Abstract
Background: Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that specific injury patterns predispose to its development. Materials and Methods: Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019. Study Selection: Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included. Data Extraction: Two authors independently extracted data using a predesigned form. Statistics: Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960–12 December 1979, Group 2: 1 January 1980–1 December 1999, and Group 3: 1 January 2000–31 December 2019, chi-square test, χ2 test for group comparisons of categorical variables, p-value < 0.05. Results: Fifteen articles were included (n = 3095 patients). The incidence of FES decreased over time (Group 1: 7.9%, Group 2: 4.8%, and Group 3: 1.7% (p < 0.001)). FES rate according to injury pattern: unilateral high-energy fractures (2.9%) had a significantly lower FES rate than pathological fractures (3.3%) and bilateral high-energy fractures (4.6%) (p < 0.001). Conclusions: There has been a significant decrease in the incidence of FES over time. The injury pattern impacts the frequency of FES. The diagnostic and therapeutic approach to FES remains highly heterogenic to this day.
Highlights
Fat embolism continues to represent a major complication in patients with acute trauma [1,2]
Lower et al provided the first description of Fat embolism syndrome (FES) about 300 years ago in dogs, the current clinical relevance for patients with long bone fractures was only recognized in the 1970s
The initial search yielded a total of 1024 publications, of which 890 were unique after screening for titles and abstracts, and 85 articles were selected for full-text screening
Summary
Fat embolism continues to represent a major complication in patients with acute trauma [1,2]. The symptoms following acute fat embolization may vary between subclinical changes (e.g., evidence of fat globules in retinal arterioles) and fulminant acute lung failure with subsequent organ dysfunction [6]. Lower et al provided the first description of FES about 300 years ago in dogs, the current clinical relevance for patients with long bone fractures was only recognized in the 1970s. FES was a major reason to delay surgeries of long bone fractures [1,7]. FES was associated with simple techniques of artificial ventilation It was unclear whether early FES or artificial ventilation were among the main reasons for pulmonary complications after fracture fixation. The first diagnostic approaches to differentiate between ventilator-associated complications and FES relied on the direct proof of increased fat contents in the systemic circulation, which may be a rather transient phenomenon [8]
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