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Case Reports
Fat Embolism Syndrome in an Adolescent Before Surgical Treatment of an Isolated Closed Tibial Shaft Fracture
Am J Orthop. 2012 December;41(12):565-568
Author and Disclosure Information
Cayce B. Nawaf, BS, Derek M. Kelly, MD, William C. Warner Jr, MD, James H. Beaty, MD, Leslie Rhodes, NP, and Jeffrey R. Sawyer, MD
Mr. Nawaf is Medical Student, Dr. Kelly is Assistant Professor, Dr.
Warner Jr is Professor, and Dr. Beaty is Professor, University of
Tennessee-Campbell Clinic Department of Orthopaedic Surgery,
Memphis.
Ms. Rhodes is Pediatric Nurse Practitioner, Pediatric Orthopaedic
Service, LeBonheur Children’s Hospital, Memphis, Tennessee.
Dr. Sawyer is Associate Professor, University of Tennessee-
Campbell Clinic Department of Orthopaedic Surgery, Memphis.
Fat embolism syndrome (FES) occurs most commonly in adults with high-energy trauma, especially fractures of the long-bones and pelvis. Because of unique age-related physiologic differences in the immature skeleton, as well as differences in fracture management in pediatric patients, FES is rare in children. To our knowledge, this is the first case report of FES occurring before surgical fixation of a closed tibial shaft fracture in an adolescent.
A 16-year-old, 109 kg, Caucasian adolescent boy developed FES after closed diaphyseal fractures of the distal tibia and fibula, showing signs of respiratory distress and mental status changes.
The FES resolved with supportive respiratory care and intramedullary nailing of the fracture was done without further respiratory compromise.
FES is uncommon in children and adolescents. A high index of suspicion is required to make the diagnosis promptly and institute appropriate treatment. Intramedullary nailing of a long-bone fracture can be done safely and successfully after resolution of the FES.