BACKGROUND: Fat embolism syndrome (FES) is a potentially lethal condition most commonly seen in polytrauma patients with multiple long-bone fractures. Treatment has centred around supportive care and early fracture fixation. Several small clinical trials have suggested corticosteroids benefit patients with FES, but this treatment remains controversial. Our objective was to determine the effect of corticosteroids in preventing FES in patients with long-bone fractures. METHODS: We conducted a meta-analysis of published studies of patients with long-bone fractures who were randomly assigned to groups receiving corticosteroids or standard treatment for the prevention of FES (1966-2006). Data were extracted on quality, population, intervention and outcomes. Our primary outcome was the development of FES. We used random-effects models to pool results across studies, assessing for study heterogeneity. RESULTS: Of the 104 studies identified, 7 met our eligibility criteria. Overall, the quality of the trials was poor. Our pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78% (95% confidence interval [CI] 43%-92%) and that only 8 patients needed to be treated (95% CI 5-13 patients) to prevent 1 case of FES. Similarly, corticosteroids significantly reduced the risk of hypoxia. We found no differences in the rates of mortality or infection. Rates of avascular necrosis were not reported in any of these studies. CONCLUSION: Evidence suggests that corticosteroids may be beneficial in preventing FES and hypoxia but not mortality in patients with long-bone fractures. The risk of infection is not increased with the use of corticosteroids. However, methodological limitations of these trials necessitate a large confirmatory randomized trial.
BACKGROUND:Fat embolism syndrome (FES) is a potentially lethal condition most commonly seen in polytraumapatients with multiple long-bone fractures. Treatment has centred around supportive care and early fracture fixation. Several small clinical trials have suggested corticosteroids benefit patients with FES, but this treatment remains controversial. Our objective was to determine the effect of corticosteroids in preventing FES in patients with long-bone fractures. METHODS: We conducted a meta-analysis of published studies of patients with long-bone fractures who were randomly assigned to groups receiving corticosteroids or standard treatment for the prevention of FES (1966-2006). Data were extracted on quality, population, intervention and outcomes. Our primary outcome was the development of FES. We used random-effects models to pool results across studies, assessing for study heterogeneity. RESULTS: Of the 104 studies identified, 7 met our eligibility criteria. Overall, the quality of the trials was poor. Our pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78% (95% confidence interval [CI] 43%-92%) and that only 8 patients needed to be treated (95% CI 5-13 patients) to prevent 1 case of FES. Similarly, corticosteroids significantly reduced the risk of hypoxia. We found no differences in the rates of mortality or infection. Rates of avascular necrosis were not reported in any of these studies. CONCLUSION: Evidence suggests that corticosteroids may be beneficial in preventing FES and hypoxia but not mortality in patients with long-bone fractures. The risk of infection is not increased with the use of corticosteroids. However, methodological limitations of these trials necessitate a large confirmatory randomized trial.
Authors: Phil Edwards; Miguel Arango; Laura Balica; Rowland Cottingham; Hesham El-Sayed; Barbara Farrell; Janice Fernandes; Tamar Gogichaisvili; Nyoman Golden; Bennie Hartzenberg; Mazhar Husain; Mario Izurieta Ulloa; Zouheir Jerbi; Hussein Khamis; Edward Komolafe; Véronique Laloë; Gabrielle Lomas; Silke Ludwig; Guy Mazairac; Maria de los Angeles Muñoz Sanchéz; Luis Nasi; Fatos Olldashi; Patrick Plunkett; Ian Roberts; Peter Sandercock; Haleema Shakur; Caridad Soler; Reto Stocker; Petr Svoboda; Stefan Trenkler; N K Venkataramana; Jonathan Wasserberg; David Yates; Surakrant Yutthakasemsunt Journal: Lancet Date: 2005 Jun 4-10 Impact factor: 79.321
Authors: W P Coleman; D Benzel; D W Cahill; T Ducker; F Geisler; B Green; M R Gropper; J Goffin; P W Madsen; D J Maiman; S L Ondra; M Rosner; R C Sasso; G R Trost; S Zeidman Journal: J Spinal Disord Date: 2000-06
Authors: V M Ranieri; P M Suter; C Tortorella; R De Tullio; J M Dayer; A Brienza; F Bruno; A S Slutsky Journal: JAMA Date: 1999-07-07 Impact factor: 56.272