Q: Out of the following, which has shown promise in the treatment of  "Fat Embolism Syndrome" (FES)? 

 A) Aspirin

B) Prophylactic antibiotics

C) Plasma Exchange (PE)

D) Emergent Hemodialysis (HD)

E) Statins

Answer: A (Aspirin) 

The best and evidence based treatment to reduce the risk of "Fat Embolism Syndrome" after long bone fractures is early immobilization of fractures and preferably operative correction. Also limiting the elevation in intraosseous pressure during orthopaedic procedures, reduces the intravasation of intramedullary fat and other debris. Other maneuvers which can be used to limit intraosseous pressure, are use of cementless fixation of hip prostheses and unreamed intramedullary femoral shaft stabilization.

Corticosteroid have been suggested for long time but is controversial and has very weak evidences, but it remained in use as risk vs benefit ratio is low.

Interestingly, treatment of patients with FES with aspirin resulted in significant normalization of blood gases, coagulation proteins, and platelet numbers when compared with controls.

Heparin has also been suggested as its clear lipaemic serum by stimulating lipase activity , but heparin greatly increases the risk of bleeding in patients with bone fracture.

Statins, Antibiotics, PE and HD have no role in FES.