The role of rehydration in the prevention of fat embolism syndrome.

We encountered three cases of young sportsmen developing fat embolism syndrome (FES) after sustaining isolated tibial shaft fractures whilst playing football. All fractures were treated with intra-medullary nails and all three patients were kept nil-by-mouth pre-operatively without intravenous fluids. Correction of shock is often quoted as an important factor in the prevention of FES. However, animal studies have shown that dehydration, as opposed to hypovolaemia, may also be of great importance. We therefore examined the specific gravity of the urine of 20 patients with musculoskeletal injuries sustained during sport. The mean urinary specific gravity was significantly higher than that of a control group of 10 members of staff. We emphasise the importance of adequate pre-operative rehydration, especially if injuries were sustained during heavy exercise, as this may reduce the risk of developing FES.