Key role of orthopaedician and radiologist in successful management of fat embolism syndrome

Fat embolism syndrome (FES) is an emergency fatal condition, if not diagnosed early and timely managed. Careful observation of patients with multiple bone fractures aids in early diagnosis. Rehydration is an important factor in preventing FES. Most often the syndrome is self-limiting. High risk cases are treated with steroids and with respirator assistance.

Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb / 中国骨伤

OBJECTIVE@#To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.@*METHODS@#Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups.@*RESULTS@#Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ2=6.455, P<0.05). After the intervention, SaO2, PaO2 and OI in two groups were higher than those before the intervention(P<0.05), and after the intervention, SaO2, PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194, P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747, P<0.05).@*CONCLUSION@#DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.

El reto del diagnóstico en síndrome de embolia grasa / The challenge of fat embolism syndrome diagnosis

Resumen El síndrome de embolia grasa es una complicación inusual del trauma ortopédico. Las manifestaciones clínicas son inespecíficas y no hay una prueba diagnóstica de oro, por lo que se debe tener un alto índice de sospecha. Se describen cuatro pacientes quienes, luego de presentar fractura de huesos largos, se complicaron con síndrome de embolia grasa. La manifestación común en todos ellos fue la hipoxemia. Los hallazgos más frecuentes en la tomografía de tórax fueron opacidades en vidrio esmerilado, compromiso del pulmón derecho y de los lóbulos inferiores y derrame pleural laminar. La evolución clínica fue satisfactoria en tres pacientes; el cuarto presentó extenso compromiso pulmonar, requirió ventilación mecánica invasiva y tuvo una hospitalización prolongada. Ningún paciente falleció ni quedó con secuelas. Esta es la primera serie de casos en Colombia que muestra el comportamiento clínico e imagenológico de pacientes con síndrome de embolia grasa.

Abstract Fat embolism syndrome is an unusual complication of orthopedic trauma. The clinical manifestations are non-specific and there is no gold standard diagnostic test, so a high index of suspicion is required. Four patients are described who after presenting long bone fracture were complicated with fat embolism syndrome. The common manifestation in all of them was hypoxemia. The most frequent findings in chest tomography were ground-glass opacities, involvement of the right lung and lower lobes, and laminar pleural effusion. The clinical evolution was satisfactory in three patients; the fourth had extensive pulmonary involvement, required invasive mechanical ventilation and had a prolonged hospitalization. None of the patients died or had sequelae. This is the first case series in Colombia showing the clinical and imaging behavior of patients with fat embolism síndrome.

Fat Embolism Syndrome – A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management

@#Fat Embolism Syndrome (FES) is a poorly defined clinical phenomenon which has been attributed to fat emboli entering the circulation. It is common, and its clinical presentation may be either subtle or dramatic and life threatening. This is a review of the history, causes, pathophysiology, presentation, diagnosis and management of FES. FES mostly occurs secondary to orthopaedic trauma; it is less frequently associated with other traumatic and atraumatic conditions. There is no single test for diagnosing FES. Diagnosis of FES is often missed due to its subclinical presentation and/or confounding injuries in more severely injured patients. FES is most frequently diagnosed using the Gurd and Wilson criteria, like its rivals it is not clinically validated. Although FES is a multi-system condition, its effects in the lung, brain, cardiovascular system and skin cause most morbidity. FES is mostly a self-limiting condition and treatment is supportive in nature. Many treatments have been trialled, most notably corticosteroids and heparin, however no validated treatment has been established.

Study on the expression of Toll-like receptor 4 and its effect on prognosis in fat embolism mice model / 上海交通大学学报（医学版）

