Fat embolism syndrome following femoral shaft fracture: A case report and diagnostic considerations

Fat embolism syndrome (FES) is a rare but serious complication that can arise after long bone fractures or orthopedic surgeries. This case report presents a 40-year-old male who developed FES following surgical fixation of a femoral shaft fracture using 2 plates. The day after surgery, the patient exhibited tachycardia, respiratory distress, and a fever of 38.5°C, initially raising concerns for pulmonary embolism. A computed tomography (CT) angiography of the lungs showed no evidence of pulmonary thromboembolism, and methylprednisolone was administered due to the suspicion of fat embolism. On the second postoperative day, petechial and purpuric lesions appeared on the neck, chest, and the surgical limb, strengthening the suspicion for FES. The patient fulfilled 2 major and 3 minor criteria for FES according to the Gurd and Wilson criteria, and scored 8 points on the Schonfeld Fat Embolism Index, indicating a high likelihood of FES. Despite these clinical signs, imaging studies did not reveal any embolic events. The patient was treated with supportive care, including oxygen therapy and anticoagulation, and his condition stabilized over the next 24 hours. He was mobilized and discharged in stable condition. This case highlights the critical need for early recognition of fat embolism syndrome (FES) in postorthopedic surgery patients, as timely diagnosis and intervention are key to preventing serious complications. Although clinical signs may not always align with imaging results, vigilant monitoring and prompt supportive care can significantly improve patient outcomes.