A fat embolism is a type of embolism that is often (but not always) caused by physical trauma.

Fat emboli can occur whenever there is a chance for fat to enter the circulatory system, such as during surgery or trauma. A common scenario is fatty marrow entering the circulation after a fracture to a large long bone such as the femur or pelvis, or after surgery on such a bone.It can also occur during childbirth.

The term ‘fat embolism‘ was mentioned in the season finale of the popular TV series House. Because of this, people are searching for it and some are tweeting it.

Here is the detail of fat embolism:

There is no specific therapy for fat embolism syndrome; prevention,early diagnosis, and adequate symptomatic treatment are of paramount importance. Supportive care includes maintenance of adequate oxygenation and ventilation, stable haemodynamics, blood products as clinically indicated, hydration, prophylaxis of deep venousthrombosis and stress-related gastrointestinal bleeding, and nutrition. The goals of pharmacotherapy are to reduce morbidity and prevent complications. Supportive care is the mainstay of therapy for clinically apparent fat embolism syndrome. Mortality is estimated to be 5-15% overall, but most patients will recover fully.[2,11]

Early immobilization of fractures reduces the incidence of fat embolism syndrome and the risk is further reduced by operative correction rather than conservative management. Another strategy to prevent fat embolism syndrome is to limit the elevation in intraosseous pressure during orthopaedic procedures, in order to reduce the intravasation of intramedullary fat and other debris.[14] In a randomised trial of 40 patients, half were randomised to receive a venting hole for drainage of the medullary cavity between the greater and the lesser trochanter in order to limit intraoperative rises in intraosseous pressure. Significantly fewer major embolic events were detected by transoesophagealechocardiography in the venting group (20% vs 85%). Other operative refinements may also serve to limit intraosseous pressure, including the use of cementless fixation of hip prostheses and unreamed intramedullary femoral shaft stabilization.[14]

The use of corticosteroid prophylaxis is controversial, largely because it is difficult to definitively prove efficacy in a condition with a low incidence, unclear risk factors, low mortality,and a good outcome with conservative management. Nevertheless,a number of studies report decreased incidence and severity of fat embolism syndrome when corticosteroids are given prophylactically.[12,13]In a double-blind randomized study, 64 consecutive patients with lower-extremity long-bone fractures received either placeboor methylprednisolone, 7.5 mg kg-1 every 6 h for 12 doses.[13]Fat embolism syndrome was diagnosed in 9 of 41 placebo-treated patients and 0 of 21 steroid-treated patients (P < 0.05).No complications related to steroid treatment were observed. One rational, conservative approach would be to give prophylacticsteroid therapy only to those patients at high risk for fat embolism syndrome, for example, those with long bone or pelvicfractures, especially closed fractures. Methylprednisolone 1.5mg kg-1 i.v. can be administered every 8 h for six doses. Corticosteroids have been extensively studied, and recommendedby some, for the management of the fat embolism syndrome. Theproposed mechanism of action is largely as an anti-inflammatoryagent, reducing the perivascular haemorrhage and oedema. There are insufficient data to support initiating steroid therapy once fat embolism syndrome is established. An experimental study showed no beneficial effect, and there have been no prospective,randomized, and controlled clinical studies that have demonstrated a significant benefit with their use. A prospective study of 58 patients with uncomplicated fractures showed that the treatment of patients with aspirin resulted in significant normalization of blood gases, coagulation proteins,and platelet numbers when compared with controls. Heparin is known to clear lipaemic serum by stimulating lipase activity and has been advocated for the treatment of fat embolism syndrome .However, activation of lipase is potentially dangerous if increasesin free fatty acids are an important part of the pathogenesis. There is also a possibility of increased risk of bleeding inpatients with multiple
trauma.





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