DISCUSSION
Dyspnoea in the postoperative period after orthopaedic surgery is not a rare occurrence and can vary in cause and severity. Fat embolism syndrome (FES) is one of the most frequent, but also one of the most overlooked causes of dyspnoea. It is a potential life-threatening complication of long bone fractures and orthopaedic reaming procedures. It is estimated to occur in 3-4% of patients with long bone or pelvic fractures.1,2 The diagnosis of fat embolism syndrome is often missed because of a subclinical illness or coexisting distracting injuries or diseases. Other causes of dyspnoea after trauma are pulmonary contusions, shock lung or thromboembolism, but also cardiovascular and metabolic causes are possible. The terms fat embolism (FE) and fat embolism syndrome are not interchangeable. Fat embolism refers to the presence of circulating fat globules in the circulation and the pulmonary parenchyma. Fat embolism syndrome is the clinical manifestation of fat embolism. It usually presents as a triad of respiratory insufficiency, altered mental status and petechiae.
In 1861 Zenker reported the first case of fat embolism in an autopsy by describing fat droplets in the lung of a railroad worker who sustained fatal thoracoabdominal injuries.1 It was only in 1865 that Wagner described the correlation of FE with fractures. The clinical fat embolism syndrome was first described in 1873 by Bergmann as a triad of confusion, dyspnoea and petechiae, following long bone fractures.2
It was not until the 1920s that the two main pathophysiologic theories were proposed. The first set of clinical criteria was presented by Gurd in 1970.