Incidence, mortality, and factors associated with fat embolism syndrome in patients with long bone fractures at a trauma referral center in Bogotá, Colombia: 2016–2019 and 2022–2023

To estimate the incidence, mortality, and factors associated with the development of fat embolism syndrome (FES) in patients with long bone fractures treated at a trauma referral center in Bogotá, D.C., Colombia. Retrospective cohort study including patients >18 years with diaphyseal fractures of humerus, femur, tibia, or fibula, treated between 2016-2019 and 2022-2023. COVID-19 pandemic years (2020-2021) were excluded. Statistical analyses included univariate, bivariate, and multivariate logistic regression. Among 3,475 patients with long bone fractures, FES incidence was 4.3% (n=148) with 5.4% in-hospital mortality. Multivariable analysis identified femoral fractures as the strongest risk factor (aOR=4.63; 95%CI:2.99-7.22; p<0.001), while early surgical fixation (<24h) demonstrated significant protection (aOR=0.42; 95%CI:0.25-0.71; p<0.001). Obesity independently increased FES risk (aOR=2.63; 95%CI:1.33-4.93; p=0.004). Most cases (97%) resulted from high-energy trauma, predominantly motorcycle accidents. Respiratory compromise was severe, with 93.9% of FES patients requiring advanced ventilatory support versus 16.8% in controls (p<0.001). This study demonstrates that early surgical fixation significantly reduces FES risk and identifies humeral fractures as an underrecognized risk factor. These findings support immediate implementation of early fixation protocols and expanded monitoring beyond femoral fractures in high-energy trauma patients.