Advances and uncertainties in fat embolism syndrome: a review

Summary

Fat embolism syndrome (FES) is a complex and potentially life-threatening condition resulting from fat particles entering the circulation, leading to embolic and inflammatory injury across multiple organs, particularly the lungs, brain, and skin. Although the classical triad of respiratory distress, neurological dysfunction, and petechial rash was first described decades ago, clinical presentation remains heterogeneous and often non-specific, complicating timely diagnosis. Existing criteria (Gurd, Wilson, and Lindeque) lack robust validation and remain inadequate in current practice. Imaging modalities, particularly chest CT and brain MRI, alongside emerging biomarkers, such as interleukin-6, might improve diagnostic accuracy, though specificity remains limited. FES management is primarily supportive, focusing on maintaining oxygenation and hemodynamic stability, with invasive ventilation or extracorporeal support required in severe cases. Early fracture stabilization within 24 hours remains the most effective preventive strategy, whereas the use of corticosteroids is controversial owing to inconsistent efficacy and potential adverse effects. In this review, we aim to summarize current understanding of the diagnosis, management, and prevention of FES, while identifying unresolved clinical and research challenges. Relevant literature was identified through PubMed and Scopus searches of English language articles on traumatic and non-traumatic FES published up to 2025. Despite extensive clinical observation, many uncertainties persist regarding the pathophysiology, risk stratification, and optimal treatment of FES. Future directions include refinement of diagnostic criteria through integration of imaging, biomarkers, and artificial intelligence, as well as multicenter studies to establish evidence-based management strategies.