Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 476-481
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.476
Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report
Jin Shao, De-Ce Kong, Xin-Hui Zheng, Tian-Ning Chen, Tie-Yi Yang
Jin Shao, De-Ce Kong, Tie-Yi Yang, Department of Orthopedics, Pudong New Area Gongli Hospital, School of Clinical Medicine, Shanghai University, Shanghai 200135, China
Xin-Hui Zheng, Tian-Ning Chen, Graduate School, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
Author contributions: Shao J, Kong DC, and Yang TY participated in the diagnosis and treatment of the patient, provided follow-up, and drafted and reviewed the manuscript; Kong DC, Zheng XH, and Chen TN acquired clinical data; Shao J, Kong DC, and Yang TY conducted investigations, reviewed literature, and assisted in polishing the manuscript for final publication; All of the authors read and approved the final manuscript.
Supported by The Subject Leadership Project of Shanghai Pudong New Area, No. PWRd2016-06; and the Featured Clinical Discipline Project of Shanghai Pudong, No. PWYts2018-03.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Tie-Yi Yang, MD, Chief Doctor, Director, Professor, Department of Orthopedics, Pudong New Area Gongli Hospital, School of Clinical Medicine, Shanghai University, No. 219 Miaopu Road, Pudong New Area, Shanghai 200135, China.
Received: August 27, 2020
Peer-review started: August 27, 2020
First decision: November 3, 2020
Revised: November 9, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: January 16, 2021

Fat embolism syndrome (FES) is a rare disease characterized by pulmonary distress, neurologic symptoms, and petechial rash and seriously threatens human life and health. It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms. No studies on FES with pulmonary embolism (PE) and tympanic membrane perforation have been reported to date. Here, we report a rare case of concomitant FES, PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.


A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road. X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification. A successful minimally invasive operation was performed 3 d after the injury. Postoperatively, the patient developed sudden symptoms of respiratory distress and hearing loss. Early diagnosis was made, and supportive treatments were used at the early stage of FES. Seven days after surgery, he presented a clear recovery from respiratory symptoms. The outcome of fracture healing was excellent, and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.


Concomitant FES, PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms. Early diagnosis and treatment can reduce the mortality of FES, and prevention is better than a cure.

Keywords: Fat embolism syndrome, Tibiofibular fracture, Pulmonary embolism, Tympanic membrane perforation, Postoperative complication, Case report

Core Tip: Fat embolism syndrome (FES) is a rare complication after internal fixation. This case suggests that any clinical manifestations of patients should be identified after internal fixation to avoid delays in treatment. Even with a lack of verifiable diagnostic criteria for FES, it should be highly suspected for patients with sudden hypoxemia and atypical neurological symptoms. Early diagnosis and supportive treatment are still recommended.