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. 2024 Aug;50(4):1775-1781.
doi: 10.1007/s00068-024-02516-9. Epub 2024 Apr 17.

Epidemiology and risk factors for fat embolism in isolated lower extremity long bone fractures

Natthida Owattanapanich  1   2 , Meghan Lewis  1 , Subarna Biswas  1 , Elizabeth R Benjamin  3 , Demetrios Demetriades  4
Affiliations

Epidemiology and risk factors for fat embolism in isolated lower extremity long bone fractures

Natthida Owattanapanich et al. Eur J Trauma Emerg Surg. 2024 Aug.

Abstract

Purpose: Fat embolism syndrome (FES) is a serious complication after orthopedic trauma. The aim of this study was to identify risk factors for FES in isolated lower extremity long bone fractures.

Methods: The National Trauma Data Bank "NTDB" study included patients with isolated femoral and tibial fractures. A total of 344 patients with FES were propensity score matched with 981 patients without FES. Multivariate logistical regression was used to identify independent risk factors for FES.

Results: FES was diagnosed in 344 (0.03%) out of the 1,251,143 patients in the study populations. In the two matched groups, the mortality was 7% in the FES group and 1% in the No FES group (p < 0.001). FES was associated with an increased risk of ARDS, VTE, pneumonia, AKI, and stroke. Younger age, femur fractures, obesity, and diabetes mellitus were independent predictors of FES. Early operative fixation (≤ 48 h) was protective against FES.

Conclusion: FES increases mortality by seven times. Young age, obesity, and diabetes mellitus are significant independent risk factors for FES. Early fixation is independently associated with a reduced risk of FES.

Level of evidence: Level III.

Study type: Prognostic study.

Keywords: Fat embolism; Lower extremity fractures; Risk factors.

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