ABSTRACT
Objectives
To assess the incidence and risk factors for fat embolism syndrome.
Materials and Methods
Data from the National Hospital Discharge Survey (NHDS) were analyzed using International
Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
Results
From 1979 through 2005 among 928,324,000 patients discharged from short-stay hospitals
in the United States, 41,000 (0.004%) had fat embolism syndrome. Among 21,538,000
patients with an isolated fracture of the femur (any site), tibia, fibula, pelvis,
ribs, humerus, radius, or ulna, 25,000 (0.12%) developed fat embolism syndrome. Patients
with multiple fractures of the femur (excluding neck) more often had fat embolism
syndrome than those with isolated fractures (1.29% versus 0.54%). The incidence of
fat embolism syndrome was lower with isolated fractures of the tibia or fibula (0.30%)
and even lower with isolated fractures of the neck of the femur (0.06%). The incidence
of fat embolism was too low to calculate with isolated fractures of the pelvis, ribs,
humerus, radius, or ulna. Nonorthopedic conditions rarely, if ever, were accompanied
by fat embolism syndrome. The fat embolism syndrome was more frequent in men (relative
risk 5.71). Children, aged 0 to 9 years rarely had fat embolism syndrome. The fat
embolism syndrome most commonly affected patients aged 10 to 39 years.
Conclusions
The incidence of the fat embolism syndrome depends on the bone involved, whether fractures
are isolated or multiple, the age of the patient and the gender. It rarely occurs
as a result of medical conditions.
KEY INDEXING TERMS
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References
- Fat embolism: an aid to diagnosis.J Bone Joint Surg Br. 1970; 52: 732-737
- The fat embolism syndrome: a review.Clin Orthop Relat Res. 1990; : 281-286
- Fat embolism syndrome: prospective evaluation in 92 fracture patients.Crit Care Med. 1990; 18: 42-46
- Fat embolism syndrome. A 10-year review.Arch Surg. 1997; 132: 435-439
- Fat embolism syndrome.Orthop Rev. 1993; 22: 567-571
- Post-traumatic fat embolism—its clinical and subclinical presentations.J Trauma. 1984; 24: 45-49
- A panel by correspondence. Fat embolism.Arch Surg. 1974; 109: 12-16
- The syndrome of fat embolism: analysis of thirty consecutive cases compared to trauma patients with similar injuries.J Trauma. 1970; 10: 299-306
- Clinical aspects and results of treatment of post-traumatic fat embolism.Monatsschr Unfallheilkd Versicherungsmed. 1961; 64: 365-383
- Blood alcohol and fat embolism syndrome.J Bone Joint Surg Am. 1977; 59: 878-880
- Fat embolism: a review and report of 100 cases.Can J Surg. 1974; 17: 196-199
- Early complications in patients with multiple injuries and polytraumatism with special regard to traumatic fat embolism.Czech Med. 1988; 11: 217-240
- Fat embolism syndrome: history, definition, epidemiology.Injury. 2006; 37S: S3-S7
- Subclinical fat embolism: a prospective study of 50 patients with extremity fractures.J Trauma. 1973; 13: 9-16
- On diagnosis, therapy and prophylaxis of fat embolism.Langenbecks Arch Chir. 1966; 314: 292-306
- Clinical aspects and prevention of fat embolism.Med Klin. 1969; 64: 1107-1110
- US Department of Health and Human Services, Public Health Service, National Center for Health Statistics National Hospital Discharge Survey 1979-1999 Multi-year Public-Use Data File Documentation. 2008 (Available at, Last accessed February 28)
- Fat embolism in Hong Kong Chinese.J Bone Joint Surg Am. 1980; 62: 1138-1143
- Increasing our knowledge of the pathogenesis of fat embolism: a prospective study of 43 patients with fractured femoral shafts.J Trauma. 1974; 14: 955-962
- The fat embolism syndrome in severe combined traumas.Vestn Khir Im I I Grek. 2006; 165: 68-71
- “Low-dose” corticosteroid prophylaxis against fat embolism.J Trauma. 1987; 27: 1173-1176
- Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients.Ann Intern Med. 1983; 99: 438-443
- Fat embolism syndrome in isolated femoral fractures: does timing of nailing influence incidence?.Injury. 1998; 29: 131-133
- Fat embolism in patients with an isolated fracture of the femoral shaft.J Trauma. 1988; 28: 383-390
- Fat embolism in patients with multiple injuries.J Trauma. 1982; 22: 891-894
- Fat embolism syndrome: a review of the pathophysiology and physiological basis of treatment.Clin Orthop Relat Res. 1982; : 68-82
- Fat embolism. A current concept.Clin Orthop Relat Res. 1969; 66: 241-253
- MRI of bone marrow: advanced MRI 2002: from head to toe. 2007 (Available at, Last accessed November 1)
- Fat embolism.Can Med Assoc J. 1950; 62: 548-550
- Incidence of hip fractures in osteoporotic women treated with sodium fluoride.J Bone Miner Res. 1987; 2: 123-126
- Longitudinal study of bone loss in pre- and perimenopausal women: evidence for bone loss in perimenopausal women.Osteoporos Int. 2000; 11: 493-498
- Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study.BMJ. 1994; 309: 691-695
- Red and yellow marrow in the femur: age-related changes in appearance at MR imaging.Radiology. 1990; 175: 219-223
- Fat embolism syndrome: incidence, significance and early features.Aust N Z J Surg. 1981; 51: 546-551
- Bone mineral and body composition analysis of whole body in 292 normal subjects assessed by dual X-ray absorptiometry.Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003; 25: 66-69
- Menopause and Bone Loss.J Clin Endocrinol Metab. 2006; 91 (Available at, Accessed November 3, 2008)
- Prediction of fracture risk using axial bone mineral density in a perimenopausal population: a prospective study.J Bone Miner Res. 1995; 10: 302-306
- Fat embolism syndrome.Orthopedics. 1996; 19: 41-48
- Fat embolism in diabetes mellitus.Sud Med Ekspert. 1983; 26: 49-50
- Fat embolism in acute pancreatitis.Arch Pathol Lab Med. 1989; 113: 503-506
- Fat embolization and pulmonary infiltrates after bone marrow transplantation.Med Pediatr Oncol. 1987; 15: 24-27
- Fat embolism in sickle cell disease. Report of a case with brief review of the literature.Arch Intern Med. 1984; 144: 181-182
- Systemic fat embolism following acute primary osteomyelitis.JAMA. 1967; 199: 150-152
- An unusual form of a pulmonary fat embolism in fulminant viral hepatitis.Pathologe. 1996; 17: 154-156
- Beaten to death: why do they die?.J Trauma. 1996; 40: 27-30
- The fat embolism syndrome.J Bone Joint Surg Br. 1974; 56B: 408-416
Article info
Publication history
Accepted:
March 7,
2008
Received:
February 7,
2008
Identification
Copyright
© 2008 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
