Fat embolism, ARDS, coma, death: the four horsemen of the fractured hip.

The pathophysiology of fat embolism syndrome (FES) is presented in the context of total joint arthroplasty. The current literature is reviewed with recommendations for surgical technique, anesthetic and pulmonary management. Diagnosis is quite difficult but can be established by imaging techniques such as MRI, SPECT, and transcranial Doppler sonography. Early steroid treatment may limit morbidity.