A traumatic case of fat embolism

Abstract

A fit and healthy 47-year-old woman developed type I respiratory failure 2 days following surgical fixation for a left intertrochanteric neck of femur fracture. She presented to the acute trauma unit following a fall off a horse and had a long dynamic hip screw fixation in theatre. Postoperatively, she became confused and hypoxic. Her chest X-ray was inconclusive and her CT pulmonary angiogram showed diffuse patchy ground glass shadowing in keeping with acute respiratory distress syndrome. Following review by intensive care and respiratory physicians, a diagnosis of acute lung injury secondary to fat embolism was reached. The patient made a good recovery on the orthopaedic ward with supportive treatment.

Figure 1

Initial pelvic X-ray on presentation.

Figure 2

Orthopaedic pinning of left hip.

Figure 3

Chest X-ray day 2 postoperatively.

Figure 4

CT pulmonary angiogram on day 2 postoperatively.