Fat Embolism


Epidemiology

Sex

  • Fat Embolism is More Common in Men than in Women
    • Associated with Incidence of Trauma in Males (vs Females) (Orthopedics, 1996) [MEDLINE] (Am J Med Sci, 2008) [MEDLINE]

Age

  • Peak of Fat Embolism Incidence is Between 10-40 y/o
    • Associated with Incidence of Trauma in This Age Group


Etiology

Orthopedic (Common)

Long Bone Fracture

  • Epidemiology
    • Incidence of Fat Embolism Increases with Long Bone Fracture (Chest, 2021) [MEDLINE]
    • Incidence of Fat Embolism Increases with the Number of Fractures
      • Incidence of Fat Embolism with Multiple Fractures is Approximately (1.29%), as Compared to Incidence with Single Fracture (0.17%) (Am J Med Sci, 2008) [MEDLINE] (J Trauma, 2011) [MEDLINE]
    • Incidence of Fat Embolism Increases with Open (vs Closed) Fracture (Chest, 2021) [MEDLINE]
    • Delay in Time to Operation Increases the Risk of Fat Embolism (Chest, 2021) [MEDLINE]
    • Other Risk Factors for Fat Embolism Include Hypomagnesemia, Hyperphosphatemia, Hypoalbuminemia, and Blunt Traumatic Mechanism of Injury (Indian J Orthop, 2021) [MEDLINE]
  • Physiology
    • Subclinical Fat Emboli Routinely Occur During these Orthopedic Procedures (as Documented by Echocardiography and Pulmonary Artery Blood Samples)
    • In Dog Studies Using a Simulated Total Hip Replacement (Cemented Arthroplasty) Model, Fat Globules were Observed to Traverse the Pulmonary Circulation After Orthopedic Surgery (Being Found Intravascularly in the Brain, Heart, and Kidneys within 3 hrs), Despite the Absence of Any Intracardiac Shunt (Am J Resp Crit Care Med, 1994) [MEDLINE]
      • Interestingly, Solid Radiolabeled Microspheres (15 Microns in Diameter) Did Not Traverse the Pulmonary Circulation, Suggesting that the Deformability of Fat May Contribute to its Ability to Cross the Pulmonary Circulation

Pelvic Fracture

  • Epidemiology
    • XXXX

Fracture of Other Marrow-Containing Bones (Ribs, etc)

  • Epidemiology
    • XXXX

Intraosseous (IO) Vascular Access/Infusion (see Intraosseous Vascular Access)

  • Epidemiology
    • XXXX

Total Hip Arthroplasty (see Total Hip Arthroplasty)

  • Epidemiology
    • Fat Embolism is Rare (Even Though Bone Marrow Needs to Be Manipulated for Hardware Placement)

Total Knee Arthroplasty (see Total Knee Arthroplasty)

  • Epidemiology
    • Fat Embolism is Rare (Even Though Bone Marrow Needs to Be Manipulated for Hardware Placement) (Neurosciences-Riyadh, 2016) [MEDLINE]

Vertebroplasty

  • Epidemiology
    • Cases Have Been Reported (Spine J, 2014) [MEDLINE]

Non-Orthopedic (Uncommon)

Bone Marrow Harvest/Transplant (see Hematopoietic Stem Cell Transplant)

  • Epidemiology
    • Cases Have Been Reported (Bone Marrow Transplant, 1991) [MEDLINE]

Burns (see Burns)

  • Epidemiology
    • XXXX

Chest Compressions (with/without Rib Fractures) (see Cardiopulmonary Resuscitation)

  • Epidemiology
    • XXXX

Liposuction/Lipoinjection/Fat Grafting

  • Epidemiology
    • XXXX

Lung Transplantation (see Lung Transplant)

  • Epidemiology
    • Cases Have Been Reported

Soft Tissue Injury (Injury to Adipose Tissue)

  • Epidemiology
    • XXXX
  • Physiology
    • Injury to Adipose Tissue

Other (Rare)

Acute Pancreatitis (see Acute Pancreatitis)

  • Epidemiology
    • Case Reports

Bone Tumor Lysis

  • Epidemiology
    • Case Reports

Corticosteroid Therapy (Prolonged) (see Corticosteroids)

  • Epidemiology
    • XXXX

Diabetes Mellitus (see Diabetes Mellitus)

  • Epidemiology
    • XXXX

Hepatic Steatosis (Fatty Liver) (see Hepatic Steatosis)

  • Epidemiology
    • Case Reports

Intramuscular Injection of Oil for Cosmetic Purposes

  • Epidemiology
    • Case Reports

Lipid Infusion (see Total Parenteral Nutrition)

  • Epidemiology
    • Case Reports

Osteomyelitis (see Osteomyelitis)

  • Epidemiology
    • Case Reports

Panniculitis (see Panniculitis)

  • Epidemiology
    • Case Reports

Renal Angiomyolipoma Invasion of the Inferior Vena Cava

  • Epidemiology
    • Case Reports

Sickle Cell Disease (see Sickle Cell Disease)

  • Epidemiology
  • Physiology
    • Bone Marrow Infarction

Thalassemia (see Thalassemias)

  • Epidemiology
    • Case Reports

Physiology

Mechanical Theory

Biochemical Theory


Diagnosis

Chest X-Ray (CXR) (see Chest X-Ray)

Chest Computed Tomography (Chest CT) (see Chest Computed Tomography)

Computed Tomography Pulmonary Artery Angiogram (CT PA Angiogram) (see Computed Tomography Pulmonary Artery Angiogram)

Ventilation/Perfusion (V/Q) Scan (see Ventilation-Perfusion Scan)

Echocardiogram (see Echocardiogram)

Swan-Ganz (Pulmonary Artery) Catheter (see Swan-Ganz Catheter)

Bronchoscopy with Bronchoalveolar Lavage (BAL) (see Bronchoscopy)

Urine Sudan Fat Stain


Clinical Manifestations

General Comments

Cardiovascular Manifestations

Myocardial Dysfunction

Pulmonary Hypertension with Right Ventricular Failure (Cor Pulmonale) (see Congestive Heart Failure)

Sinus Tachycardia (see Sinus Tachycardia)

Dermatologic Manifestations

Petechiae (see Petechiae)

Hematologic Manifestations

Anemia (see Anemia)

Disseminated Intravascular Coagulation (DIC) (see Disseminated Intravascular Coagulation)

Thrombocytopenia (see Thrombocytopenia)

Neurologic Manifestations

Cerebral Fat Embolism with Multiple Cerebrovascular Infarcts (see Ischemic Cerebrovascular Accident)

Ophthalmologic Manifestations

Retinal Scotomata (Purtscher’s Retinopathy)

Pulmonary Manifestations

Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome)

Renal Manifestations

Acute Kidney Injury (AKI) (see Acute Kidney Injury)

Lipiduria (see Lipiduria)

Other Manifestations

Fever (see Fever)


Prevention

Corticosteroids (see Corticosteroids)

Clinical Efficacy

Recommendations

Early Fracture Fixation

Intraosseous Pressure Limitation During Orthopedic Procedures


Treatment

Supportive Care

Hemodynamic Support

Corticosteroids (see Corticosteroids)

Rationale

Specific Treatment of Pulmonary Fat Embolism (with Acute Chest Syndrome) Associated with Sickle Cell Disease (see Sickle Cell Disease)

Treatments without Defined Clinical Benefit


Prognosis

In Trauma Patients, the Presence of Fat Embolism Increases the Mortality Rate

Mortality Rate


References

General

Epidemiology

Etiology

Diagnosis

Clinical

Prevention

Treatment