Early acute fat embolism syndrome caused by femoral fracture: A case report

Table 1 Laboratory examinations

Variable	Reference range	1.5 h after trauma	3 h after trauma	5 h after trauma
RBC, 1012/L	3.8-5.1	3.86	3.73	2.54
WBC, 109/L	3.5-9.5	18.35	23.79	9.55
HG level, g/L	115-150	84.00	92.00	61.20
HCT level, %	35-45	28.70	29.70	19.82
PLC, 109/L	125-350	340.00	243.00	92.40
ALT level, U/L	7-40	19.10	21.30	18.70
AST level, U/L	13-35	26.20	29.30	45.00
Total protein level, g/L	65-85	66.30	49.20	41.30
Albumin level, g/L	40-55	41.60	29.10	26.50
Arterial blood gas level
Partial pressure of CO2, mmHg	35-45		30.50	24.90
Partial pressure of O2, mmHg	80-100		80.50	160.30

RBC: Red blood cell count; WBC: White blood cell count; HG: Hemoglobin; HCT: Hematocrit; PLC: Platelet count; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Table 2 Demographic profile of the reported fat embolism syndrome patients whose latent period was < 12 h

Ref.	Age/gender	Latent period	Trauma	Outcome
Tsuru and Adachi[13]	83/F	55 min	Left distal femur fracture	Comatose and eventually died
Chen et al[17]	31/M	1 h	Right femoral and tibia fracture	Comatose and eventually died
Scarpino et al[18]	17/M	2 h	Right open femur and tibia fracture	Brain death on hospital day 2
Our case	29/F	2.5 h	The middle and left femur fracture	After 29 d in a coma, she became conscious. Returned to work at 6 mo after trauma
You et al[19]	54/M	2 h 53 min	Multiple fracture (rib, clavicle, femur) and pulmonary contusion and pneumothorax	Brain death on hospital day 5
Dillerud[20]	25/M	3 h	Right femur and left tibiofibular fracture	Minimal memory impairment
Millen et al[21]	17/F	4 h	Multiple fracture (rib, clavicle, femur, tibia, fibular, pubic rami, sacral ala)	After 2 mo in a coma, she was alert, oriented, following with progressively improving cognition
Xu et al[22]	63/W	4 h	Right tibia and fibula fractures	One month later, the patient was discharged from the hospital without any residual neurological deficit
Yang et al[23]	46/W	5 h	Left femur fracture	Patient consciousness was restored but language disorders were left
Cronin et al[24]	26/M	6 h	Right open tibiofibular shaft fracture	Returned to work at 3 mo after trauma
Paredes et al[4]	54/M	10 h	Multiple fractures: Femoral shaft, radius, patella, metatarsal	A residual mild cognitive impairment

Table 3 Gurd’s criteria

Gurd’s criteria
Major criteria
Petechial rash
Respiratory symptoms with radiographic changes
Central nervous system signs unrelated to trauma or other condition
Minor criteria
Tachycardia
Pyrexia
Retinal changes (fat or petechiae)
Renal abnormalities (oliguria, anuria, or lipiduria)
Acute thrombocytopenia
Acute decrease in hemoglobin
High erythrocyte sedimentation rate
Fat globules in sputum

Typically, the diagnosis of fat embolism syndrome requires 1 major and 4 minor criteria[5].