Premonitory hypoxia as an early indicator of perioperative fat embolism syndrome following closed tibial fracture: a case report

Abstract

Fat embolism syndrome (FES) is an uncommon but potentially life-threatening complication of long-bone fractures. Early diagnosis is challenging due to subtle and nonspecific initial manifestations, particularly in isolated injuries. We report a case of a young adult with an isolated closed tibial shaft fracture who developed unexplained preoperative hypoxia followed by rapid postoperative deterioration consistent with FES. A 24-year-old male developed hypoxia (SpO₂ 89% on room air) on the third day following injury without any clinical respiratory symptoms. After undergoing reamed intramedullary nailing, he developed acute respiratory distress, fever, thrombocytopenia, and bilateral pulmonary infiltrates. Infective causes were ruled out, and a diagnosis of FES was established using Gurd and Wilson’s criteria. The patient was managed with noninvasive ventilation and supportive care, resulting in gradual recovery over 10 days. Unexplained preoperative hypoxia may represent an early manifestation of FES. Early recognition and vigilant perioperative monitoring are essential to prevent rapid deterioration and improve outcomes.