title: Bilateral femoral shaft fractures complicated by fat and pulmonary embolism: a case report.
abstract: A 25-year-old man was admitted to our hospital because of pulmonary embolism and suspected fat embolism after sustaining bilateral femoral shaft fracture. A left arm weakness, tachycardia and sudden hemoglobin drop delayed his definitive fixation with intramedullary nailing. His clinical course was further complicated by bleeding from the pin sites of the external fixators which had initially been used to temporarily stabilize his femoral fractures (clotting disturbances). A lower leg Doppler ultrasound and a new pelvic-chest CT angiography excluded any remaining thrombus, meanwhile the embolus had broken in smaller pieces, more distally. His unfractionated heparin was revised to a Low Molecular Weight Heparin at prophylactic dose. After a 10 day period and when his condition had been improved bilateral reamed nailing was performed. Although bilateral closed femoral shaft fractures should be stabilized early, fat embolism syndrome (FES) and thromboembolic events (TEV) should always be kept in mind in these patients.
authors.affiliation: Hip Department, Orthopedics and Trauma II, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy. Electronic address: filippo.randelli@fastwebnet.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Randelli
authors.affiliation: Hip Department, Orthopedics and Trauma II, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capitani
authors.affiliation: Hip Department, Orthopedics and Trauma II, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pace
authors.affiliation: Hip Department, Orthopedics and Trauma II, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Favilla
authors.affiliation: Hip Department, Orthopedics and Trauma II, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Galante
authors.affiliation: 2nd Department of Orthopaedics and Traumatology, IRCCS Policlinico San Donato, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Randelli
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D001858:Bone Nails / Q000009:adverse effects; D004620:Embolism, Fat / Q000188:drug therapy* / Q000209:etiology; D016267:External Fixators / Q000009:adverse effects*; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: bilateral femoral shaft fractures; damage control orthopedics; deep venous thrombosis (DVT); fat embolism syndrome (FES); pulmonary embolism (PE); venous thromboembolism (VTE)