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Introduction: the purpose of this study was to describe the profile of serum lipases in patients with bone fractures and to investigate the associated factors., Methods: we conducted a cross-sectional study at the Kokolo Military General Hospital in Camp Kokolo (KMGHICK) from July to October 2013. All patients admitted with bone fractures who had agreed to take part in the study were included. The control group included voluntary blood donors. The parameters of interest were demographic characteristics, serum lipase, lipidogram, the site and the number of fractures., Results: eighty-three patients were included in the study, they were all male subjects. Mean age of patients was 35.8±12.8 years; 78.3% of fractures were due to gunshot-related trauma. Femur was the most common seat of fractures (30%), followed by forearm (20%) and ulna (15%). Mean serum lipase concentration was 43.6 ± 2.9 IU/L (normal value: ≤38IU/L) in patients with fractures compared with 30.3 ± 2.3 IU/L in the control group (p<0.0001)., Conclusion: a significantly higher rate of hyperlipasemia was found in patients with bone fractures compared with the control group. Hyperlipasemia was not associated with clinicobiological fatty embolism syndrome., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Mamy Mbelu et al.)

Purpose of Review: Fat embolism syndrome (FES) is a rare disorder with potentially devastating neurologic complications. This article reviews the history, pathophysiology, clinical features, diagnosis, and treatment of FES with a focus on its neurologic aspects., Recent Findings: The neurologic complications of FES are more commonly recognized with current diagnostic testing and increase awareness of the disorder. FES may present initially with neurologic manifestations. Prompt diagnosis of FES and of its neurologic manifestations could be lifesaving. This includes respiratory support and management of neurological complications. The classic clinical triad of pulmonary insufficiency, neurologic disturbances, and petechial skin rash typically presents 24 to 72 h following an initial insult, most commonly a traumatic long bone fracture. Early onset (< 24 h) and delayed onset (> 72 h) have been described. Neurologic manifestations may include ischemic/hemorrhagic strokes, retinal ischemia, seizures, autonomic dysfunction, and diffuse brain injury. Diagnosis remains clinical. Management consists mainly of supportive care.

The clinical and laboratory retrospective and prospective study orientated to the observation of total posttraumatic response of the organisms to serious injuries (fractures of long bones of lower extremities, fractures of bones of pelvis, serious multiple injuries of body cavities associated with fractures) has concentrated hyperglobulaemia and at the same time also of disorders of blood coagulation. These in all three institutes on the verification of the significance of hyperglobulaemia, disorders of blood coagulation and persistent tachycardia. The analysis of the relations between the findings of fat hyperglobulaemia, disorders of coagulation and persistent tachycardia has made it possible to present a thesis which is very important from the practical viewpoint, and namely that the persistent tachycardia in case of in-patients is in fact a clinical reflection or manifestation, an equivalent, even of the incidence of fat studies concentrated on the syndrome of traumatic fat embolism (F. E.) were carried out within a uniform concept of "post-traumatic dyslipidemic coagulopathy - PDC". A statistically significant relation has been proved between the incidence of fat hyperglobulaemia and the incidence of persistent tachycardia. When identifying the relations between individual laboratory and clinical findings the authors have proceeded from a pre-requisite we have objectified before, and namely that fat hyperglobulaemia and disorders in blood coagulation contribute significantly to the development of the syndrome of post-traumatic fat embolism. The origin of persistent tachycardia which is motivated in patients with fractures of bones neither by the increase of temperature nor by any other pathophysiological circumstances, represents a turning point or a time limit between PDC as a latent pathological condition and PDC with clinical manifestations, being associated in the subclinical form only with persistent tachycardia or in the manifest form with other evident symptoms (including persistent tachycardia). It is then possible to use the symptom of an early and persistent tachycardia in the clinical practice for the prognostication of possibilities of unfavourable pathophysiological development of the subclinical form of fat embolism into the clinically manifest form of fat embolism.

Serum lipoprotein electrophoresis and other laboratory tests were made on 14 injured patients over 10 days. Reduction in the pre-beta fraction to an average of 6 per cent, with an elevation of the alpha lipoprotein fraction to an average of 41 per cent, were recorded. The patients without complications regained their normal lipoprotein pattern within 48 hours, while in the two cases who developed fat embolism, the deranged pattern lasted for up to 10 days. The clinical diagnosis of fat embolism is based on signs that appear generally within 3 days following injury. As prognosis depends on early diagnosis, in order to start treatment before full blown clinical signs are present, there is the need for a laboratory test which gives early results and is reliable and easy to perform. This study shows an apparently distinct pattern of the serum lipoproteins which may provide us with a warning about which patients are at risk of developing fat embolism.

Serum cholesterol, triglycerides, phospholipids, and lipoprotein levels were studied by electrophoresis in 43 trauma patients with multiple fractures of the lower extremities and pelvis. Ten healthy volunteers were used for control studies. The fat embolism syndrome was diagnosed in eight of the 43 patients. The lipid values of all the trauma patients were lower than the control values. A decrease in cholesterol and phospholipids was observed in the fat embolism patients during 4 days; these changes were not observed in the other trauma patients. The triglycerides of all the trauma patients increased slowly over a period of 4 days. Changes in the lipoprotein fractions after the trauma were minor. An early increase in the alpha1 lipbrotein fraction was noted in the fat embolism patients simultaneously with a decrease in the pre-beta lipoprotein fraction; the values of the other trauma patients were at the control levels. Normalization was observed in 6 hours. The lipid concentrations of plasma and serum did not change with filtration with 1.2, 5, and 8mum Millipore filters. No differences were noted between the femoral and cubital vein samples.

In our opinion, this clinical study demonstrates the intravascular formation of globules, macroglobules and their aggregations both in the association with the type of general anaesthesia and with the operative osteosynthesis of long bones. Within the framework of this study changes in the level of lactic acid in blood serum and of total ketosubstances in blood were followed as well as the levels of total lipids, triglycerides, phospholipides, serum lipase, non-esterified and esterified fatty acids, changes in blood coagulation and 17-ketosteroides in blood. The observed changes supported the opinion that the development of fat globulemia was associated with humoral and physicochemical changes in blood. Repeated evaluations of fat globulemia in plasma are important for studies on pathogenesis and development of fat embolism. In practice, they help: to diagnose especially subclinical forms of fat embolism with non-marked clinical symptoms; to define a suitable term of both primary and delayed operation performed in the period of ending katabolic phase after severe trauma; to define an optimum time for the indication of osteosynthesis to the end of manifest fat embolism; to control positive effects of drugs used for the prophylaction and treatment of fat embolism. In this way it is possible to objective the effectiveness of a rational prophylaxis and treatment of fat embolism. Following factors contribute to macroglobulamia and to manifestation of F. E.: injuries to bones, tissues and organs; stress, posttraumatic shock; severe hemorrhagic hypotension; posttraumatic hypercoagulation with possible binding to the development of a consumption coagulopathy; heavy changes of acid-base balance; increase of catecholamines in plasma; hormonal and general metabolic disturbances; posttraumatic dyslipidemia with special regard to the decrease of beta-lipoproteins and of lipoproteinlipase activity together with the increase of lipoproteins having a very low density and with the occurrence of a significant lipoprotein coalescence. The prospective study on the globulemia changes is based on the following examinations: in 76 injured patients: a short time observation (24 hours) of the globulemia changer after osteosyntheses in general anesthesia. The operative interventions were usually performed 6 to 8 days after injury. in 60 injured patients with fractures (single or multiple fractures, fractures in polytrauma patients): a long-time observation (28 days) of the globulemia changes.