Clinical analysis of relapse of fat embolism syndrome in patients after fracture internal fixation

Abstract

Objective To explore the mechanism of and clinical strategy for the relapse of fat embolism syndrome (FES) in patients after fracture internal fixation.Methods A retrospective study was conducted to analyze the clinical data of 7 cases of FES relapse which had occurred after fracture internal fixation from January 2000 to November 2011 in our department.They were 5 men and 2 women,24 to 46years of age (average,36 years).They all had multiple injuries.Femoral fracture occurred in 6 cases (including one case of double femoral fractures),tibial fracture in 5 cases (including one case of double tibial fractures and 2 cases of floating knee),humeral fracture in 2 cases,ulna and radius fractures in 2 cases,and pelvic fracture in 3 cases.Their injury severity scores (ISS) averaged 19 points and their revised injury severity scores (RISS) 21 points.They were diagnosed and treated with the Gurd criteria and modified grading of early FES.Results In this group all the 7 cases achieved,after treatment,gradual and steady recovery,normal results of blood and biochemical tests,normal respiratory function and stable fixation of all the fractures.They were discharged 14 to 20 days postoperatively.By the Gurd criteria and modified grading of early FES,2 cases had typical relapse and 5 untypical relapse.Typical cases were consistent with all the Gurd criteria and untypical ones presented with fever with no infection focus identified,anemia,increased pulse and decreased oxygen partial pressure which were relieved by symptomatic and supporting treatment.Conclusion Since the recurrence risk of FES exists during and after internal fixation in patients with fracture and FES,we should be more careful in the timing and surgicai skills of the internal fixation as to reduce or block the recurrence of FES. Key words: Embolism, fat; Fracture; Recurrence; Fracture fixation