• Robin Hall Dunn, Trevor Jackson, Clay Cothren Burlew, Fredric M Pieracci, Charles Fox, Mitchell Cohen, Eric M Campion, Ryan Lawless, and Cyril Mauffrey.
• Department of Orthopedics, University of Colorado School of Medicine, 12631 E. 17th Avenue, Mail Stop B202, Aurora, CO, 80045, USA.
• Int Orthop. 2017 Sep 1; 41 (9): 1729-1734.

PurposeFat emboli syndrome is a rare but well-described complication of long-bone fractures classically characterised by a triad of respiratory failure, mental status changes and petechial rash. In this paper, we present the case of a patient who sustained bilateral femoral fractures and subsequently developed FES. Our aim was to review and summarise the current literature regarding the pathophysiology and management of fat emboli syndrome (FES) and propose an algorithm for treating patients with bilateral femoral fractures to reduce the risk of FES.MethodsA literature analysis was performed to determine implications in the clinical setting.ResultsCurrently, there exists little high-quality evidence to guide the orthopaedic surgeon in identifying patients at highest risk of FES or in preventing FES in patients with multiple long-bone fractures. However, the literature does suggest that the risk is directly related to the volume of marrow displaced and inversely related to both the time to fracture stabilisation and the respiratory reserve of the patient. Based on these correlations, we propose an algorithm for treating patients with bilateral femoral fractures, taking into consideration haemodynamic and pulmonary stability.ConclusionsOur algorithm for managing bilateral femoral fractures prioritises early stabilisation with external fixation, staged intramedullary nailing and conversion to plate fixation if FES develops. This protocol is meant to be the basis of future investigations of optimal treatment strategies.

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