Fat embolism as a complication of lower extremity long-bone surgery

Abstract

Introduction Fat embolism syndrome (FES) is a formidable complication that occurs with extremity long-bone fractures. Overall, the mortality of FES is estimated to be 10–36 % depending on the severity of the injury. Early detection of complications, selection of optimal methods for fracture fixation and for anesthesia that would prevent FES are essential. The objective was to assess the incidence of clinical manifestations of FES in patients with lower extremity long-bone fractures, determine the optimal methods of prevention, methods of anesthesia and surgical intervention in the management of the patients. Material and methods The study included 355 patients with lower extremity long-bone fractures treated between 2020 and 2021 at the Trauma Department, State Budgetary Healthcare Clinical N.I. Pirogov Hospital No. 1. Patients were grouped according to different parameters including frequency of occurrence of FES depending on the length of the preoperative period: patients with a long and short preoperative period; treatment strategy: patients treated surgically or conservatively; preoperative use of prophylaxis: patients receiving and not receiving "Essentiale"; anesthetic aidused: general or spinal anesthesia. Results Of the 355 patients examined, FES was detected in 8 patients with fractures of the lower extremities, one patient died. FES developed mainly in the first 72 hours of injury. FES occurred in less than 12 hours (n = 1), in 12‑24 hours (n = 2), in 24‑48 hours (n = 2), in 48-72 hours (n = 3). Discussion FES developed in patients with a delayed operative period and in patients treated conservatively. The prophylaxis policy suggests timely diagnosis using Schonfeld's scoring system for FES and taking "Essentiale" early post trauma. Patients who underwent surgery with spinal anesthesia showed a decreased incidence of FES as compared with patients operated on using general anesthesia. Conclusion There is a high incidence of FES. Hepatoprotectors can be used on the first days after injury to prevent FES. Osteosynthesis under spinal anesthesia is the preferred method of treatment.

Keywords

• fat embolism syndrome
• spinal anesthesia
• general anesthesia
• plating
• extrafocal osteosynthesis