -

Hacker A, Irvine D S, MacDougal S, et al. (September 19, 2023) The Development of Fat Embolism Syndrome (FES) and Multiple Small Pulmonary Emboli Following Open Reduction Internal Fixation (ORIF) of a Left Femur Fracture: A Case Report. Cureus 15(9): e45551. doi:10.7759/cureus.45551