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Traumatic fat embolism occurs in 90 percent of individuals with severe skeletal injuries, but the clinical presentation is usually mild and goes unrecognized. Approximately 10 percent of these patients develop clinical findings, collectively known as fat embolism syndrome (FES). In its most severe form, FES is associated with a 1-2 percent mortality rate [1]. FES can also occur under several nontraumatic conditions. It can be seen following cardiopulmonary resuscitation, parenteral feeding with lipid infusion, liposuction and pancreatitis. FES has also been proposed as a major cause of the acute chest syndrome in patients with sickle cell disease [2].

The most effective approach to treatment of FES is prevention. An accepted prevention strategy is early stabilization of fractures, particularly of the tibia and femur, which allows patients to mobilize more quickly. This has been found to decrease the incidence of FES, ARDS and pneumonia and reduce the length of hospital stay [5-7]. Aggressive fluid resuscitation and maintenance of an adequate circulatory volume have also been shown to be protective. More controversial is the use of prophylactic corticosteroids. Nearly all trials of both low and high dose methylprednisolone have demonstrated a reduction in the incidence of FES as well as less severe hypoxemia [8-10]. Since most cases of FES are mild and the great majority of patients recover, concerns regarding the risk of infection and wound healing impairment have limited the routine use of corticosteroids. Once symptoms develop, treatment is supportive. Corticosteroids may be beneficial if cerebral edema is present. Respiratory insufficiency is treated with oxygen therapy and continuous positive           Abstract Fat embolism syndrome (FES) is an ill-defined clinical entity that arises from the systemic manifestations of fat emboli within the microcirculation. Embolized fat within capillary beds cause direct tissue damage as well as induce a systemic inflammatory response resulting in pulmonary, cutaneous, neurological, and retinal symptoms. This is most commonly seen following orthopedic trauma; however, patients with many clinical conditions including bone marrow transplant, pancreatitis, and following liposuction. No definitive diagnostic criteria or tests have been developed, making the diagnosis of FES difficult. While treatment for FES is largely supportive, early operative fixation of long bone fractures decreases the likelihood of a patient developing FES.

FES is most often associated with orthopedic trauma. Rare cases of FES have been reported to occur following bone marrow transplantation, osteomyelitis, pancreatitis, alcoholic fatty liver, and even liposuction.[4] Since most cases of FES occur following orthopedic trauma, available research focused on FES in orthopedic trauma patients.

EPIDEMIOLOGY Fat embolization occurs frequently following orthopedic trauma. Fat globules have been detected in the blood of 67% of orthopedic trauma patients in one study.[5] This number increased to 95% when the blood is sampled in close proximity to the fracture site.[6] Hypoxemia may suggest fat embolization causing subclinical FES. Almost all patients monitored with continuous pulse oximetry following a long-bone fracture will have episodes of hypoxemia.[7] Further embolization may occur during operative fixation. Intraoperative transesophageal echocardiogram studies have detected fat embolization in 41% of patients during the fixation of long-bone fractures.[8] While almost all patients will have fat globules detected in the blood or develop transient hypoxia, the incidence of FES is much lower. In his initial study defining the clinical criteria for FES, Gurd reported the incidence of FES as 19% in a group of trauma patients.[9] As early operative fixation of long-bone fractures has become standard care, modern studies report an incidence of FES between 0.9% and 11%.[10-12] PATHOPHYSIOLOGY Fat particles enter the circulation and cause damage to capillary beds. While the pulmonary system is most frequently affected, fat embolism can occur in the microcirculation of the brain, skin, eyes, and heart can be involved.