Study on the Circulating Fat Macroglobule in Fracture

Kim, Nam Hyun; Hwang, Sung Kwan; Chung, In Hee; Shin, Jung Soon

Abstract

Fat embolism is a condition in which fat appears in the circulating blood, not in the fine emulsion of a metabolic lipemia, but in droplets large enough to occlude arterioles and capillaries. It may occur as a complication of fracture, particularly multiple fractures of the long bones, pelvis, and ribs.. Since Zenker described the first case of fat embolism in 1862 there has never been a reliable diagnostic test for this condition. Lipid changes in the blood and demonstration of macroglobules could be used as aids for early post- traumatic fat embolism syndrome. The purpose of the present,study was to analyze the blood lipid changes in the fracture and to determine their value in the early detection of fat embolism syndrome. Twenty-three patients with at least one diaphyseal fracture of the lower extremity or a pelvic and spine fracture were included in the study. The mean age of the patients was 30.3 years. Men outnumbered women by a ratio of 2.9:1. Nineteen of the patients were injured in traffic accidents, two patients in fall, and one in the industrial accident. Ten volunteers were used for the control studies, nine men and one woman. Their mean age was 22.8 years. For determination of blood lipids blood sample was taken from cubital vein. The flrst blood sample was taken from tbe patients less than 2 hours after the iniury, and the later samples were obtained respectively in 12, 24, 48 and 72 hours, and 7 days after injury. The samples were centrifuged immediately (2,500 rpm, 4 min.). After centrifugation, each sample of plasma or serum was divided into two aliquots. The one aliquot was studied without flltering and the other was filtered through 8 microns millipore filter (Watmann No. 40. filter paper). Determination of triglyceride, cholesterol, and phospsolipids in blood was made from the unfiltered aliquot and from the other filtrate. Two groups were formed for comparission of the results; 1) Fracture Group; 2) Non-fracture Group as control. The triglycerides was determined using the technic of the micromethod of Van Handel and Elversmith, and the cholesterol was determined by the technic of Rosenthals color reagent method. For the determination of phospholipids Youngburg, modified method was used of The results of the study lead us to conclude that: 1. The triglycerides, cholesterol, phosphollpids fractions in the unflltered allquot was slightly higher than those of the filtrate. 2. Less than two hours after injury the triglycerides concentration in blood of fracture group was similar to the concentrations of the controls. But the triglycerides and macroglobule concentration in 12 and 24 hours after fracture were higher than those of the control group. 3. The average concentration of blood cholesterol level in fracture group was slightly higher than the control. Especially the serum concentrations of cholesterol in 12, and 24 hours after fracture were much higher than those of the controls. Statistically significant differences between the groups were observed. 4. The average phospholipids concentration in fracture patients was slightly higher than the average phospholipids concentration of the control but no significant differences between the groups were observed. 5. As to the total lipids, the average concentration of fracture group was little bit higher than the concentration of the control. There was no statistical differences between the fracture and the control group. 6. The concentrations of the total lipids gradually increased after 40 years of age. 7. The concentration of total serum lipids was increased in femoral fracture in site, and in multiple fractures than single fracture.