1/51. Two episodes of clinical fat embolism following multiple fractures.Second episodes of clinical fat embolism have not previously been reported. This paper presents the case report of a patient with multiple fractures who developed two distinct attacks with a symptom-free interval. The second attack was partly responsible for death, and histological examination confirmed the diagnosis.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/51. Pulmonary fat embolism: a complication of fracture.Medical personnel must be aware of the possibility of fat embolism as a complicating factor of fractures. Ambulance, emergency room, orthopedic, and intensive-care personnel may frequently be involved in the care of these patients. Fat embolism should be suspected any time a patient exhibits bizarre mental, pulmonary, or circulatory symptoms following a fracture. Prevention may be achieved by as near immobilization of a fracture as possible. When fat embolism does occur, the course of the illness may or may not be complex. The treatment is supportive and the patient should be made as comfortable as possible.- - - - - - - - - - ranking = 1.4keywords = fracture (Clic here for more details about this article) |
3/51. Transcranial doppler detection of fat emboli.BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.- - - - - - - - - - ranking = 0.8keywords = fracture (Clic here for more details about this article) |
4/51. Prolonged coma due to cerebral fat embolism: report of two cases.Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. The true incidence is difficult to assess as many cases remain undiagnosed. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is more sensitive in the detection of a suspected brain embolism. Two cases of post-traumatic cerebral fat embolism, manifested by prolonged coma and diffuse cerebral oedema, are presented. The clinical course of the disease as well as the intensive care unit management are discussed.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
5/51. Fat embolism syndrome after cementless total hip arthroplasty.There are few reports in the literature of fat embolism syndrome after cementless total hip arthroplasty (THA). Most reported cases have occurred after fracture or cemented THA. We report a case of a healthy 51-year-old woman who underwent THA for osteoarthritis under spinal anesthesia. A press-fit cup and extensively porous-coated diaphyseal locking stem were used and inserted without cement. In the recovery room, the patient became hypoxemic and hypotensive and developed cortical blindness. The next day, a petechial rash was evident. Gurd's criteria for fat embolism syndrome were fulfilled. Her symptoms resolved over a 2-week period. patients undergoing cementless THA are at risk for fat embolism syndrome, and this must be considered in the differential diagnosis for postoperative hypoxemia and neurologic deficits.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
6/51. Cerebral embolization presenting as delayed, severe obtundation in the postanesthesia care unit after total hip arthroplasty.Catastrophic neurologic events occur rarely postoperatively and must be diagnosed quickly. A 63-year-old woman who had undergone uneventful total hip arthroplasty experienced obtundation after admission to the postanesthesia care unit. Cranial magnetic resonance imaging revealed multiple lesions consistent with ischemia or infarction, and fat cerebral embolism was diagnosed. We describe the numerous complications that may occur in patients in the postanesthesia care unit and review the differential diagnosis of altered mental status in such patients. Paradoxical cerebral fat embolization must be considered in the differential diagnosis of altered mental status after pelvic or long bone fracture or lower extremity major joint replacement, and this condition may occur despite normal pulmonary function and no patent foramen ovale or right-to-left intracardiac shunt. magnetic resonance imaging with T2-weighted sequences is the cranial imaging study of choice for early evaluation of patients with sudden multifocal neurologic deficits and suspected fat embolism syndrome.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
7/51. Sudden death from pelvic hemorrhage after bilateral central fracture dislocations of the hip due to an epileptic seizure.Fracture and dislocation of major joints may be caused by the forceful tonic muscular contractions of seizure activity. A 77-year-old man who was found dead in bed with no sign of external trauma had bilateral central fracture dislocations of the femoral head through the acetabular floor with fatal pelvic hemorrhage and extensive pulmonary fat and bone marrow embolism. He had epilepsy, but the last seizure was 6 years earlier, and he had long discontinued medication. The fractures were attributed to a new unwitnessed seizure. This is the twentieth case of central fracture dislocation of the hip since 1970, when better anesthesia eliminated convulsive therapy-induced fractures. The authors review these 20 cases. seizures followed inflammation, infarction or neoplasia of the brain, eclampsia, metabolic or iatrogenic causes, or epilepsy (6 cases, 2 of which had no prior seizures for 5 years). There were 11 men (mean age, 64 years) and 9 women (mean age, 47 years). Fractures were unilateral in 13 and bilateral in 7. Additional fractures (in vertebrae, shoulders, or femur) were present in eight. Only eight had prior bone disease. Local symptoms led to diagnosis in most, but two were identified incidentally on imaging. The current patient was the only one to die suddenly, but six other patients presented with shock and three died (one of whom had injuries that led to a suspicion of manslaughter). Central fracture-dislocation of the hip is a rare and little known consequence of seizures, with strong potential for misdiagnosis and lethal complications.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
8/51. Fat embolism, ARDS, coma, death: the four horsemen of the fractured hip.The pathophysiology of fat embolism syndrome (FES) is presented in the context of total joint arthroplasty. The current literature is reviewed with recommendations for surgical technique, anesthetic and pulmonary management. diagnosis is quite difficult but can be established by imaging techniques such as MRI, SPECT, and transcranial Doppler sonography. Early steroid treatment may limit morbidity.- - - - - - - - - - ranking = 0.8keywords = fracture (Clic here for more details about this article) |
9/51. Fat embolization and fatal cardiac arrest during hip arthroplasty with methylmethacrylate.PURPOSE: This case report describes a cardiac arrest during a cemented hip arthroplasty procedure. Hemodynamic instability during methylmethacrylate use in arthroplasty surgery can be explained by fat embolization rather than the inherent toxicity of the monomer. CLINICAL FEATURES: A 78-yr-old woman required a cemented hemiarthroplasty for a pathologic left subcapital fracture. The patient's past medical history included stable angina, diet-controlled type II diabetes and metastatic breast cancer. During the cementing of the canal and insertion of the femoral prosthesis, desaturation, hypotension and cardiac arrest occurred. The patient underwent a successful intraoperative resuscitation and was transferred to the intensive care unit where she subsequently developed disseminated intravascular coagulopathy. The patient died 24 hr later and autopsy confirmed the cause of death as fat embolization. CONCLUSION: The deleterious cardiovascular effects of methylmethacrylate have been discussed in the literature. However, clinical evidence supports fat embolization during arthroplasty surgery as a greater determinant of hemodynamic compromise. Surgical precautions are paramount in minimizing the sequelae of Bone Implantation syndrome and anesthetic treatment consists of supportive care.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
10/51. Cerebral fat embolism after a nondisplaced tibial fracture: case report.Fat embolism syndrome has been observed after traumatic or nontraumatic events. In traumatic cases, fat embolism syndrome is known to occur in patients with a fracture of a long bone. The case of a patient with a cerebral fat embolism associated with a nondisplaced fracture of the tibial shaft is reported.- - - - - - - - - - ranking = 1.2keywords = fracture (Clic here for more details about this article) |
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