title: Fat embolism syndrome after nailing an isolated open tibial fracture in a stable patient: a case report.
abstract: BACKGROUND
  Fat embolism syndrome is a potentially fatal complication of long bone fractures. It is usually seen in the context of polytrauma or a femoral fracture. There are few reports of fat embolism syndrome occurring after isolated long bone fractures other than those of the femur.
  
  
  METHODS
  We describe a case of fat embolism syndrome in a 33-year-old Caucasian man. He was being seen for an isolated Gustilo's grade II open tibial fracture. He was deemed clinically stable, so we proceeded to treat the fracture with intramedullary reamed nailing. He developed fat embolism syndrome intraoperatively and was treated successfully.
  
  
  CONCLUSIONS
  This case caused us to question the use of injury severity scoring for isolated long bone fractures. It suggests that parameters that have been described in the literature other than that the patient is apparently clinically stable should be used to establish the best time for nailing a long bone fracture, thereby improving patient safety.
authors.affiliation: Department of Orthopaedic Surgery, San Carlos University Hospital, Complutense University, c/Profesor Martín Lagos Avenue s/n, Madrid 28040, Spain. aparicio2201@gmail.com.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Aparicio
authors.forename: Isabel
authors.initials: I
authors.lastname: Soler
authors.forename: Luis
authors.initials: L
authors.lastname: López-Durán
mesh_terms: D000328:Adult; D004620:Embolism, Fat / Q000209:etiology* / Q000628:therapy; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D013977:Tibia / Q000293:injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D012122:Ventilators, Mechanical
references.citation: J Trauma. 1997 Dec;43(6):922-5; discussion 925-6
references.pmid: 9420106
references.citation: J Bone Joint Surg Br. 1974 Aug;56B(3):408-16
references.pmid: 4547466
references.citation: J Bone Joint Surg Br. 2001 Aug;83(6):781-91
references.pmid: 11521914
references.citation: J Orthop Trauma. 2001 Aug;15(6):442-5
references.pmid: 11514773
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: Indian J Crit Care Med. 2008 Jan;12(1):32-6
references.pmid: 19826589
references.citation: Injury. 2010 Nov;41 Suppl 2:S57-61
references.pmid: 21144930
references.citation: Int Orthop. 2011 Jul;35(7):951-6
references.pmid: 21243358
references.citation: J Orthop Trauma. 2011 Mar;25(3):e27-9
references.pmid: 21278599
references.citation: Saudi J Anaesth. 2011 Jul;5(3):332-4
references.pmid: 21957420
references.citation: J Trauma. 2003 Jul;55(1):7-13
references.pmid: 12855874
references.citation: Chest. 2003 Apr;123(4):982-3
references.pmid: 12684280
references.citation: J Trauma. 1993 Apr;34(4):540-7; discussion 547-8
references.pmid: 8487339
references.citation: J Am Acad Orthop Surg. 2009 Sep;17(9):541-9
references.pmid: 19726738
references.citation: J Trauma. 1984 Aug;24(8):742-6
references.pmid: 6471139