Abstract
IntroductionFat embolism syndrome with respiratory failure after intramedullary nailing of a femur fracture is a rare but serious complication in trauma patients.Case presentationWe present the case of a 20-year-old Caucasian man who experienced paradoxical cerebral fat embolism syndrome with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shunt.ConclusionFat embolism syndrome may occur as a fulminant complication following femoral fracture repair in the presence of a concomitant atrial septal defect with right-to-left shunt. Thus, in patients with cardiac right-to-left shunts, femurs should not be nailed intramedullary, not even in cases of isolated injuries.
Highlights
Fat embolism syndrome with respiratory failure after intramedullary nailing of a femur fracture is a rare but serious complication in trauma patients.Case presentation: We present the case of a 20-year-old Caucasian man who experienced paradoxical cerebral fat embolism syndrome with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shunt
Fat embolism syndrome (FES), is the symptomatic manifestation of fat embolism with symptoms such as respiratory failure, thrombocytopenia or cerebral confusion [2], which occur within 48 hours after trauma in most patients [2,3]
Case presentation We present the case of a Caucasian man who experienced paradoxical cerebral FES with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shunt, which is still present today
Summary
FES may occur as a fulminant complication of femoral fractures in cases of a concomitant atrial septal defect with a right-to-left shunt. The hypothetical question remains whether FES is caused by the injury itself or by intramedullary nailing. In patients with cardiac right-to-left shunts, femurs should not be nailed intramedullary, not even in case of an isolated injury. Pell AC, Hughes D, Keating J, Christie J, Busuttil A, Sutherland GR: Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale. Kallina C, Probe R: Paradoxical fat embolism after intramedullary rodding: a case report. Doi:10.1186/1752-1947-5-142 Cite this article as: Mueller et al.: Post-traumatic fulminant paradoxical fat embolism syndrome in conjunction with asymptomatic atrial septal defect: a case report and review of the literature. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests
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