Early complications in patients with multiple injuries and polytraumatism with special regard to traumatic fat embolism.
In the introductory part contemporary data concerning fat embolism occurrence and mortality, as taken from the world literature, are evaluated. Thus, the author opens the whole complicated problem of post-mortem examination findings with a different extent of fat embolization (most often in the lungs, rarely in organs belonging to the area supplied by the systemic blood circulation) on the one hand and the fat embolism clinical syndrome on the other hand. The clinical syndrome is a rare phenomenon in comparison with the relatively frequent morphological abduction findings of a more serious character (of the 2nd and higher degree). The evaluation of fat embolism as the main cause of death cannot be based only on the morphological findings, ascertained at the post-mortem examination in the organs of patients who died of injury consequences. At the same time, however, the question is open of evaluating the fat embolism syndrome as the contrary of the fulminant form of fat embolism to the classical fat embolism syndrome as it manifests itself in practice after the free interval. The author sees the mentioned contrary in the fact that the diagnosis of the fulminant fat embolism syndrome resulting in death within a few hours is mainly based on the microscopical findings of fat embolism in the capillaries of the organs whereas that of the classical fat embolism syndrome is possible not only clinically but can be confirmed also macroscopically and microscopically, morphologically and histologically in the cases of death of such injured patients. The morphological confirmation of the classical fat embolism syndrome after an accidental death within some weeks after the injury and after the clinical course of the classical syndrome has, however, time limits as far as the macroscopical findings but especially the microscopical evidence of fat embolism are concerned. In this part of the study many statements of the author are based on the occurrence of 208 patients with fat embolism in the continuously observed clinical material of all the hospitalized injured persons (16,706) at the Research Institute of Traumatology between 1963-1983. In consideration of the accumulated admission of severely injured patients from traffic accidents especially, the total mortality is 6.55% (6.25% of men; 7.18% of women). Fat embolism as the main cause of death makes up 10.15% (8.25% of men; 13.61% of women) of total mortality. The occurrence of the fat embolism syndrome is, however, much lower: 1.25% (1.16% of men; 1.43% of women). The fat embolism syndrome mortality is high: 53.73% (44.70% of men; 68.42% of women).
Kroupa
J
J
Research Institute of Traumatology, Brno.
Unger
K
K
D004620:Embolism, Fat / Q000209:etiology* / Q000473:pathology; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D009104:Multiple Trauma / Q000150:complications*; D011655:Pulmonary Embolism / Q000209:etiology / Q000473:pathology