Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries

Abstract

Symptoms of fat embolism occurred in 95 out of 1059 patients with multiple injuries treated in the intensive care unit between 1967 and 1974. The criteria for the diagnosis were: typical snowstorm infiltration on the chest X-ray films, disturbance of consciousness, petechial rash, hypoxaemia, pyrexia and tachypnoea. Long-bone fractures were usual and an important aetiological factor in the development of fat embolism. Early administration of oxygen was most important in treatment, together with regular measurement of blood gases. Tracheostomy was necessary for 28 patients. Fat embolism was not a centra-indication to operative treatment. Indeed, internal fixation of long-bone fractures seemed to reduce the incidence of fat embolism. The number of patients with clinical fat embolism decreased yearly between 1967 and 1974 from 21 to 0. From 1971, however, most of the longbone fractures in patients with multiple injuries were treated by operative fixation in the first days after injury, and this seemed to prevent many cases of clinical fat embolism.