Post on 03-Jun-2018
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FAT EMBOLISM
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• It is an early complication of bone
#,commonly in closed pelvis and long bone #• The fat embolism syndrome (FES) is a rare
clinical condition in which circulating fatemboli or fat macroglobules lead to
multisystem dysfunction
• It is usually asymptomatic, but a few patientswill develop signs and symptoms of
multiorgan dysfunction, particularly involvingthe triad of lungs, brain, and skin
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Causes
• Traumatic # of long bones, pelvis and postoperatively after
intramedullary nailing and pelvic and knee arthroplasty
Massive soft tissue injury
Severe burn Bone marrow biopsy/transplant
Liposuction
•
Non traumatic Acute pancreatitis Fatty liver
Corticosteroid therapy – fat deposition
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Risk factors
• Young age
• Closed #
•
Multiple #• Conservative for long bone #
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Mechanism
1. Direct embolization of fat globules from the #
site
2. Circulating triglycerides splits into glycerol
and fat generating many small particles of
circulating fat
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Mechanical theory
Large fat droplets are released into the venous system.
deposited in the pulmonary capillary beds
travel through arteriovenous shunts to the brain.
Microvascular lodging of droplets
produces local ischemia and inflammation, withconcomitant release of inflammatory mediators,
platelet aggregation, and vasoactive amines.
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Biochemical theory
• Hormonal changes caused by trauma and/or
sepsis induce systemic release of free fatty
acids as chylomicrons and create the
physiologic reactions
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Mechanism
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Clinical features
• Pulmonary dysfunction
Tachypnea,
Dyspnea,
Cyanosis
• Cerebral changes
Confusion/drowsiness
Convulsion
Coma
• Skin dysfunction
Petechial rashes
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Prevention
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• Prompt immobilization of all long-bone fractures
Reduces the intravasation of intramedullary fat and other
debris, and may reduce the incidence of FES .
• Observation (all patients who have sustained a
long-bone fracture ) Frequent arterial blood gas level readings will allow early
detection in patients in whom hypoxemia is developing
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•
Prophylactic corticosteroids The use of corticosteroids prophylactically is controversial
because FES is uncommon and most patients recover with
supportive care alone. We favor prophylactic corticosteroids for
patients who are at high risk for developing FES (patients withlong bone or pelvic fractures, especially closed fractures)
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Management
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1. High flow rate oxygen is given
Maintain the arterial oxygen tension in the normal range.
Early intubation and mechanical respiration, when
indicated by abnormal arterial gas levels.
Positive end-expiratory pressure (PEEP) in mechanical
respiration is usually necessary to open collapsed alveoliand decrease intrapulmonary shunting
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2. Fluid replacement
Maintenance of intravascular volume is important, becauseshock can exacerbate the lung injury caused by FES.
Albumin has been recommended for volume resuscitation in
addition to balanced electrolyte solution, because it not only
restores blood volume but also binds with the fatty acids and
may thus decrease the extent of lung injury.
Heparin is another agent that has been advocated
because of its lipemic clearing capability. However, because
of the increased bleeding problems associated with
trauma, heparin has not been extensively used for this
syndrome.
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3. Corticosteroids
Reversing the toxic effect of free fatty acids appears to
be anti-inflammatory property Experimental studies with fat embolization have shown
that corticosteroids reduce hypoxia secondary to thisprocess
4. Rigid fixation of bone # in cases of multipleinjury
5. Chest physiotherapy
To reduce the risk of secondary pulmonary infection
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THANK YOU
REFERENCES1. Essential Orthopaedics and Trauma
2. Pocketbook of Orthopaedics and Fractures (McRae)
3. http://www.onlinejets.org/article.asp?issn=0974-
2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikh
4. http://www.annualreviews.org/doi/pdf/10.1146/annurev.me.28.020177.000505
http://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.annualreviews.org/doi/pdf/10.1146/annurev.me.28.020177.000505http://www.annualreviews.org/doi/pdf/10.1146/annurev.me.28.020177.000505http://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikhhttp://www.onlinejets.org/article.asp?issn=0974-2700;year=2009;volume=2;issue=1;spage=29;epage=33;aulast=Shaikh