Objective • To investigate the effect of Toll-like receptor 4 (TLR4) in the pathological injury in fat embolism mice model. Methods • One hundred and twenty male C57BL/6 mice were randomly divided into 10 groups. One group was set as blank control group, and others were injected separately with 1, 2…9 μL/g of allogeneic perirenal fat via tail vein, respectively. The mortality of each group was counted, median lethal dose (LD50) of fat injection in mice was calculated by Bliss method, and the fat embolism LD50 mice model was established. The TLR4 protein expression in the pulmonary tissue of surviving mice was detected by Western blotting. Sixty male C57BL/6 mice were randomly divided into the control group (the same dose of saline was given via tail vein) and the experimental groups (group 2 h, group 8 h, group 24 h and group 48 h, the LD50 fat was given via tail vein). The TLR4 protein expression at different time after fat injection was detected by Western blotting. The mortality of 20 TLR4 gene-knockout mice (TLR4-/- mice) was recorded and compared with 60 wild-type mice after LD50 fat injection. Results • The LD50 of fat embolism mice model was (3.93±0.78) μL/g. After the injection of 1-7 μL/g fat, the expressions of TLR4 protein in the pulmonary tissue of all seven groups were significantly increased, compared with the control group (all P=0.000). In the fat embolism LD50 mice model, compared with the control group, the expressions of TLR4 protein in group 2 h were significantly increased (P=0.005). Then, expression level of TLR4 protein was gradually reduced after 2 h, and there was no significant difference between the control group and group 48 h. The mortality of TLR4-/- mice injected with LD50 fat was lower than that of wild-type mice (P=0.043). Conclusion • TLR4 protein involves in the pathologic process of fat embolism syndrome. The knockout of TLR4 gene can reduce the mortality of fat embolism mice. TLR4 and its correlated non-infectious inflammatory response may be an important molecular mechanism of biochemical injury in fat embolism syndrome. Blocking the activation of TLR4-mediated signaling pathway can significantly improve the prognosis, which provides new basis for the prevention, evaluation and treatment of fat embolism syndrome.

Study on the expression of Toll-like receptor 4 and its effect on prognosis in fat embolism mice model / 上海交通大学学报（医学版）

Objective · To investigate the effect of Toll-like receptor 4 (TLR4) in the pathological injury in fat embolism mice model. Methods · One hundred and twenty male C57BL/6 mice were randomly divided into 10 groups. One group was set as blank control group, and others were injected separately with 1, 2…9 μL/g of allogeneic perirenal fat via tail vein, respectively. The mortality of each group was counted, median lethal dose (LD50) of fat injection in mice was calculated by Bliss method, and the fat embolism LD50 mice model was established. The TLR4 protein expression in the pulmonary tissue of surviving mice was detected by Western blotting. Sixty male C57BL/6 mice were randomly divided into the control group (the same dose of saline was given via tail vein) and the experimental groups (group 2 h, group 8 h, group 24 h and group 48 h, the LD50 fat was given via tail vein).The TLR4 protein expression at different time after fat injection was detected by Western blotting. The mortality of 20 TLR4 gene-knockout mice (TLR4-/-mice) was recorded and compared with 60 wild-type mice after LD50 fat injection. Results · The LD50 of fat embolism mice model was (3.93±0.78) μL/g.After the injection of 1-7 μL/g fat, the expressions of TLR4 protein in the pulmonary tissue of all seven groups were significantly increased, compared with the control group (all P=0.000). In the fat embolism LD50 mice model, compared with the control group, the expressions of TLR4 protein in group2 h were significantly increased (P=0.005). Then, expression level of TLR4 protein was gradually reduced after 2 h, and there was no significant difference between the control group and group 48 h. The mortality of TLR4-/- mice injected with LD50 fat was lower than that of wild-type mice (P=0.043).Conclusion · TLR4 protein involves in the pathologic process of fat embolism syndrome. The knockout of TLR4 gene can reduce the mortality of fat embolism mice. TLR4 and its correlated non-infectious inflammatory response may be an important molecular mechanism of biochemical injury in fat embolism syndrome. Blocking the activation of TLR4-mediated signaling pathway can significantly improve the prognosis, which provides new basis for the prevention, evaluation and treatment of fat embolism syndrome.

Clinics in diagnostic imaging (184). Fat embolism syndrome (FES)

A 23-year-old Indian man presented with shortness of breath and new-onset confusion along with a rash on his chest on Postoperative Day 2, following internal fixation of his femur fracture. Although computed tomography pulmonary angiography was negative for filling defects in the pulmonary vasculature, it showed mosaic attenuation changes with some interlobular septal thickening. Magnetic resonance imaging of the brain showed patchy signal abnormalities, predominantly in the grey-white matter junction region with extensive susceptibility artefacts, consistent with petechial haemorrhages. The laboratory work-up showed thrombocytopenia and anaemia. A diagnosis of fat embolism syndrome was established, based on the clinical presentation combined with laboratory and imaging findings. The clinical and imaging features of fat embolism syndrome are discussed.

