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.

Embolia gordurosa encefálica / Cerebral fat embolism

A embolia gordurosa é constituída pela presença de glóbulos de gordura dentro da microcirculação periférica e pulmonar, com ou sem quadro clínico. Há uma fase precoce, representada por uma obstrução mecânica, e uma fase tardia, representada por um fenômeno inflamatório, que se inicia aproximadamente 48 a 72 horas após a obstrução mecânica. O diagnóstico clínico da síndrome de embolia gordurosa pode ser auxiliado pelos critérios de Gurd-Wilson e deve ser suspeitado em doentes com traumatismo e fraturas de ossos longos e deterioração neurológica de forma inexplicada. É necessário no mínimo um critério maior (insuficiência respiratória, sinais neurológicos não relacionados ao traumatismo craniano e manifestações dermatológicas) e quatro menores ou dois maiores. Exames complementares são geralmente inespecíficos. A tomografia de crânio pode estar normal. A ressonância magnética de encéfalo pode mostrar áreas puntiformes que costumam desaparecer em 20 dias, sugerindo que a lesão pode ser predominantemente inflamatória, e não necrótico-isquêmica. Um tratamento específico para a síndrome de embolia gordurosa não existe. Ele consiste no suporte cardiopulmonar e neurológico, além de prevenção e diagnóstico precoce, auxiliando nos cuidados com o doente.

Fat embolism is constituted by the presence of fat globules in the peripheral microcirculation and lung with or without symptoms. There is an early stage, represented by a mechanical obstruction, and a late phase, represented by an inflammatory process, which begins approximately 48-72 hours after the mechanical obstruction. The clinical diagnosis of the syndrome of fat embolism can be aided by the criteria of Gurd-Wilson, and must be suspected in patients with trauma and long bone fractures and unexplained neurological deterioration. It is necessary at least one major criteria (respiratory failure, neurological signs unrelated to head trauma and skin lesions) and four small or two larger ones. Additional tests are usually nonspecific. CT scan may be normal. MRI may show punctate areas that usually disappear in 20 days, suggesting that the inflammatory lesion may be predominantly necrotic and non-ischemic. Specific treatment for fat embolism syndrome does not exist. It is the neurological and cardiopulmonary support, and prevention and early diagnosis, assisting in patient care.

Disnea súbita después del terremoto / After the earthquake sudden dyspnea

Fat embolism syndrome (FES) remains a diagnostic challenge for physicians. It is commonly as associated with fractures of long bones and it is a major source of morbidity and mortality inpatients with multiple injuries. Overall mortality is between 5-15 percent in all studies. These facts motivate us to present the case of a young woman suffering bone fractures in both legs during the earthquake in Chile on February 27, 2010. She presented a FES 72 hours later. It is important to understand this syndrome, as it can be confused with other serious diseases that require different management. We should be able to have a high FES suspicion in the appropriate context, in as much as an early diagnosis, and treatment may improve the prognosis of this severe condition.

El síndrome de embolia grasa (SEG) sigue siendo un reto diagnóstico para los médicos. Se asocia fundamentalmente en fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. La mortalidad general se encuentra entre el 5 a 15 por ciento en todos los estudios. Esto nos motiva a presentar el caso de una mujer joven que 72 horas después de fracturas sufridas durante el terremoto ocurrido en Chile el 27 de febrero del 2010, presentó un SEG. Es importante conocer este síndrome, ya que se puede confundir con otras patologías graves que requieren un manejo distinto y al tener una alta sospecha en el contexto adecuado, se permite un diagnóstico oportuno, tratamiento precoz y mejorar el pronóstico.

