| Fat Embolism Syndrome with Bone Fractures |
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Byung Il Kim, Se Kyu Kim, Joon Chang, Hyung Gil Kim, Sung Kyu Kim, Won Young Lee |
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Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea |
| 골절에 동반된 지방색전증후군 |
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김병일, 김세규, 장준, 김형길, 김성규, 이원영 |
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| Abstract |
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The fat embolism syndrome is considered to be a symptom complex of acute respiratory distress, cerebral disturbance, and petechiae after one or more long bone fractures. The clinical picture of a full-blown fat embolism syndrome may develop within 72 hr after trauma mostly and must be differentiated from cardiogenic pulmonary edema, aspiration pneumonia, pulmonary thromboembolism and sepsis. The symptoms of fat embolism syndrome is disappeared after several days of supportive care, for example oxygen therapy, but seldom cases develop adult respiratory distress syndrome. We reviewed 4 cases of fat embolism syndrome, their clinical characteristics and outcome, from April 1987 to July 1989 at Severance Hospital.
The results are as follows:
1) Age of patient was from 31 to 89 year and the male to female rato was 1:1.
2) Out of the 4 patients, 3 were car accidents and one was falling down.
3) Hypoxia was noted in all patients from 7 to 72 hr after injury. On breathing room air, the mean arteria l oxygen tension was 54 mmHg (Range 44 to 67), and the mean alveolar-arterial oxygen gradient was 54 mmHg (range 40 to 75).
4)Petechiae were appeared on the anterior chest wall of all patients, and also noted on the anterior axillary fold, subconjuctiva and abdominal wall.
5) Cerebral disturbances were manifested in all patients, as confusion, agitation and drowsy state.
6) Thrombocytopenia was noted in 3 cases (range 45,000 to 72,000/ mm3), prolongation of the prothrombin time and partial thromboplastin time was notedï n a case. Increase of fibrin degradation products was noted in 2 cases and abnormal X-ray pattern was noted in 2 cases as interstitial pulmoary edema and patchy pneumonic infiltration.
7) Hypoxia was contròlled after 3-9 days of nasal oxygen therapy alone. Cerebral disturbance was disappeared 24 hours after the onset of symptoms and thrombocytopenia was corrected 2-7 days after insult with supportive care In conclusion fat embolism syndrome must be considered in all long bone fracture, especially multiple lower leg fracture. Early immobilization, adequate fluid and blood replacement and careful monitoring of blood gas tension, chest X-ray and physical status is important to these patients for prevention and early detection of fat embolism syndrome. If fat embolism syndrome is appeared, early oxygen therapy must be initiated with other supportive management. Mechanical ventilation with PEEP and corticosteroid therapy can be considered in severe cases. |
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