Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Fat embolism syndrome Henry Gong Jr MD To cite this article: Henry Gong Jr MD (1977) Fat embolism syndrome, Postgraduate Medicine, 62:6, 40-48, DOI: 10.1080/00325481.1977.11714697 To link to this article: http://dx.doi.org/10.1080/00325481.1977.11714697
Published online: 07 Jul 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [University of Newcastle, Australia]
Date: 01 February 2017, At: 03:42
topics in primary care fat embolism syndrome a puzzling phenomenon Henry Gong, Jr, MD University of Californie Center for the Health Sciences los Angeles
Fat emboli are a life-threatening source of respiratory insufficiency. Whether they are of mechanical or chemical origin remains a subject of controversy. Fat embolism syndrome is most often seen after fracture of long bones, and immobilization of the fracture site may decrease risk of its development. Adequate oxygenation is the most important aspect of therapy; most patients given vigorous supportive treatment recover with no residuallung injury.
40
• Although fat embolism syndrome is a life-threatening form of respiratory insufficiency, relative! y little information on the subject is found in the general medicalliterature. Because fat emboli are commonly associated with trauma, most related findings have appeared in surgical and orthopedie journals, and the reports have been divergent and controversial. This article reviews the pathogenesis, diagnosis, and management of the fat embolism syndrome.
Incidence and Occurrence The exact incidence of posttraumatic fat embolism syndrome bas never been accurately determined. Figures vary greatly depending on the type of case analyzed and the clinical or pathologie criteria used. Perhaps every fracture or severe injury produces lipemia and pulmonary fat emboli. 1 The number of fat emboli seen at au tops y depends on severa! variables: degree and type of injury, quality of medical or surgical care, accuracy of pathologie analysis, and length of survival. (The longer a patient survives after injury, the fewer fat emboli are found at au tops y.) The maximum number is found within approximately 48 hours after injury, with a steady decline thereafter. 2 When autopsy bas been carefully done, fat emboli have been found in as many as 90% of persans who died immediately after trauma and fracture. However, in a retrospective autopsy study 3 of 5,265 randomly selected injury-related cases, systemic fat emboli were noted as the "cause of death" in 289 cases (5%) and pulmonary fat emboli were found to be a secondary cause of death in 566 additional cases. A computer search of results of 8,126 autopsies performed from 1955 to 1976 at the University ofCalifornia Center for the Health Sciences, Los Angeles, found only 30 reports (0.4%) of fat emboli, 21 of them in the period from 1955 to 1960 and only nine in the period from 1961 to 1976. These figures are misleading, however, because they include results of a careful study done between 1955 and 1960 that was directed specifically at the incidence of fat emboli in patients who died after undergoing extracorporeal circulation. 4 (The emboli were due, perhaps, to denaturation of lipoproteins and agglomeration of chylomicrons.) Therefore, the higher incidence observed between 1955 and 1960 was almost certain!y a result of more careful analysis
POSTGRADUATE MEDICINE • December 1977 • Vol. 62 • No. 6
Illustration: Jennifer Sandler
of the lungs rather than of an actual increase in frequency. Thus, incidence data, even from autopsy studies, can be biased by patient selection and by the interest and awareness of the pathologist. Although there are multiple causes of fat embolism syndrome, trauma, especially with fracture, is the most important and common cause (table 1). Manifestations vary from subclinical to fulminant. Based on available
Vol. 62 • No. 6 • December 1977 • POSTGRADUATE MEDICINE
data, the incidence of obvious fat embolism syndrome in patients with severe fractures probably is low (
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Fat embolism syndrome Henry Gong Jr MD To cite this article: Henry Gong Jr MD (1977) Fat embolism syndrome, Postgraduate Medicine, 62:6, 40-48, DOI: 10.1080/00325481.1977.11714697 To link to this article: http://dx.doi.org/10.1080/00325481.1977.11714697
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [University of Newcastle, Australia]
Date: 01 February 2017, At: 03:42
topics in primary care fat embolism syndrome a puzzling phenomenon Henry Gong, Jr, MD University of Californie Center for the Health Sciences los Angeles
Fat emboli are a life-threatening source of respiratory insufficiency. Whether they are of mechanical or chemical origin remains a subject of controversy. Fat embolism syndrome is most often seen after fracture of long bones, and immobilization of the fracture site may decrease risk of its development. Adequate oxygenation is the most important aspect of therapy; most patients given vigorous supportive treatment recover with no residuallung injury.
40
• Although fat embolism syndrome is a life-threatening form of respiratory insufficiency, relative! y little information on the subject is found in the general medicalliterature. Because fat emboli are commonly associated with trauma, most related findings have appeared in surgical and orthopedie journals, and the reports have been divergent and controversial. This article reviews the pathogenesis, diagnosis, and management of the fat embolism syndrome.
Incidence and Occurrence The exact incidence of posttraumatic fat embolism syndrome bas never been accurately determined. Figures vary greatly depending on the type of case analyzed and the clinical or pathologie criteria used. Perhaps every fracture or severe injury produces lipemia and pulmonary fat emboli. 1 The number of fat emboli seen at au tops y depends on severa! variables: degree and type of injury, quality of medical or surgical care, accuracy of pathologie analysis, and length of survival. (The longer a patient survives after injury, the fewer fat emboli are found at au tops y.) The maximum number is found within approximately 48 hours after injury, with a steady decline thereafter. 2 When autopsy bas been carefully done, fat emboli have been found in as many as 90% of persans who died immediately after trauma and fracture. However, in a retrospective autopsy study 3 of 5,265 randomly selected injury-related cases, systemic fat emboli were noted as the "cause of death" in 289 cases (5%) and pulmonary fat emboli were found to be a secondary cause of death in 566 additional cases. A computer search of results of 8,126 autopsies performed from 1955 to 1976 at the University ofCalifornia Center for the Health Sciences, Los Angeles, found only 30 reports (0.4%) of fat emboli, 21 of them in the period from 1955 to 1960 and only nine in the period from 1961 to 1976. These figures are misleading, however, because they include results of a careful study done between 1955 and 1960 that was directed specifically at the incidence of fat emboli in patients who died after undergoing extracorporeal circulation. 4 (The emboli were due, perhaps, to denaturation of lipoproteins and agglomeration of chylomicrons.) Therefore, the higher incidence observed between 1955 and 1960 was almost certain!y a result of more careful analysis
POSTGRADUATE MEDICINE • December 1977 • Vol. 62 • No. 6
Illustration: Jennifer Sandler
of the lungs rather than of an actual increase in frequency. Thus, incidence data, even from autopsy studies, can be biased by patient selection and by the interest and awareness of the pathologist. Although there are multiple causes of fat embolism syndrome, trauma, especially with fracture, is the most important and common cause (table 1). Manifestations vary from subclinical to fulminant. Based on available
Vol. 62 • No. 6 • December 1977 • POSTGRADUATE MEDICINE
data, the incidence of obvious fat embolism syndrome in patients with severe fractures probably is low (
