Faaiz Ali Shah, Waqar Alam, Wali Mohammad Khan.
Fat embolism syndrome in long bone fractures: Our experience at Lady Reading Hospital Peshawar.
Pak J Surg Jan ;33(1):25-9.

Objective: To find out the frequency, demography, clinical features and outcome of fat embolism syndrome in post traumatic long bones(femur, tibia) fractures. Study design: Descriptive case series Place and duration: Orthopaedic “A” Unit Medical Teaching Institution (MTI) Lady Reading Hospital (LRH) Peshawar from January 2014 to January 2017. Material and methods: Patients both gender and age 16 years and above with closed fractures of femur and tibia fulfilling the inclusion criteria were included in the study. Patients were labelled to have fat embolism syndrome when Gurd and Wilson’s at least two major or one major and four minor clinical features or laboratory investigations were positive. Demographic data of all the patients, their clinical presentation, time of onset of symptoms and outcome was documented. Results: A total of 473 closed fractures of long bones, 283 patients of Tibia (59.8%), 190 cases of femur fracture (40.1%), in 458 trauma patients were assessed for fat embolism syndrome. Male patients were 410(86.6%) while female patients were 63(13.3%). Fat embolism syndrome was diagnosed in 13(2.8%) patients (mean age 28 years) using Gurd and Wilson’s criteria. Bilateral femur shaft fractures were found in 6(1.26%) while isolated femur shaft fracture was found in 3(0.63%) patients. Tachycardia was present in all 13(100%) patients while hypoxemia in 10(76.9%) patients. Hemoglobin drop (average 6.2g/dl) was the most common in 5 patients (38.4%) laboratory findings. Mortality was found in 2 patients (15.3%). Conclusion: Younger male patients with bilateral closed femur fractures were more prone to develop lethal fat embolism syndrome than isolated femur or tibia fracture. Tachycardia and hypoxemia were the most frequent and early clinical features while sudden drop in hemoglobin was the commonest laboratory finding of fat embolism syndrome.

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