Cerebral fat embolism syndrome following urgent debridement and application of skeletal traction for the right femur: A case report

Background: The incidence of fat embolism syndrome (FES) can be found in 3 to 4% of patients who have major trauma, especially with long-bone fractures. Objective: To describe a healthy patient with manifestations of FES following urgent debridement and application of skeletal traction for the femur and review the diagnosis, investigation and management of this condition. Case Report: A healthy 23-year-old man was injured in a motorcycle accident and underwent urgent debridement of the open tibia fracture and application of skeletal traction for the right femur. After one hour of surgery; the patient was suddenly agitated, developed a generalized tonic-clonic seizure and progressed into a coma with the GCS of 6. Petechial skin rash was noted on the anterior chest. The magnetic resonance imaging (MRI) of the brain at postoperative 24 hours provided a confirmation of clinical suspicious of cerebral FES. His postoperative course showed gradual improvement with a slowly resolving encephalopathy in the period of four months. Conclusion: FES is a known complication of long bone trauma and a clinical diagnosis characterized with respiratory insufficiency, neurologic impairment and a petechial rash. MRI of the brain can be used to confirm the diagnosis. Supportive care is the mainstay of therapy for clinically apparent FES.