DISCUSSION
Dyspnoea in the postoperative period after orthopaedic surgery is not a
rare occurrence and can vary in cause and severity. Fat embolism
syndrome (FES) is one of the most frequent, but also one of the most
overlooked causes of dyspnoea. It is a potential life-threatening
complication of long bone fractures and orthopaedic reaming procedures.
It is estimated to occur in 3-4% of patients with long bone or pelvic
fractures.1,2 The diagnosis of fat embolism syndrome
is often missed because of a subclinical illness or coexisting
distracting injuries or diseases. Other causes of dyspnoea after trauma
are pulmonary contusions, shock lung or thromboembolism, but also
cardiovascular and metabolic causes are possible. The terms fat embolism
(FE) and fat embolism syndrome are not interchangeable. Fat embolism
refers to the presence of circulating fat globules in the circulation
and the pulmonary parenchyma. Fat embolism syndrome is the clinical
manifestation of fat embolism. It usually presents as a triad of
respiratory insufficiency, altered mental status and petechiae.
In 1861 Zenker reported the first case of fat embolism in an autopsy by
describing fat droplets in the lung of a railroad worker who sustained
fatal thoracoabdominal injuries.1 It was only in 1865
that Wagner described the correlation of FE with fractures. The clinical
fat embolism syndrome was first described in 1873 by Bergmann as a triad
of confusion, dyspnoea and petechiae, following long bone
fractures.2
It was not until the 1920s that the two main pathophysiologic theories
were proposed. The first set of clinical criteria was presented by Gurd
in 1970.