Incidence

The true incidence of fat embolism syndrome is unknown but is under-reported. It is most closely associated with fractures of the pelvis and long bones of the lower extremity, with a reported incidence of 3.4 per cent for tibial fractures and 9 per cent for femoral fractures, rising to 20 per cent for fractures of both tibia and femur (PeJiieJ..1969). Although injury is the main triggering factor leading to fat embolism syndrome, orthopedic procedures such as hip arthroplasty and intramedullary nailing for lower limb fractures may lead to the release of marrow fat into the circulation.

There is no consistent relationship between the amount of fat released and the probability of developing fat embolism syndrome. The condition has been reported in association with isolated fractures of bones such as the clavicle and vertebrae where the amount of fat released is small. Moreover, fat embolism syndrome may develop in any condition where there is potential for fat release into the circulation, such as muscle injury and burns.

Of those patients who develop clinically evident fat embolism syndrome, 20 per cent show a fulminant course with a mortality approaching 50 per cent. Although the condition may occur at any age, it is most commonly seen in those most at risk of serious trauma, i.e. young males.

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