[Clinical relevance of fat embolism. Review of the literature].

Fat embolism is since many decades a known and feared complication of fracture of long bones, polytrauma and also in endoprosthetic surgery. During this literature study old and actual experiences about fat embolism, in reference to pathophysiology and diagnosis, were summarized, the actual state of knowledge defined and also different possibilities of reducing fat embolism risks presented and evaluated. In order to estimate the clinical importance of fat embolism, 106 cases of fat embolism (51 clinical and 55 death cases) after hip and knee endoprosthesis were obtained from the literature and retrospectively compared with the results obtained by our own patients. Within a period of 10 years there were in Kantonsspital Liestal 834 primary hip prosthesis and 235 revisions, with 3 deaths. In none of the cases, fat embolism could be shown. Seven patients had respiratory complications after operation, but in only 2 cases the suspicion of fat embolism could not be excluded with certainty. Only 1 case out of 6 patients who had to stay in the intensive care unit after the operation could possibly be connected with intraoperative liberation of fat. At the end of this study simple and clinical proven methods are suggested, which can be helpful to reduce the risks of fat embolism.