Semita I Nyoman, Fatmawati Heni, Raharjo Angga Mardro, Gandi Parama, Juliasih Ni Njoman
Department of Orthopedic and Traumatology, Dr. Soebandi General Hospital, Faculty of Medicine, University of Jember, Indonesia.
Departement of Radiology, Dr. Soebandi General Hospital, Faculty of Medicine, University of Jember, Indonesia.
Int J Surg Case Rep. 2025 Jan;126:110646. doi: 10.1016/j.ijscr.2024.110646. Epub 2024 Nov 26.
Treatment of respiratory distress in fat embolism syndrome (FES) often ends in death. FES is generally associated with orthopedic trauma, with the highest incidence in long bone fractures.
We present a case, 20-year-old woman with an initial diagnosis of a closed fracture in the right femur and left cruris after traffic accidents, underwent open reduction and internal fixation 17 h after an incident. Thirty hours after the surgery, she experienced respiratory distress, loss of consciousness, and petechial rash. Thoracic radiography revealed bilateral patchy infiltrates; brain CT found cerebral oedema; brain MRI showed multiple small non-confluent lesions; arterial blood gas analysis indicated respiratory acidosis; pulse oximetry was 95 %, leading to a diagnosis of FES. Complete blood count revealed anaemia through a decrease in haemoglobin, haematocrit, increase in erythrocyte sedimentation rate, thrombocytopenia, hypocalcaemia, and hypoalbuminemia. The patient was promptly transferred to the intensive care unit with central venous pressure measuring, consulted to a neurologist, pulmonologist, anaesthesiologist, and cardiologist for supportive treatment and mechanical ventilation for nine days. The patient recovered gradually to be normal. FES treatment has been successful, and the patient discharged after 16 days.
The prevention of FES depends on timing, surgical technique, and early diagnosis. Early surgical fixation of long bone fractures within 24 h reduces pulmonary complications by 70 %. FES can present in a wide variety of severity and symptom. There is no specific treatment.
Prevention, early diagnosis, and prompt management of FES are the cornerstone in managing this condition.
脂肪栓塞综合征（FES）所致呼吸窘迫的治疗往往以死亡告终。FES通常与骨科创伤相关，在长骨骨折中发病率最高。
我们报告一例病例，一名20岁女性，交通事故后初步诊断为右股骨和左小腿闭合性骨折，事故发生17小时后接受切开复位内固定术。术后30小时，她出现呼吸窘迫、意识丧失和瘀点疹。胸部X线检查显示双侧斑片状浸润影；脑部CT发现脑水肿；脑部MRI显示多个小的不融合病灶；动脉血气分析提示呼吸性酸中毒；脉搏血氧饱和度为95%，从而诊断为FES。全血细胞计数显示血红蛋白降低、血细胞比容降低、红细胞沉降率升高、血小板减少、低钙血症和低白蛋白血症，提示贫血。患者立即被转至重症监护病房进行中心静脉压监测，并咨询神经科医生、肺科医生、麻醉科医生和心脏病专家进行支持治疗及机械通气9天。患者逐渐恢复正常。FES治疗成功，患者16天后出院。
FES的预防取决于时机、手术技巧和早期诊断。长骨骨折在24小时内尽早进行手术固定可使肺部并发症减少70%。FES的严重程度和症状表现多样。目前尚无特效治疗方法。
FES的预防、早期诊断和及时处理是治疗该病的基石。
