International Journal of Physical Medicine & Rehabilitation
Open Access

Abstract

Fat Embolism Syndrome: A Two-Hit Mechanism of Mechanical and Biochemical Injury

Craig H. Lichtblau*, Stephen Quinnan, Jaroslaw Michal Deszczynski, Gabrielle Meli, Marta Walachowska, Michalina Prowotorow

Fat Embolism Syndrome (FES) is a complication arising from skeletal trauma. It is characterized by a combination of delayed onset respiratory insufficiency, neurologic dysfunction, and petechial rash. These manifestations typically arise 24-72 hours after injury. Current consensus supports a model involving the initial fat embolization being followed by secondary inflammation and an amplification cascade that leads to organ injury and dysfunction. Fat embolization is common, but clinically significant FES only occurs in a small proportion of patients. Risk increases with multiple injuries and fractures and when stabilization is delayed. Morbidity and mortality risk increases when there is cerebral involvement. FES management focuses on supportive care, and most of those who survive FES end up achieving significant neurologic recovery.

Published Date: 2026-03-23; Received Date: 2026-02-20