Sindrome de embolismo graso con predominio de sintomas neurologicos / Fat embolism syndrome with predominance of neurological symptoms

El sindrome de embolismo graso hace referencia a un conjunto de signos y sintomas secundarios a la liberacion de lipidos dentro de la circulacion sanguinea. Ocurre en alrededor del 1% de los pacientes con fracturas de femur. La triada clasica de este sindrome incluye dificultad respiratoria con hipoxemia, alteracion neurologica y exantema petequial. Pese a las descripciones aisladas que documentan la mejoria de los sintomas despues de administrar corticoides, no existe clara evidencia de la utilidad de estos farmacos, por lo que el manejo actual consiste en soporte cardiovascular y respiratorio. Se presenta un paciente adulto joven con sindrome de embolismo graso y manifestaciones respiratorias minimas tras una fractura traumatica de femur.

Fat embolism syndrome refers to a set of signs and symptoms caused by the release of fat in the bloodstream. It occurs in about 1% of patients with femur fractures. The classic triad includes respiratory distress with hypoxemia, neurologic impairment and petechial rash. Isolated reports document symptom improvement after administration of corticosteroids, but solid evidence of the usefulness of these drugs is lacking; therefore current management includes cardiovascular and respiratory support. We present a young adult patient with fat embolism syndrome and minimal respiratory symptoms after traumatic femoral fracture.

Embolia pulmonar grasa: Presentación de un caso / Pulmonary fat embolism. Case report

La embolia grasa (EG) es una obstrucción de los vasos sanguíneos por glóbulos de grasa. Ha sido descrita en la circulación pulmonar con una gran variedad de asociaciones, pero las más comunes e importantes se dan con fracturas de huesos largos y daño de tejido blando debido a traumatismo grave. Por su parte, el síndrome de embolia grasa (SEG) es una manifestación poco frecuente, aunque grave, del fenómeno de embolia grasa, que se caracteriza clínicamente por la tríada disnea, petequias y confusión mental. La razón de la discrepancia entre la presencia de embolia grasa y el desarrollo del síndrome no es clara. Presentamos el caso de un hombre de 41 años que, inmediatamente después del trauma, presentó en la tomografía computada (TC) inicial defectos de llenado de atenuación grasa dentro de las arterias pulmonares. Estos fueron interpretados como múltiples embolias grasas macroscópicas. Los valores de atenuación de la tomografía computada multidetector (TCMD) de las embolias pulmonares deben examinarse cuidadosamente en el contexto de un traumatismo agudo o después de procedimientos ortopédicos, debido a la complicación rara pero potencialmente fatal del SEG. En los centros de trauma, la TCMD es una herramienta esencial para hacer el diagnóstico de la embolia grasa macroscópica, así como también para descartar otras causas de hipoxia, como la embolia pulmonar trombótica. La reconstrucción de cortes finos debe utilizarse para la evaluación detallada de la vasculatura pulmonar.

Fat embolism (FE) may be defined as the blockage of blood vessels by fat globules. Pulmonary fat embolisms are reported to be associated with a wide variety of conditions, with the most common and important ones being with long bone fractures and soft tissue damage due to severe trauma. Fat embolism syndrome (FES) is a rare but serious manifestation of the fat embolism phenomenon, characterized clinically by a triad of dyspnea, petechiae, and mental confusión. The discrepancy between the presence of a fat embolism and the development of fat embolism syndrome is unclear. The case is presented of a 41 year-old mate who, on the initial trauma CT sean, presented with filling defeets of fat attenuation within the pulmonary arteries. Those were interpreted as múltiple macroscopic fat emboli. The CT attenuation valúes of pulmonary embolism should be carefully examined in the setting of acute trauma or after orthopedic procedures, as the rare but potentially fatal complicaron of FES may result. In trauma centers, multidetectorcomputed tomography is an essential tool to make the diagnosis of macroscopic fat embolism, and to exelude other causes of hypoxia, such as thrombotic pulmonary embolism. These reconstructions should be used for detailed evaluation of the pulmonary vasculature.

