Effective Management of Femur Fracture Using Damage Control Orthopedics Following Fat Embolism Syndrome

Fat embolism syndrome (FES) is a rare event following a traumatic injury, and its pathophysiologic mechanism continues to be elusive. Fat embolism syndrome generally occurs when a bone marrow fat enters the bloodstream resulting in a cascade of inflammatory response, hyper-coagulation, and an array...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2020-03, Vol.12 (3), p.e7455
Main Authors: Wilson, Abralena, Hanandeh, Adel, Shamia, Ahmed A, Louie, Kevin, Donaldson, Brian
Format: Article
Language:English
Subjects:
Bone marrow
Cardiac arrhythmia
Case reports
Circulatory system
Edema
Embolisms
Fractures
Hematology
Hospitals
Ischemia
Magnetic resonance imaging
Mortality
Orthopedics
Patients
Surgeons
Surgery
Trauma
World War I
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Summary:Fat embolism syndrome (FES) is a rare event following a traumatic injury, and its pathophysiologic mechanism continues to be elusive. Fat embolism syndrome generally occurs when a bone marrow fat enters the bloodstream resulting in a cascade of inflammatory response, hyper-coagulation, and an array of symptoms that generally begin within 24-48 hours. FES early symptoms include petechial rash, shortness of breath, altered mental status, seizures, fever, and may result in decreased urine output. The common etiologies of a fat embolism include long bone fractures, mainly femoral and pelvic fractures.  There are multiple management methods described in the literature to help prevent FES and other long bone fracture complications from occurring. Although not universally adopted, the damage control orthopedics (DCO) has been the major management option for patients with a long bone fracture. DCO is entertained by provisional immobilization of patients with long bone fractures and those who are considered severely traumatized patients (STP). Thus, immobilization can help minimize the traumatic effect and the subsequent second hit by performing non-life saving surgical procedures. In this case, a patient with a transverse femur fracture suffered disconcerting symptoms of fat embolism prior to definitive femur repair. Hence, damage control orthopedics was entertained with a postponement of his femur repair to facilitate stabilization. The use of damage control orthopedics was successful in this patient with no long term complications.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.7455