Fat embolism syndrome primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Effective measurement for the primary prevention of fat embolism include early fixation of long bone fractures, external fixation with a plate and screw and use of small-diameter nails.

Primary Prevention

Effective measurement for the primary prevention of fat embolism are as follows:[1]

Pre-operative preventive measures:

  • Preoperative intravenous injection of dexamethasone.[2]
  • Continuous pulse oximetry to detect hypoxemia at early stages.[3][4][5]
  • Early fixation of long-bone fracture.
  • External fixation or fixation with plate and screw decreases the possibility of fat embolism than than nailing the medullary cavity and venting the medullary canal during nailing.[4]
  • If nails are needed, smaller-diameter nails and unreamed nailing may be better.[6]

In-operation preventive measures:

In patients having surgery for long bone fractures following preventive measures should be taken:

  • Early detection of the symptoms by careful vigilence and high degree of clinical suspicion.
  • Continuous monitoring for the fall in oxygen saturation.
  • An early initiation of supplemental oxygen and steroids may help in inhibiting the hypoxic insult and manifestations of full-blown FES.
  • The patient should not be over sedated.
  • Careful monitroing of vitals and temperature is mandatory.
  • Periodic neurological assessment.
  • Albumin should be used for volume resuscitation as it binds with free fatty acids and reduces lung injury.

References

  1. Jiang J, Wang H, Wang Y (2010). "[Clinical study on effect of dexamethasone in preventing fat embolism syndrome after cemented hip arthroplasty]". Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 24 (8): 913–6. PMID 20839434.
  2. Cavallazzi R, Cavallazzi AC (2008). "[The effect of corticosteroids on the prevention of fat embolism syndrome after long bone fracture of the lower limbs: a systematic review and meta-analysis]". J Bras Pneumol. 34 (1): 34–41. PMID 18278374.
  3. Wong MW, Tsui HF, Yung SH, Chan KM, Cheng JC (2004). "Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures". J Trauma. 56 (2): 356–62. doi:10.1097/01.TA.0000064450.02273.9B. PMID 14960980.
  4. 4.0 4.1 Schmidt J, Sulk C, Weigand C, La Rosée K, Schneider T (2001). "[Preventing fat embolism syndrome (FES) in implantation of cemented hip endoprosthesis shafts with a trans-prosthetic drainage system (TDS)]". Biomed Tech (Berl). 46 (11): 320–4. PMID 11778316.
  5. Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE; et al. (1983). "Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients". Ann Intern Med. 99 (4): 438–43. PMID 6354030.
  6. Pitto RP, Kössler M, Draenert K (1998). "[Prevention of fat and bone marrow embolism in cemented total hip endoprosthesis with vacuum cement technique]". Z Orthop Ihre Grenzgeb. 136 (4): Oa24. PMID 9795426.

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