2. Intro
• Indicate the presence of fat globals in lung parenchyma and
peripheral circulation after fracture of a long bone on major trauma
• Usually occurs within 72 hours of skeleton trauma
• Often associated with multiple fractures. Major bone fractures, pelvic
fracture multi system injury like chest and abdomen, head injury.
• Causes a devastating, clinical deterioration within hours
• Patience with bilateral similar fractures are at particular risk and have
a higher risk of ARDS and death
5. Mechanical theory
• Suggest that fat globules are
forcibly intravasated from marrow
through disrupted vessels, and
then they are transported to the
pulmonary vascular bed and are
trapped as emboli in the lung
capillaries
• Some reaches systemic circulation,
causing embolisation in areas such
as brain, kidney, retina or skin
6. Biochemical theory
• Toxic theory –lung lipase hydrolysis neutral
fat to chemically toxic free fatty acids. This
causes severe inflammatory changes by
producing endothelial damage, inactivation
of lung surfactant and increase in capillary
permeability leading to ARDS
• Obstructive theory-a chemical event at site
of fracture releases, mediators that affect
the solubility of lipids, causing coalescence
and subsequent embolisation. Normal
chylomicrons may coalesce and form fat
globules which are capable of occluding the
lung capillaries
7.
8. Clinical features
• The classical syndrome involves pulmonary
,cerebral and cutaneous manifestations
• Pulmonary-
Tachypnoea,dyspnoea,cyanosis,tachycardia
• Cerebral-headache, irritable, delirium,
stupor, convulsions and coma
• Cutaneous and retinal-retinal exudate
,edematous patches, cotton wool spots
and patechial haemorrhages
12. Management
• Non-specific
1. keep airway patent
and immobilise the
fracture
2. Restore blood,
volume fluid and
electrolyte balance
3. Avoid careless
handling of the
injured
13. Specific
1. respiratory support- O2 administration to full
respiratory support
2. Drugs –
i. steroids-methylprednisolone
ii. Heparin –decrease s.lipase activity and no. Of
circulating fat globules
iii. Low molecular wt dextran-useful in prophylaxis,act
by inc pl vol,dec blood viscosity nd reduce platelet
adherence
iv. Hypertonic glucose-dec FFA production,imp art
oxygenation
v. I/V Alcohol-dec s.lipase activity
3. Definitive fracture treatment