Clinical significance of serum triglyceride and D-dimer in the early diagnosis of fat embolism syndrome after fracture / 中国综合临床

Objective To investigate the clinic significance of blood lipid and D-dimer in the early diagnosis of fat embolism syndrome (FES) after fracture.Methods Forty-nine cases of fracture complicated with fat embolism syndrome patients and 50 patients with fracture at the same time were selected as our subjects.The levels of serum triglyceride (TG) and D-dimer level were detected.Results Among the FES patients,61.2％ (30/49) were hemoglobin decline,followed by 57.1％ (28/49) with hypoxemia,51.0％ (25/49) with mucous membrane bleeding point,16.3 ％ (8/49) with pulmonary symptoms and 20.4％ (10/49) temperature ＞38℃.The levels of TG level and D-dimer in FES patients were (2.57 ± 0.84) mmol/L and (1758.5 ± 144.2) μg/L,significantly higher than patients without FES ((1.16 ± 0.34) mmol/L,(562.4 ±76.8) μg/L;P =0.000).ROC curve showed that the area under the curve(AUC) of TG in the diagnosis of FES was 68.3％,and the cut-off value was 2.04 mmol/L,with the sensitivity of 66.7％ and the specificity of 63.5％.The AUC of D-dimer was 67.4％,and the cut-off was 1 045.7 μg/L,with the sensitivity of 66.7％ and the specificity of 61.5％.Conclusion There is an important diagnostic value of serum TG and D-dimer in predicting FES after long and pelvic fracture,which can be used as a clinical powerful auxiliary examination in the diagnosis of FES.There is important clinical significance to improve the cure rate and reduce the death of FES.

Experiences of diagnosis and treatment of fat embolism syndrome / 中华神经医学杂志

Objective To investigate the clinical characteristics of fat embolism syndrome (FES) and explore the diagnosis and therapy efficacy.Methods The etiology,clinical manifestations,laboratory and radiological characteristics,diagnosis,treatments and outcomes of 11 patients with FES,admitted to our hospital from 2004 to 2014,were retrospectively analyzed.Results There were 9 patients with traumatic long bone fracture,2 with artificial knee joint replacement in 11 patients.Disturbance of consciousness was noted in 10 patients,dyspnea in one in the first onset.There were 2 with "snow storm appearance" in chest X-ray,8 with abnormality in pulmonary CT and 3 with multiple cerebral infarction in MRI.The rates of final diagnosis and misdiagnosis within 72 h were 63.63％ and 36.36％,respectively.After comprehensive treatment,7 patients were cured,one was at vegetative state and 3 died,with a mortality rate of 27.2％.Conclusions The main causes of FES include traumatic long bone fracture and operation of joint.Early definite diagnosis and effective combined modality therapy are key points of successful treatment.

The study of diagnostic test of using the ten-point scale for the early fat embolism syndrome / 中华急诊医学杂志

Objective To explore the clinical value of the ten-point scale in the early diagnosis of fat embolism syndrome.Methods The data of 129 patients with fat embolism syndrome diagnosed by Gurd criteria admitted from January 1993 to February 2012 were analyzed retrospectively.At the same time,another 97 patients with single or multiple long bone fracture and/or pelvic fracture without fat embolism admitted from July 2005 to February 2012 were enrolled as control group.Patients were excluded if they had any of the following diseases:simple brain trauma,thoracic injury,spine fracture,hemorrhagic shock and the complications of cardiopulmonary cerebral resuscitation (CPCR).The patients of two groups were comparable in respect of clinical setting.The clinical data were analyzed and scored by the ten-point scale.The x2 test were applied to statistical works.Results Among all the clinical characteristics,the incidence of increased D-dimer was the highest (74.1％) in early fat embolism syndrome,followed by the progressive decrease in hemoglobin (63.6％) and hypoxemia (57.4％),and the occurrence of dyspnea was the lowest (17.8％).The percentage of total scores over ten points in patients with fat embolism syndrome group was higher than that in those without fat embolism syndrome (x2 =202.6,P ＜ 0.01).The sensitivity of tenpoint scale was 96.12％ and the specificity was 99.8％.Conclusions Ten-point scale could be used to make early diagnosis of fat embolism syndrome,thereby reducing the occurrence of misdiagnosis and misseddiagnosis.

