title: Post-traumatic fulminant paradoxical fat embolism syndrome in conjunction with asymptomatic atrial septal defect: a case report and review of the literature.
abstract: BACKGROUND
  Fat embolism syndrome with respiratory failure after intramedullary nailing of a femur fracture is a rare but serious complication in trauma patients.
  
  
  METHODS
  We present the case of a 20-year-old Caucasian man who experienced paradoxical cerebral fat embolism syndrome with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shunt.
  
  
  CONCLUSIONS
  Fat embolism syndrome may occur as a fulminant complication following femoral fracture repair in the presence of a concomitant atrial septal defect with right-to-left shunt. Thus, in patients with cardiac right-to-left shunts, femurs should not be nailed intramedullary, not even in cases of isolated injuries.
authors.affiliation: Regensburg University Medical Center, Department of Trauma and Orthopedic Surgery, 93042 Regensburg, Germany. Muellerfj5@aol.com.
authors.forename: Franz
authors.initials: F
authors.lastname: Mueller
authors.forename: Christian
authors.initials: C
authors.lastname: Pfeifer
authors.forename: Bernd
authors.initials: B
authors.lastname: Kinner
authors.forename: Carsten
authors.initials: C
authors.lastname: Englert
authors.forename: Michael
authors.initials: M
authors.lastname: Nerlich
authors.forename: Carsten
authors.initials: C
authors.lastname: Neumann