Fat embolism syndrome and its clinical features

Abstract

Fat embolism is the obstruction of blood vessels by fat globules. This finding has been described in multiple patients and autopsies, being associated with either closed or exposed long bone fractures, extensive soft tissue injuries, or orthopedic surgeries. Fat embolism syndrome (FES) is a critical condition in which fat embolism, in a smaller percentage of patients, produces severely progressive symptoms. These symptoms, in the absence of early diagnosis, may have high morbidity and mortality. There are two theories regarding the pathophysiology of FES, which explain the characteristic symptoms of the disease, including the classical triad. Currently, there is a series of scoring criteria that are useful in clinical practice as a means of supporting diagnosis. In addition, the incorporation of imaging studies with clinical characteristics suggestive of the disease, allow the clinician to find the diagnosis accurately. The Intensive Care Units have varied the measures of treatment and support of these patients to ensure survival.

This document is a bibliographic review of novel articles on FES over a period of time between 2014 and 2019. There are clinical symptoms that are very characteristic of fat embolism syndrome, in addition to particular patterns in the image studies of the disease.

The patients with long bone fractures and polytraumas are mostly young individuals, which present the classic triad, being the respiratory deficit the most frequent element, followed by the neurological deficit and finally the petechial rash. Symptom onset time ranges from 24 to 48 hours in most patients, whereas a minimal percentage develops a severe form in less than 12 hours. Treatment remains controversial and varies among intensive care units. The biggest challenge is to achieve a timely diagnosis.