Fat Embolism Syndrome: Mapping to Guide Timely Diagnosis

PURPOSE: Fat embolism syndrome (FES) is rare, but can be a critical complication in trauma victims. Diagnostic criteria were made by Gurd and subsequently revised by Gurd and Wilson. Despite numerous attempts to improve the criteria, a suitable justification remains absent. This study was designed to understand the course of FES, and attempt its mapping. METHODS: A retrospective study was performed by reviewing the medical records. Twenty-five patients whose diagnoses are compatible with FES were gathered from 1997 to 2009. Their demographic data, mechanism of injury, numbers of diagnostic criteria fulfilled, days when the symptoms and signs occurred, patterns and severity of injuries, and treatment results were gathered. Statistical analysis was conducted using SPSS 12.0, Chi-square, t-test and correlation analysis. RESULTS: The major criteria, including petechiae, respiratory and neurologic symptoms, occurred most commonly on the 1st and 2nd days after injury. The minor criteria, including tachycardia, fever, anemia, thrombocytopenia and oliguria, occurred frequently during the 1st and 2nd days, but with more variable ranges. There were no significant correlations between injury severity and the onset times of the major criteria. CONCLUSION: Mapping of FES was performed. All the major criteria in FES occurred between days 0 to 3 after injury. The minor criteria, although nonspecific, showed more variable distributions for the day of onset. Health care providers must understand the course of illness, especially the onset times of each criterion, in order to make timely diagnosis and disease prediction.

Síndrome de embolia gordurosa / Fat embolism syndrome

A síndrome de embolia gordurosa é marcada pela existência de glóbulos de gordura livre dentro da vasculatura pulmonar e, geralmente, derivados da medula óssea. A morbidade subjacente mais encontrada em associação à síndrome de embolia gordurosa é o trauma, que causa ruptura das células gordurosas da medula óssea e laceração das veias medulares. Neste artigo de revisão, dá-se ênfase a quadro clínico, patogênese, diagnóstico, tratamento e prevenção.

The fat embolism syndrome is determined by fat-free globules within the pulmonary vasculature, generally originated from the bone marrow. The most frequently found subjacent morbidity associated to this syndrome is trauma, which causes a disruption of fat cells in the bone marrow, as well as laceration of medullar veins. In this review, its clinical aspect, pathogenesis, diagnosis, treatment and prevention are emphasized.

A Case of Fat Embolism Syndrome of Fat Globules Found in BAL Fluid after Recovery from Acute Respiratory Failure / 결핵및호흡기질환

Fat embolism syndrome is a rare clinical diagnosis of dyspnea with acute respiratory failure and neurological signs caused by a traumatic long bone fracture. We report a case of fat embolism in a 22 year-old man after a traffic accident. Dyspnea and stuporous mental changes developed on the 1st day after the external fixation operation of a left metaphyseal femur fracture. On the following day, he was transferred from a hospital to this one because of acute respiratory failure. After recovery, macrophages with fat droplets were found in the bronchoalveolar lavage fluid 1. It is important to diagnose a fat embolism as the correct cause of acute respiratory failure through the BAL in the acute state of fat embolism syndrome It is believed that clinically apparent or sometimes hidden fat embolism syndrome can be diagnosed from the BAL during the recovery state.

Cerebral Fat Embolism after External Fixation of Open Ankle Fracture in a Patient with Multiple Fracture: A case report / 대한마취과학회지

Even though cerebral fat embolism develops rarely after long bone fracture, it may be very important complication because it can be fatal and the early detection is not easy. Neurologic symptoms include confusion, restlessness, disorientation, seizure, and stroke with focal deficits. High intensive T2 signal MRI of the brain is most sensitive for diagnosis of cerebral fat embolism. We report a case of cerebral fat embolism diagnosed after external fixation of ankle open fracture in a 46 year old woman patient with multiple fracture.

Embolia grasa: un síndrome clínico complejo / Fat embolism: a complex clinic syndrome

La embolia grasa describe la presencia de grasa en la circulación sanguínea asociada o no, al desarrollo de un síndrome de severidad variable e identificable por sus signos y síntomas. Puede ser secundaria a traumatismos, incluyendo cirugía ortopédica y estética, y a causas no traumáticas. Se han descrito diversas teorías para explicar el origen del émbolo y las manifestaciones sistémicas como la intravasación, la lipasay los ácidos grasos libres, la embolia grasa de origen no traumático, la del choque y la coagulación. Las manifestaciones clínicas dependen del órgano o sistema afectado, habitualmente del aparato respiratorio, sistema nervioso central y hematológico. El diagnóstico se puede hacer mediante los criterios clínicos de Gurd y/o Lindeque. La determinación de grasa en sangre y orina carecen de sensibilidad, y la identificación de macrófagos alveolares con grasa depende de una muestra adecuada de lavado broncoalveolar; la tomografía de alta resolución y la resonancia magnética nuclear son promisorias para demostrar la entidad. El tratamiento es de soporte y no específico. El uso de esteroides ha producido disminución de la mortalidad en la mayoría de estudios, pero si se requiere de ventilación mecánica, la mortalidad en la mayoría se incrementa. En cirugía ortopédica y traumatología es posible prevenir el evento, y en general, evitando la hipoxemia, hipotnesión y la deshidratación perioperatoria y postraumática.