Fat embolism and fat embolism syndrome; management trends

Fat Embolism and the associated Fat Embolism Syndrome is a serious and potentially life threatening condition. It tends to occur usually after fractures or intramedullary instrumentation of long bones. Non-traumatic conditions such as Diabetes Mellitus severe Burns, SLE, sickle cell disease and Pancreatitis can also lead to Fat Embolic syndrome. Young adults are commonly affected. Presentation consists of an asymptomatic interval followed by pulmonary and neurological manifestations combined with petechial haemorrhages. The diagnosis largely depends on high index of suspicion and exclusion of other conditions. Treatment of this condition remains supportive. Mortality associated with this condition is significant, ranging from 10-20%

Embolismo graso: presentación de un caso: revisión de las manifestaciones radiológicas / Fat embolism, a case presentation: review of radiographic manifestations

Paciente de 14 años con cuadro de disnea progresiva y tos seca de un dia de evolución. 48 horas antes del ingreso presentó fractura diafisiaria de fémur, por caída de dos metros de altura. El examen físico de ingreso evidenció taquipnea y cianosis leve, como únicas alteraciones de importancia. Teniendo en cuenta los hallazgos en los estudios de imágenes, el cuadro clínico y el antecedente traumático se realizó una impresión diagnostica de embolismo pulmonar graso, lo que se confirmó por la presencia de glóbulos de grasa en el parcial de orina. El paciente evolucionó satisfactoriamente con medidas de soporte.

Embolismo gorduroso / Fat embolism

Embolia gordurosa é uma síndrome associada com trauma ortopédico e considerada um subtipo da síndrome de angústia respiratória aguda. O prognóstico depende, sobretudo, da perspicácia do médico em suspeitar precocemente do embolismo e iniciar as medidas preventivas o mais cedo possível...

Síndrome de embolismo graso / Fat embolism syndrome

El síndrome de embolismo graso se presenta como complicación de fracturas en huesos largos y pelvis y, en ocasiones, posterior a procedimientos diagnósticos usados en la práctica médica. El cuadro clínico se caracteriza por insuficiencia respiratoria aguda, deterioro progresivo de sensorio, no explicable por lesiones craneoencefálicas; y rash petequial en piel y mucosas. El diagnóstico se fundamenta en los hallazgos al examen clínico y en estudios paraclínicos poco específicos. La prevención descansa en la fijación quirúrgica precoz de la fractura de los huesos largos comprometidos y el tratamiento consiste en el soporte ventilatorio y circulatorio, así como en el uso profiláctico de esteroides en individuos de alto riesgo

Embolia gordurosa pós-traumática: revisäo da literatura / Post-traumatic fat embolism: review of the literature

Os traumatismos causam inúmeras alteraçöes metabólicas, sistêmicas e distúrbios repiratórios. A elevaçäo da taxa sangüínea de gordura tem sido cada vez mais responsabilizada pela hipóxia pós-traumática. O encontro de gordura na micro-circulaçäo (embolia gordurosa) ocorre em mais de 90// dos pacientes com fratura traumática de ossos longos porém, a síndrome da embolia gordurosa ocorre numa minoria. A etiopatogenia continua näo totalmente esclarecida, porém as manifestaçöes clínicas, laboratoriais e as alteraçöes anátomo-patológicas säo bem conhecidas. O tratamento constitui-se basicamente em medidas de suporte e o prognóstico varia de acordo com a gravidade do trauma e intensidade das lesöes pulmonares e neurológicas. Os autores realizam uma revisäo da literatura, abordando os aspectos relacionados a embolia gordurosa pós-traumática

Fat embolism syndrome following long bone fractures

During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided.

Embolia gordurosa(relato de um caso e revisao do assunto) / Fat embolism (Case report and subject review

A sindrome da embolia gordurosa costuma ocorrer, mais frequentemente,em pacientes politraumatizados com fraturas de ossos longos. Os autores relatam o caso de um paciente vitima de acidente de moto, com a forma classica da sindrome. Alteracoes neurologicas, respiratorias e a presenca de petequias constituem a triade classica para o diagnostico. O paciente evoluiu satisfatoriamente. O tratameneto incluiu apenas, medidas suportivas. Foi revisada a fisiopatogenia, criterios para o diagnostico precoce e novas perspectivas para o tratamento