Injury, Int. J.
Care Injured (2006) 37S, S1—S2
Editorial
Hans-Christoph Pape, Peter V Giannoudis
Historically, the term “fat embolism” has often been
related to patients with fractures. In 1862, Zenker
first described this syndrome at autopsy in a patient
who had died following a severe injury. In 1873, von
Bergmann clinically diagnosed the “fat embolism
syndrome” for the first time. It was a major concern
and a cause of delay to surgery in the middle of the
last century, when intensive care facilities were un-
able to routinely perform artificial ventilation. The
term fat embolism syndrome should be distinguished
from acute fat embolism, which may occur during
resuscitation and manual chest decompression, or
during instrumentation of a shaft fracture. The oc-
currence of fat embolism in trauma patients has
been estimated to be as high as 90%, although only 5%
develop fat embolism syndrome [1]. Nowadays, with
the advances that have been made in resuscitation,
diagnostics, intensive care medicine, and implants,
the incidence of fat embolism is lower [2].
The fat embolism phenomenon was widely investi-
gated by Peltier in the 1950s [3, 4], who quantified
the amount of fat in a femur and investigated the
chemical components involved. Similarly, Dankwart-
Liljestrom performed numerous studies in animals
to assess the potential hazards [5]. Other authors
investigated the fate of the fat and the chemi-
cal/physiological changes after fat embolism to the
lung [6, 7].
Although the relationship between fat embolism
and intramedullary nailing was initially described
by Küntscher [8] in his first publications, it was not
until the late 1980s that some authors reviewed their
studies and reported unexpected complications fol-
lowing femoral nailing. The famous transesophageal
echocardiography studies done by Wenda and others
in the 1990s have documented thoroughly that this
entity exists even with modern nailing techniques
[9, 10].
There is continuing debate as to whether the
intravasation of fat in the pulmonary tree is always
0020–1383/$ — see front matter # 2006 Published by Elsevier Ltd.
doi:10.1016/j.injury.2006.08.034
www.elsevier.com/locate/injury
clinically relevant. Several authors have reported
on the potential mechanisms of endothelial damage
that result in the full blown fat embolism syndrome.
It appears that local and systemic reactions are
responsible and the immunoinflammatory system is
profoundly involved [11].
Current evidence suggests that patients in special
situations, such as pathological femoral fractures
and bilateral femoral fractures subjected to si-
multaneous intramedullary reaming and nailing,
are at high risk of fat embolism syndrome [12]. An
additive effect in term of intravasation of fat has
been suggested. Venting of the femoral canal and
staging of procedures appear to be good preventive
measures.
In view of the impact that this biological phe-
nomenon has had in the clinical setting, several
companies have made considerable efforts to modify
their reamer systems to minimize even the potential
effects of fat embolism induced by nailing.
This special issue gives an overview of the current
knowledge regarding this topic. We appreciate that
it is not possible to cover every aspect of this sub-
ject but the selected articles are very informative.
We would like to thank AO and the authors for their
contribution to science.
Bibliography
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S2 Editorial

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