Fat embolism: an aid to diagnosis
01 Nov 1970-Journal of Bone and Joint Surgery-british Volume (The British Editorial Society of Bone and Joint Surgery)-Vol. 52, Iss: 4, pp 732-737
TL;DR: A diagnostic procedure is described which is specific for fat embolism and allows identification of the pathological fat globules on a stained slide and the amount of pathological fat can be estimated by comparing the serum triglyceride levels before and after filtration.
Abstract: 1. A diagnostic procedure is described which is specific for fat embolism. It allows identification of the pathological fat globules On a stained slide.2. The amount of pathological fat can be estimated by comparing the serum triglyceride levels before and after filtration.3. The method is simple, reproducible and inexpensive.
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TL;DR: Total knee arthroplasty using the OrthoPilot system led to increased precision of tibial and femoral component positioning in comparison with hand-guided replacement surgery and the radiographic results were significantly better in the computer-assisted group.
Abstract: UNLABELLED In our clinical study, 200 total knee arthroplasties were evaluated to compare the use of the OrthoPilot system with conventional mechanical instrumentation. Long-term outcome of total knee replacement depends mainly on the accuracy of implant positioning and restoration of the mechanical leg axis. Our experience was that navigation could achieve a greater degree of accuracy concerning the aforementioned aspects. Among 513 primary-inserted total knee replacements, 100 navigated knees were compared with 100 conventionally implanted knees after matching the two groups of patients by gender, body mass index, age, preoperative deformities, radiographic findings, and operating time. Three weeks after surgery, the radiographic results were significantly better in the computer-assisted group compared with the results in the conventional group when we assessed component positioning in four axes. Only the sagittal tibial component angle was not significantly different. Total knee arthroplasty using the OrthoPilot system led to increased precision of tibial and femoral component positioning in comparison with hand-guided replacement surgery. An additional 10 minutes of operating time was acceptable. Navigation-specific complications were not seen, and the number of outliers decreased. Because computer navigation in orthopaedics is a new technology, data regarding long-term outcomes are not available. LEVEL OF EVIDENCE Diagnostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
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Cites background from "Fat embolism: an aid to diagnosis"
...This may result in respiratory symptoms, with changes observed on chest radiographs, neurologic symptoms, and even death.(10,13,31) With modern intramedullary alignment methods, some studies have shown the persistence of echogenic material with transesophageal ultrasound when the tourniquet is released....
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TL;DR: The AAOS has worked to communicate the importance of membership in broad-based regional and national organizations and encouraged the growth of state and regional orthopaedic societies.
325 citations
TL;DR: A 10-year review of the experiences at a level I trauma center found that fat embolism syndrome remains a diagnosis of exclusion and is based on clinical criteria, and the management of FES remains primarily supportive.
Abstract: Background: The effect of recent advances in critical care and the emphasis on early fracture fixation in patients with fat embolism syndrome (FES) are unknown. Objective: To better define FES in current practice by conducting a 10-year review of the experiences at our level I trauma center. Design: The medical records of all patients in whom FES was diagnosed from July 1, 1985, to July 1, 1995, were reviewed for demographics, injury severity and pattern, diagnostic criteria, and management. Setting: A level I trauma center. Results: Twenty-seven patients with clinically apparent FES were identified. This resulted in an incidence of 0.9% of all patients with long-bone fractures. The mean injury severity score was 9.5 (range, 4-22). The diagnosis of FES was made by clinical criteria, including hypoxia, 26 patients (96%); mental status changes, 16 patients (59%); petechiae, 9 patients (33%); temperature higher than 39°C, 19 patients (70%); tachycardia (heart rate >120 beats per minute), 25 patients (93%); thrombocytopenia (platelet count Conclusions: (1) Fat embolism syndrome remains a diagnosis of exclusion and is based on clinical criteria. (2) Clinically apparent FES is unusual but may be masked by associated injuries in more severely injured patients. (3) No association could be identified between FES and a specific fracture pattern or location. (4) Early intramedullary fixation does not increase the incidence or severity of FES. (5) While FES seems to have a direct effect on survival, the management of FES remains primarily supportive. Arch Surg.1997;132:435-439
290 citations
TL;DR: Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries and is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail.
Abstract: Objectives:
The timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition.
252 citations
Cites methods from "Fat embolism: an aid to diagnosis"
...The diagnosis of a fat embolism syndrome was made according to a scoring system.(25)...
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TL;DR: A 49-year-old man with a history of prostate cancer metastatic to bone suffered a pathological fracture to the left femur while hospitalized and developed hypoxemia and hypotension followed by confusion and a petechial rash in the left axilla, and was diagnosed with fat embolism syndrome.
Abstract: A 49-year-old man with a history of prostate cancer metastatic to bone suffered a pathological fracture to the left femur while hospitalized (Figure 1A). Eighteen hours after the fracture, he developed hypoxemia and hypotension followed by confusion and a petechial rash in the left axilla. Chest X-ray obtained after intubation demonstrated new diffuse bilateral patchy infiltrates (Figure 1B). Urgent transthoracic echocardiogram showed right ventricular dilation and free wall hypokinesis with preserved contractility of the right ventricular apex (McConnell’s Sign; Figure 2, Movie I in the online-only Data Supplement). Based on the clinical presentation and supportive imaging, the patient was diagnosed with fat embolism syndrome. He was transferred to the intensive care unit for further management.
Figure 1.
Initial imaging. X-ray of the left lower extremity demonstrating a closed, oblique fracture of the left femur with displacement of the distal femoral fragment ( A ). Chest X-ray obtained shortly after endotracheal intubation showing bilateral patchy infiltrates consistent with acute respiratory distress syndrome (ARDS; B ).
Figure 2.
Transthoracic echocardiogram images obtained during diastole ( A ) and systole ( B ) demonstrating right ventricular dysfunction with hypokinesis of the mid right ventricular free wall and preservation of the apex.
Although it was observed centuries ago that intravenous injection of oil resulted in mechanical obstruction of small vessels,1 the exact pathophysiology of fat embolism syndrome (FES) remains uncertain. Fat embolism (FE) is defined by the presence of fat globules in the pulmonary microcirculation regardless of clinical significance. FES describes a characteristic pattern of clinical findings that follow an insult associated with the release of fat into the circulation.
FES is most commonly associated with orthopedic trauma, with highest incidence in closed, long bone fractures of the lower extremities, particularly the femur.2 The risk of FES complicating orthopedic trauma is highest in ages 10 to 40 years and occurs in …
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References
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