scholarly journals Fatal Pulmonary Fat Embolism Occurring in Lumbar Spinal Fusion Surgery: Case Report and Review of Literature

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Lu Zhang ◽  
Jie Zhang ◽  
Zihui Cheng ◽  
Lingjie Kong ◽  
Liang Wang ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Lumbar Fusion ◽  
Relevant Literature ◽  
Severe Trauma ◽  
Fat Embolism ◽  
Long Bone ◽  
Pathological Examination ◽  
Disc Disease ◽  
Lumbar Intervertebral Disc ◽  
Fusion Surgery

Fat embolism system is one of the serious complications of orthopedic surgery, which is common seen in cases of severe trauma with long bone fractures. However, in clinical medical practice, it is rarely seen for Fat embolism system in orthopaedic lumbar fusion surgery. This paper report a case of sudden shock and death during lumbar fusion due to lumbar intervertebral disc disease. By forensic pathological examination, the pulmonary and brain fat embolism were observed in tissue sections, and the patient was diagnosed as FES. Based on the review of relevant literature and the pathological findings of this case, the clinical characteristics, diagnosis and treatment of FES in lumbar fusion are commentated in this paper. At the same time, it is emphasized that the clinical practise should strengthened the understanding and attention of non-traumatic fat embolism cases in order to timely identify, diagnose and treat the disease, improve the effectiveness of treatment, and reduce the corresponding medical disputes.

Lumbar Fusion Surgery for Patients With Back Pain and Degenerative Disc Disease: An Observational Study From the Canadian Spine Outcomes and Research Network

2021 ◽  
pp. 219256822098547
Author(s):  
Nathan Evaniew ◽  
Ganesh Swamy ◽  
W. Bradley Jacobs ◽  
Jacques Bouchard ◽  
Roger Cho ◽  
...  
Keyword(s):  
Back Pain ◽  
Degenerative Disc Disease ◽  
Short Form ◽  
Lumbar Fusion ◽  
Research Network ◽  
Disc Disease ◽  
Fusion Surgery ◽  
Degenerative Disc ◽  
Lumbar Fusion Surgery ◽  
Related Quality

Study Design: Uncontrolled retrospective observational study. Objectives: Surgery for patients with back pain and degenerative disc disease is controversial, and studies to date have yielded conflicting results. We evaluated the effects of lumbar fusion surgery for patients with this indication in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We analyzed data that were prospectively collected from consecutive patients at 11 centers between 2015 and 2019. Our primary outcome was change in patient-reported back pain at 12 months of follow-up, and our secondary outcomes were satisfaction, disability, health-related quality of life, and rates of adverse events. Results: Among 84 patients, we observed a statistically significant improvement of back pain at 12 months that exceeded the threshold of Minimum Clinically Important Difference (MCID) (mean change -3.7 points, SD 2.6, p < 0.001, MCID = 1.2; 77% achieved MCID), and 81% reported being “somewhat” or “extremely” satisfied. We also observed improvements of Oswestry Disability Index (-17.3, SD 16.6), Short Form-12 Physical Component Summary (10.3, SD 9.6) and Short Form-12 Mental Component Summary (3.1, SD 8.3); all p < 0.001). The overall rate of adverse events was 19%. Conclusions: Among a highly selective group of patients undergoing lumbar fusion surgery for degenerative disc disease, most experienced a clinically significant improvement of back pain as well as significant improvements of disability and health-related quality of life, with high satisfaction at 1 year of follow-up. These findings suggest that surgery for this indication may provide some benefit, and that further research is warranted.

