Journal: J Trauma [EPub ahead of print]:1-4, 2008. 20 References
Reprint: Department of Surgery, University of Ottowa, Ottowa, Ontario, Canada (W Weiss, MD) LE.14 SP0819/259 ©2008
Faculty Disclosure: Abstracted by L. Easley, who has nothing to disclose.
The embolization of intramedullary fat into the circulation has been shown to occur routinely in pelvic and long bone fractures, and with a variety of orthopedic procedures. Because of the complexity of presentation, the pathophysiologic mechanisms of fat embolism syndrome are controversial. A case is presented of delayed presentation of fat embolism syndrome after intramedullary nailing of a fractured femur. A 27-year-old man suffered a closed trans¬verse diaphyseal femoral shaft fracture after a large granite block fell on his left leg. The procedure was performed using fluoroscopy, and there were no intraoperative complications. The patient had no difficulties postoperatively; he was treated with 10 L/min oxygen by mask in recovery, given morphine, fentanyl, dimenhydrinate, ondansetron, dalteparin, cefazolin, oxycodone, and acetaminophen, and allowed to begin weight bearing as tolerated.
On postoperative day 3, the patient presented to the emergency room incoherent and in respiratory distress. A chest X-ray film was reported by the radiologist as demonstrating mixed pulmonary alveolar and interstitial opacities in both lungs consistent with fat embolism. Because of the lack of evidence for thromboembolic disease and for infec¬tion, a diagnosis of acute respiratory distress syn¬drome (ARDS) secondary to fat embolism was made and the patient was intubated and treated supportively in the intensive care unit without anticoagulation or antibiotics. After discharge, the patient underwent rehabilitation for his femur fracture, and experienced no further difficulties. |
