Massive fat embolism syndrome after complex arthroplasty complicated by disseminated intravascular coagulation and subarachnoid hemorrhage: a case report and literature review
DOI:
https://doi.org/10.70577/3j9nwt27Keywords:
fat embolism syndrome, disseminated intravascular coagulation, subarachnoid hemorrhage, arthroplasty, postoperative complication, transthecal migrationAbstract
Introduction: Fat embolism syndrome (FES) is a rare but potentially fatal complication of orthopedic surgery, characterized by microvasculature obstruction by fat droplets from bone marrow, triggering a systemic inflammatory response (Gurd & Wilson, 1974). Disseminated intravascular coagulation (DIC) and subarachnoid hemorrhage (SAH) are exceptional complications that may coexist with massive FES (Harper, 2000; Woo et al., 2010). Objective: To describe the clinical characteristics and pathophysiological mechanisms of the triad of massive FES, DIC, and SAH after complex arthroplasty. Methodology: Case report and systematic literature review following PRISMA 2020 guidelines (Page et al., 2021). A search was conducted in PubMed, LILACS, SciELO and Cochrane for studies published between 1980 and 2026. Results: Five relevant studies were identified. Harper (2000) reported a case of fulminant FES with DIC and multiple organ dysfunction syndrome after closed tibial fracture reduction. Fallon et al. (2001) documented a case of fatal fat embolism with DIC during cemented hemiarthroplasty. Woo et al. (2010) and Carreres Polo et al. (2017) described cases of fat embolism with SAH associated with sacral fractures with dural laceration. Chaturvedi et al. (2020) reviewed post-traumatic subarachnoid fat embolism. Conclusion: Massive FES with DIC and SAH represents a catastrophic cascade requiring early recognition and multidisciplinary management. The distinction between vascular embolization and transthecal fat migration is crucial for diagnosis and treatment.
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