Primary Fixation and Delayed Nailing of Long Bone Fractures in Severe Trauma

1996 ◽  
Vol 11 (1) ◽  
pp. 59-66 ◽  
Author(s):  
H P Friedl ◽  
R Stocker ◽  
B Czermak ◽  
H Schmal ◽  
O Trentz
Keyword(s):  
Bone Fractures ◽  
Severe Trauma ◽  
Long Bone ◽  
Long Bone Fractures

Complications of fractures

2011 ◽  
Author(s):  
James Wilson-MacDonald ◽  
Andrew James
Keyword(s):  
Bone Fractures ◽  
Fat Embolism ◽  
Gas Gangrene ◽  
Long Bone ◽  
Vein Thrombosis ◽  
Embolism Syndrome ◽  
Tissue Removal ◽  
Trophic Changes ◽  
Prolonged Pain ◽  
Deep Vein

♦ Fat embolism syndrome is defined as the presence of globules of fat in the lungs and in other tissues and occurs occasionally in long bone fractures♦ Reflex sympathetic dystrophy is characterized by intense prolonged pain, vasomotor disturbance, delayed functional recovery, and trophic changes♦ Avascular necrosis typically affects intra-articular bone after fracture and can occur in up to 70% of displaced talar neck fractures♦ Immobility associated with recovery from fracture is associated with deep vein thrombosis, which carries a risk of pulmonary embolism, and should be treated with anti-coagulants♦ Gas gangrene is a rapidly-spreading infection of devitalized tissue, removal of the affected area and treatment with penicillin is required♦ Compartment syndrome within a closed compartment can result in tissue ischaemia and necrosis followed by fibrosis and muscle contracture

Timing of definitive fixation of major long bone fractures: Can fat embolism syndrome be prevented?

Injury ◽  
2017 ◽  
Vol 48 ◽  
pp. S3-S6 ◽  
Author(s):  
Taco J. Blokhuis ◽  
Hans-Christoph Pape ◽  
Jan-Paul Frölke
Keyword(s):  
Bone Fractures ◽  
Fat Embolism ◽  
Long Bone ◽  
Fat Embolism Syndrome ◽  
Long Bone Fractures ◽  
Embolism Syndrome

scholarly journals Fat Embolism Syndrome: A Case Report and Review Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Nattaphol Uransilp ◽  
Sombat Muengtaweepongsa ◽  
Nuttawut Chanalithichai ◽  
Nattapol Tammachote
Keyword(s):  
Bone Fractures ◽  
Specific Treatment ◽  
Fat Embolism ◽  
Review Literature ◽  
Long Bone ◽  
Laboratory Findings ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Neck Fracture ◽  
Magnetic Resonance Imaging Mri

Fat embolism syndrome (FES) is a life-threatening complication in patients with orthopedic trauma, especially long bone fractures. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. FES has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Here, we report a case of FES in a patient with right femoral neck fracture, which was diagnosed initially by Gurd’s criteria and subsequently confirmed by typical appearances on magnetic resonance imaging (MRI) of the brain. The patient received supportive management and a short course of intravenous methylprednisolone.

Abstract WP253: Diagnostic Evaluation and Outcome of Cerebral Fat Embolism: Single Center Retrospective Review

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Breana L Taylor ◽  
Arielle P Davis ◽  
Steven R Peters ◽  
Allison Kunze ◽  
Amita Singh ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Bone Fractures ◽  
Brain Mri ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Long Bone ◽  
Mri Findings ◽  
Diffusion Restriction

Introduction: Cerebral Fat Embolism (CFE) is an underappreciated complication of trauma and orthopedic surgery whose diagnosis is mostly based on clinical suspicion. The utility of diagnostic testing is poorly defined. Methods: Using discharge diagnosis codes and a stroke database at a Level 1 Trauma Center, we performed a retrospective chart review of diagnostic workup and outcome for CFE from 2005 to 2019. Among those with a diagnosis of systemic fat emboli syndrome after long-bone fracture, cerebral involvement was established based on altered mental status, retinal findings, brain MRI findings or a combination of these. This report focuses on those who had MRI, all of which had findings of CFE. Results: Forty patients with CFE were identified, comprising 0.3% of all patients admitted with long-bone fractures. Of these patients, the average age was 39 years (SD 22), 30 (75%) were men, 28 (70%) had hypoxemia, 2 (5%) had petechial rash, and 29 (73%) were comatose, including 16 (40%) following orthopedic surgery. Brain MRI findings of CFE included scattered diffusion-restriction (60%), confluent white-matter edema (33%) and diffuse petechial hemorrhage (30%), with 27% having multiple findings of CFE. Ophthalmologic evaluation revealed exudates or hemorrhage suggestive of Purtscher-like retinopathy in 20 (91%) of 22 patients examined. Transcranial doppler microembolic signals (MES) were detected in 17 (53%) of 32 patients examined and were associated with scattered diffusion-restriction on MRI (chi square, p =0.01). Twelve patients (30%) died before discharge, 15 (38%) were discharged to a nursing facility, 12 (30%) to a rehabilitation facility and 1 (3%) to home. After a mean of 5.4 months, 1 patient had died, 11 had severe disability and 16 had moderate disability or better. Conclusion: The diagnosis of CFE is complicated by unknown sensitivity of diagnostic modalities. Nonetheless, typical MRI and ophthalmologic findings can assist in diagnosis. MES are associated with scattered infarction on MRI, suggesting active disease. The outcome of patients with CFE is highly variable, and a better understanding of this potentially devastating disease will require studies with larger numbers of cases collected in a standard fashion at multiple trauma centers.

