Maine Orthopaedic Review Monthly Challenge

Test Your Knowledge of Bone Fractures

Bruce F. Gomberg, MD; Brad J. Yoo, MD


March 08, 2017

Fat embolism syndrome occurs when embolic fat macroglobules lodge within the microvascular pulmonary tree. This results in endothelial damage with resultant vascular permeability and respiratory failure. Fat embolism syndrome is particularly associated with fractures of long bones and increased even more with a concomitant head injury. Overaggressive reaming of the medullary canal during intramedullary nailing can exacerbate the pre-existing lung injury. Patients will present with shortness of breath, hypoxia, and confusion. Petechiae may occur over the skin. The chest x-ray may not demonstrate obvious infiltrate until after respiratory failure has occurred. In this scenario, a pneumothorax, diaphragmatic rupture, or pulmonary contusion would be readily identified on chest x-ray. The patient's symptoms are not consistent with a neurologic abnormality.[4]


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