Research Article| Volume 33, ISSUE 9, P757-759, November 2002

The role of rehydration in the prevention of fat embolism syndrome


      We encountered three cases of young sportsmen developing fat embolism syndrome (FES) after sustaining isolated tibial shaft fractures whilst playing football. All fractures were treated with intra-medullary nails and all three patients were kept nil-by-mouth pre-operatively without intravenous fluids.
      Correction of shock is often quoted as an important factor in the prevention of FES. However, animal studies have shown that dehydration, as opposed to hypovolaemia, may also be of great importance. We therefore examined the specific gravity of the urine of 20 patients with musculoskeletal injuries sustained during sport. The mean urinary specific gravity was significantly higher than that of a control group of 10 members of staff.
      We emphasise the importance of adequate pre-operative rehydration, especially if injuries were sustained during heavy exercise, as this may reduce the risk of developing FES.
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        • Evarts C.M.
        The fat embolism syndrome: a review.
        Surg. Clin. North Am. 1970; 50: 493
        • Gurd A.R.
        • Wilson R.I.
        The fat embolism syndrome.
        J. Bone Joint Surg. 1974; 56-B: 408
        • Johnson M.J.
        • Lucas G.L.
        Fat embolism syndrome.
        Orthopaedics. 1996; 19: 41
        • Levy D.
        The fat embolism syndrome: a review.
        Clin. Orthop. 1990; 261: 281
        • ten Duis H.J.
        The fat embolism syndrome.
        Injury. 1997; 28: 77
        • Harman J.W.
        • Ragaz F.
        The pathogenesis of experimental fat embolism.
        Am. J. Pathol. 1950; 26: 551
        • Talucci R.C.
        • Manning J.
        • Lampard S.
        • Bach A.
        • Carrico C.J.
        Early intramedullary nailing of femoral shaft fractures: a cause of fat embolism syndrome.
        Am. J. Surg. 1983; 146: 107
        • Moomey Jr., C.B.
        • Melton S.M.
        • Croce M.A.
        • Fabian T.C.
        • Proctor K.G.
        Prognostic value of blood lactate, base deficit, and oxygen-derived variables in an LD50 model of penetrating trauma.
        Crit. Care Med. 1999; 27: 154
        • Crowl A.C.
        • Young J.S.
        • Kahler D.M.
        • Claridge J.A.
        • Chrzanowski D.S.
        • Pomphrey M.
        Occult hypoperfusion is associated with increased morbidity in patients undergoing early femur fracture fixation.
        J. Trauma. 2000; 48: 260
        • Claridge J.A.
        • Crabtree T.D.
        • Pelletier S.J.
        • Butler K.
        • Sawyer R.G.
        • Young J.S.
        Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients.
        J. Trauma. 2000; 48: 8
        • Blow O.
        • Magliore L.
        • Claridge J.A.
        • Butler K.
        • Young J.S.
        The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 h improves outcome from major trauma.
        J. Trauma. 1999; 47: 964
        • James J.H.
        • Luchette F.A.
        • McCarter F.D.
        • Fischer J.E.
        Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis.
        Lancet. 1999; 354: 505
      1. Gaw A, Cowan RA, O’Reilly DSTJ, et al. Clinical biochemistry. Hong Kong: Churchill, 1995, p. 27.

      2. Noakes TD. Personal communication.