Luigi Vetrugno1,2, Elena Bignami3, Cristian Deana4, Flavio Bassi5, Maria Vargas6, Maria Orsaria7, Daniele Bagatto8, Cristina Intermite9, Francesco Meroi9, Francesco Saglietti10, Marco Sartori9, Daniele Orso9, Massimo Robiony11,12, Tiziana Bove13,9. 1. Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. luigi.vetrugno@uniud.it. 2. Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy. luigi.vetrugno@uniud.it. 3. Department of Medicine and Surgery, Unit of Anesthesiology, Parma University Hospital, Parma, Italy. 4. Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 1, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. 5. Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 2, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. 6. Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy. 7. Department of Medicine, Surgical Pathology Section, University of Udine, Udine, Italy. 8. Department of Diagnostic Imaging, Neuroradiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. 9. Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy. 10. School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. 11. Department of Medicine, Maxillofacial Surgery, University of Udine, Udine, Italy. 12. Azienda Sanitaria Universitaria Friuli Centrale, Maxillofacial Surgery, Udine, Italy. 13. Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
Abstract
BACKGROUND: The incidence of cerebral fat embolism (CFE) ranges from 0.9-11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the 'mechanical theory', and the 'chemical theory'. The present article provides a systematic review of published case reports of FES following a bone fracture. METHODS: We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: trauma patients; age ≥ 18 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. RESULTS: One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (±18). The mean age for males (29 ± 14) was significantly lower than for females (51 ± 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27-2.48, p < 0.001; 95%CI 0.48-2.34, p < 0.001). CONCLUSIONS: FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48-72 h.
BACKGROUND: The incidence of cerebral fat embolism (CFE) ranges from 0.9-11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the 'mechanical theory', and the 'chemical theory'. The present article provides a systematic review of published case reports of FES following a bone fracture. METHODS: We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: traumapatients; age ≥ 18 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. RESULTS: One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (±18). The mean age for males (29 ± 14) was significantly lower than for females (51 ± 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27-2.48, p < 0.001; 95%CI 0.48-2.34, p < 0.001). CONCLUSIONS: FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48-72 h.
Authors: Alejandro M Forteza; Sebastian Koch; Iszet Campo-Bustillo; Jose Gutierrez; Diogo C Haussen; Alejandro A Rabinstein; Jose Romano; Gregory A Zych; Robert Duncan Journal: Circulation Date: 2011-04-25 Impact factor: 29.690
Authors: Mark J D Griffiths; Danny Francis McAuley; Gavin D Perkins; Nicholas Barrett; Bronagh Blackwood; Andrew Boyle; Nigel Chee; Bronwen Connolly; Paul Dark; Simon Finney; Aemun Salam; Jonathan Silversides; Nick Tarmey; Matt P Wise; Simon V Baudouin Journal: BMJ Open Respir Res Date: 2019-05-24