title: Fat embolism syndrome in long bone trauma following vehicular accidents: Experience from a tertiary care hospital in north India.
abstract: BACKGROUND
  Fat embolism syndrome (FES) is a clinical problem arising mainly due to fractures particularly of long bones and pelvis. Not much literature is available about FES from the Indian subcontinent.
  
  
  METHODS
  Thirty-five patients referred/admitted prospectively over a 3-year period for suspected FES to a north Indian tertiary care center and satisfying the clinical criteria proposed by Gurd and Wilson, and Schonfeld were included in the study. Clinical features, risk factors, complications, response to treatment and any sequelae were recorded.
  
  
  RESULTS
  The patients (all male) presented with acute onset breathlessness, 36-120 hours following major bone trauma due to vehicular accidents. Associated features included features of cerebral dysfunction (n = 24, 69%), petechial rash (14%), tachycardia (94%) and fever (46%). Hypoxemia was demonstrable in 80% cases, thrombocytopenia in 91%, anemia in 94% and hypoalbuminemia in 59%. Bilateral alveolar infiltrates were seen on chest radiography in 28 patients and there was evidence of bilateral ground glass appearance in 5 patients on CT. Eleven patients required ventilatory assistance whereas others were treated with supportive management. Three patients expired due to associated sepsis and respiratory failure, whereas others recovered with a mean hospital stay of 9 days. No long term sequelae were observed.
  
  
  CONCLUSIONS
  FES remains a clinical challenge and is a diagnosis of exclusion based only on clinical grounds because of the absence of any specific laboratory test. A high index of suspicion is required for diagnosis and initiating supportive management in patients with traumatic fractures, especially in those having undergone an invasive orthopedic procedure.
authors.affiliation: Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Parvaiz A
authors.initials: PA
authors.lastname: Koul
authors.forename: Feroze
authors.initials: F
authors.lastname: Ahmad
authors.forename: Showkat A
authors.initials: SA
authors.lastname: Gurcoo
authors.forename: Umar H
authors.initials: UH
authors.lastname: Khan
authors.forename: Imtiyaz A
authors.initials: IA
authors.lastname: Naqash
authors.forename: Suhail
authors.initials: S
authors.lastname: Sidiq
authors.forename: Rafi Ahmad
authors.initials: RA
authors.lastname: Jan
authors.forename: Ajaz N
authors.initials: AN
authors.lastname: Koul
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ashraf
authors.forename: Mubasher Ahmad
authors.initials: MA
authors.lastname: Bhat
keywords: ARDS; Accidents; fat embolism syndrome; trauma