Fat embolism (FE) describes the presence of fat globules in the circulation. It may be associated with a clinical syndrome (FES) that can be readily identified by its signs and symptoms. It may follow traumatic events such as orthopedic or cosmetic surgery, or non-traumatic events. Diverse theories try to explain the origin of FE and the FES, such as intravasation, Upase and free fatty acids, FE of non-traumatic origin, and one of shock and coagulation. The clinical manifestations vary from mild to severe and include the respiratory, central nervous, dermatologic and hematologic systems. Diagnosis may be established following Gurd and/or Lindeque's clinical criteria. Fat determination in blood and urine lacks sensitivity; bronchoalveolar lavage to determine the presence of fat depends on an adequate sample of alveolar macrophages. High resolution thoracic tomography and nuclear magnetic resonance of the brain can be helpful. Treatment is only palliative and non-specific. In most studies, steroids have decreased mortality, but if ventilatory support is needed, the mortality rate increases. Prevention is possible during orthopedic and trauma surgery; hypoxemia, hypotension, and perioperative and post-traumatic dehydration should be avoided.

A study on internal fixation for long bone fractures in polytraumatized patients with fat embolism syndrome / 中华创伤骨科杂志

Objective To study method and timing of internal fixation for long bone fractures in polytraumatized patients with fat embolism syndrome (FES). Methods Twenty-eight cases of polytraumatized patients with FES received internal fixation for their long bone fractures in our hospital from January 1990 to August 2004. The method and timing of internal fixation were analyzed retrospectively. The long bone fractures in 27 cases were treated 5 to 7 days after their clinic FES symptoms disappeared, while one fracture was treated five days after the FES symptoms were relieved and the vital signs became stable. Eleven cases of long bone fracture were treated with open fixation by unreamed or slightly reamed intramedullary nailing while 27 cases were fixated with plate internally. Results Of the 27 patients who received open reduction and internal fixation for their fractures 5 to 7 days after disappearance of FES symptoms, 22 cases experienced no postoperative complications but fever and quickened pulse reoccurred in five cases after the first osteosynthesis. However, FES-like symptoms reoccurred in the one case who received the first operation when FES did not disappear. Conclusions Internal fixation by plate and intramedullary nailing without reaming are safe for polytraumatized patients with FES and long bone fractures. Proper timing of the first surgery for this kind of patient should be 5 to 7 days after the disappearance of FES.

Diagnosis and treatment of post traumatic fat embolism syndrome / 临床外科杂志

Objective To discuss diagnosis ant treatment of post traumatic fat embolism syndrome.Methods Since 1997,9 patients with FES have been treated in our hospital.These cases were analyzed on clinic features and results of treatment.Results According to Sevitt classification,there were 2 in fulminant,2 in typical,and 5 in subclinical.2 patients in fulminant died,7 patients were cured because of early diagnose and correct treatment.Conclusion Identify this disease,early and correct treatment help to improve the result.Post traumatic resuscitation is effecrive in decreasing the incidence of FES.

Diagnosis and Differential Diagnosis of Cerebral Fat Embolism Syndrome on MRI / 实用放射学杂志

Objective To discuss the features of MRI and differential diagnosis of cerebral fat embolism syndrome(CFE).Methods The features of MRI of 4 final diagnosis cases of CEF were retrospectively analysed.Results MRI showed that there were spotty and patchy high T_2-weighted signals and some of them were low or equal signals on T_1-weighted.These signals were distributed in bilateral centrum semiovale,corona radiata,thalamus,deep part white matter of brain along the lateral ventricle,the cortex of brain of watershed,collose,brain stem and the hemisphere of cerebellum.The position of these abnormal signals was symmetric in the rough.The figure of the MRI signals in the midbrain liked the reverse Chinese number "eight".Brain swelling was showed in 2 of 4 cases.Conclusion There are some features of the CEF on T_2-weighted of MRI,but the history,the physical signal and the results of laboratory must be considered,and must be differential diagnosed with the diseases liking diffuse axonal injury,etc.