Introduction
Fat embolism is an abrupt disruption of the circulatory system commonly caused by orthopedic trauma, which is shown physically by the appearance of globules of fat in the vessels of the circulatory system. Fat embolism syndrome is the systemic presentation of fat emboli in the microcirculation, manifesting with the Gurd’s triad of respiratory distress, neurological deficits, and petechial rashes [1,2].  According to the observations, pulmonary symptoms occur first, typically 24 to 72 hours after the trauma, but symptoms have been reported as early as 12 hours, usually followed by neurological symptoms [2]. The exact occurrence of FES varies from 1% to 30%, as there are no universal standards for diagnosis [3].
In 1861, Zenker was the first to conduct a clinical study of FES and discovered fat droplets in the capillaries of the lungs of a railroad worker who had died from a traumatic injury. However, despite Gauss’ mechanical explanation of FES in 1924 and Lehman and Moore’s biochemical explanation in 1927, the concept of FES remains obscure [4].
Recent studies suggest that FES may have possible connections with neurocognitive dysfunction and the development of deep vein thrombosis. Clinical manifestations of FES vary widely and can include restlessness, dyspnea, delirium, coma, and, in some cases, death. Case studies have also highlighted the rare occurrence of FES in patients not resulting from trauma, particularly during bone marrow removal, c-sections, liposuction, lung transplants, and cosmetic surgeries [2].
There are many ways to prevent FES and other long bone fractures from happening that have been discussed in the literature. Unfortunately, there is no particular treatment for FES, so the main alternatives are to give supportive care, although this is not a universal practice. