Fat embolism syndrome and ARDS following osteosynthesis: a systematic review of associated ischemic complications
DOI:
https://doi.org/10.70577/8hh6qm40Keywords:
fat embolism syndrome, acute respiratory distress syndrome, osteosynthesis, ophthalmic ischemia, gastrointestinal ulceration, systematic review, PRISMAAbstract
Introduction: Fat embolism syndrome (FES) is a rare but potentially fatal complication associated with long bone fractures and osteosynthesis procedures, characterized by the entry of fat droplets from the bone marrow into the bloodstream with multisystem involvement. Objective: To synthesize the available evidence on the incidence, clinical characteristics, and outcomes of fulminant FES associated with osteosynthesis, with emphasis on ophthalmic and gastrointestinal ischemic complications. Methodology: Systematic review following PRISMA 2020 guidelines. A systematic search was conducted in PubMed, LILACS, SciELO, and Cochrane for studies published between 2000 and 2025 reporting FES following long bone osteosynthesis. Case reports, case series, and observational studies were included. Methodological quality was assessed using the adapted Newcastle-Ottawa scale. Results: Fifteen studies (n=42 patients) were included. Mean age was 34.2 years (SD: 11.8), with male predominance (71.4%). FES occurred predominantly following femoral osteosynthesis (88.1%, n=37), followed by tibial osteosynthesis (11.9%, n=5). ARDS was reported in 85.7% of cases. Ophthalmic ischemia was documented in 14.3% (n=6), and ischemic gastrointestinal ulceration in 4.8% (n=2). Overall mortality was 19.0%. Conclusion: FES following long bone osteosynthesis presents a high incidence of ARDS and multisystemic ischemic complications. Early identification using clinical criteria and multidisciplinary management are essential to reduce associated morbidity and mortality.
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Copyright (c) 2026 Mariuxi Lorena Zúñiga Jaramillo, Carlos Humberto Gómez Cisneros, Stefanie Gisselle García Mantuano, David Mauricio Benjumea de Angel, Kimberly Nayeli Obando Soto (Autor/a)
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