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Fat Embolism and Fat Embolism Syndrome

Rothberg, David L., MD; Makarewich, Christopher A., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: April 15, 2019 - Volume 27 - Issue 8 - p e346–e355
doi: 10.5435/JAAOS-D-17-00571
Review Article

Fat embolism (FE) occurs frequently after trauma and during orthopaedic procedures involving manipulation of intramedullary contents. Classically characterized as a triad of pulmonary distress, neurologic symptoms, and petechial rash, the clinical entity of FE syndrome is much less common. Both mechanical and biochemical pathophysiologic theories have been proposed with contributions of vascular obstruction and the inflammatory response to embolized fat and trauma. Recent studies have described the relationship of embolized marrow fat with deep venous thrombosis and postsurgical cognitive decline, but without clear treatment strategies. Because treatment is primarily supportive, our focus must be on prevention. In trauma, early fracture stabilization decreases the rate of FE syndrome; however, questions remain regarding the effect of reaming and management of bilateral femur fractures. In arthroplasty, computer navigation and alternative cementation techniques decrease fat embolization, although the clinical implications of these techniques are currently unclear, illustrating the need for ongoing education and research with an aim toward prevention.

From the Department of Orthopaedics, University of Utah, Salt Lake City, UT.

Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Rothberg and Dr. Makarewich.

© 2019 by American Academy of Orthopaedic Surgeons
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