Cerebral Fat Embolism Syndrome Following Urgent Debridement and Application of Skeletal Traction for the Right Femur: A Case Report
Mingkwan Wongyingsinn MD*, Direk Tantigate MD**, Theerapol Witthiwej MD***, Orasa Chawalparit MD****
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Division of diagnosis, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The incidence of fat embolism syndrome (FES) can be found in 3 to 4% of patients who have major trauma,
especially with long-bone fractures.
Objective : To describe a healthy patient with manifestations of FES following urgent debridement and application of skeletal
traction for the femur and review the diagnosis, investigation and management of this condition.
Case Report : A healthy 23-year-old man was injured in a motorcycle accident and underwent urgent debridement of the open
tibia fracture and application of skeletal traction for the right femur. After one hour of surgery; the patient was suddenly
agitated, developed a generalized tonic-clonic seizure and progressed into a coma with the GCS of 6. Petechial skin rash was
noted on the anterior chest. The magnetic resonance imaging (MRI) of the brain at postoperative 24 hours provided a
confirmation of clinical suspicious of cerebral FES. His postoperative course showed gradual improvement with a slowly
resolving encephalopathy in the period of four months.
Conclusion : FES is a known complication of long bone trauma and a clinical diagnosis characterized with respiratory
insufficiency, neurologic impairment and a petechial rash. MRI of the brain can be used to confirm the diagnosis. Supportive
care is the mainstay of therapy for clinically apparent FES.
Keywords : Fat embolism syndrome, Cerebral fat embolism syndrome