Tactics of Operative Treatment for Closed Long Bone Fractures in Patients with Polytrauma in Early Period

2003 ◽  
Vol 10 (3) ◽  
pp. 3-9
Author(s):  
V A Sokolov ◽  
E I Byalik ◽  
V A Sokolov ◽  
E I Byalik
Keyword(s):  
Soft Tissues ◽  
Bone Fractures ◽  
Plate Osteosynthesis ◽  
Early Period ◽  
Functional Results ◽  
Fat Embolism ◽  
Long Bone ◽  
Long Bone Fractures ◽  
Embolism Syndrome ◽  
Urgent Operation

Results of the treatment of 218 victims with polytrauma were analyzed during the period from 1998 to 2202. There were 127 patients with one and 91 patients with several closed fractures. Authors consider osteosynthesis for closed long bone fractures to be an urgent operation of third term. Osteosynthesis is absolutely indicated to the patients with psychomotor excitation, in cases of the threat for skin perforation by bone fragments and in patients requiring intensive nursing for their life rescue. The choice of operative method depends on polytrauma severity and fracture type. When osteosynthesis is performed by urgent indications in patients with polytrauma the requirements to osteosynthesis stiffness are higher than in isolate injuries, as the rotation displacement, migration and fixator deformity frequently take place in unconscious patients who need constant intensive nursing. In patients with concomitant thorax injury urgent intramedullar osteosynthesis by nail is contraindicated due to the possibility of fat embolism syndrome development. In these patients plate osteosynthesis is preferred. If there are no absolute indications to urgent osteosynthesis this operation could be performed on 3-10 days after trauma using lightly traumatic and invasive methods not waiting for the complete normalization of homeostasis parameters and restoration of soft tissues in the fracture zone. In closed long bone fractures tactics of early osteosynthesis allows to decrease the rate of hypostatic complications and mortality by more than 10% and achieve good functional results.

scholarly journals Cerebral fat embolism syndrome (FES): similar cases with different outcomes

2018 ◽  
pp. bcr-2018-225261
Author(s):  
Alexis Jorgensen ◽  
Azhar Bashir ◽  
Jibanananda Satpathy
Keyword(s):  
Bone Fractures ◽  
Plate Osteosynthesis ◽  
Neurological Impairment ◽  
Fat Embolism ◽  
Sudden Onset ◽  
Clinical Syndrome ◽  
Long Bone ◽  
Fat Embolism Syndrome ◽  
Long Bone Fractures ◽  
Embolism Syndrome

Fat embolism syndrome (FES) is a rare multisystem, clinical syndrome occurring in 0.9%–2.2% of long-bone fractures. The severity of FES can vary from subclinical with mild respiratory changes and haematological aberrations to a fulminant state characterised by sudden onset of severe respiratory and neurological impairment. Here we present two patients with cerebral FES secondary to femur fracture. Both patients exhibited profound neurological impairment with varied outcomes. Our cases highlight the importance of a high clinical suspicion of FES in patients with long-bone fractures and neurological deterioration. We recommend early plate osteosynthesis to prevent additional emboli in patients with FES and situational placement of intracranial pressure monitoring. Finally, cerebral FES has low mortality even in a patient with tentorial herniation and fixed, dilated pupils.

Sign in / Sign up

Export Citation Format

Share Document