PT  - JOURNAL ARTICLE
AU  - S. Samuel Bederman
AU  - Mohit Bhandari
AU  - Michael D. McKee
AU  - Emil H. Schemitsch
TI  - Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis
DP  - 2009 Oct 01
TA  - Canadian Journal of Surgery
PG  - 386--393
VI  - 52
IP  - 5
4099  - http://canjsurg.ca/content/52/5/386.short
4100  - http://canjsurg.ca/content/52/5/386.full
SO  - CAN J SURG2009 Oct 01; 52
AB  - Background: Fat embolism syndrome (FES) is a potentially lethal condition most commonly seen in polytrauma patients with multiple long-bone fractures. Treatment has centred around supportive care and early fracture fixation. Several small clinical trials have suggested corticosteroids benefit patients with FES, but this treatment remains controversial. Our objective was to determine the effect of corticosteroids in preventing FES in patients with long-bone fractures.Methods: We conducted a meta-analysis of published studies of patients with long-bone fractures who were randomly assigned to groups receiving corticosteroids or standard treatment for the prevention of FES (1966–2006). Data were extracted on quality, population, intervention and outcomes. Our primary outcome was the development of FES. We used random-effects models to pool results across studies, assessing for study heterogeneity.Results: Of the 104 studies identified, 7 met our eligibility criteria. Overall, the quality of the trials was poor. Our pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78% (95% confidence interval [CI] 43%–92%) and that only 8 patients needed to be treated (95% CI 5–13 patients) to prevent 1 case of FES. Similarly, corticosteroids significantly reduced the risk of hypoxia. We found no differences in the rates of mortality or infection. Rates of avascular necrosis were not reported in any of these studies.Conclusion: Evidence suggests that corticosteroids may be beneficial in preventing FES and hypoxia but not mortality in patients with long-bone fractures. The risk of infection is not increased with the use of cortisosteroids. However, methodological limitations of these trials necessitate a large confirmatory randomized trial.