128 THE JOURNAL OF BONE AND JOINT SURGERY FAT EMBOLISM AND THE FAT EMBOLISM SYNDROME A DOUBLE-BLIND THERAPEUTIC STUDY

Fifty-five adults who had sustained a tibial fracture, or a femoral fracture, or both, were subjected to a double-blind randomised study to determine the efficacy of methylprednisolone in treating the fat embolism syndrome. This drug maintained arterial oxygen levels, stabilised or reduced the serum level of free fatty acids, and decreased the risk of the fat embolism syndrome in a statistically significant proportion of patients. Gurd’s criteria for the diagnosis of the fat embolism syndrome were found inadequate. Other more sensitive criteria for early diagnosis and effective management were determined. There were no deaths or serious morbidity in our series. In a classic monograph on fat embolism, Sevitt (1962) wrote: “A hundred years after its first description, there is lack of agreement and... even confusion as to its frequency, aetiology, pathogenesis, clinical significance and its clinical effect”. This report represents an attempt to clarify some of the issues. Weisz (1974) recounts the early history and refers to the first report, by Lower of Oxford (1669), who injecte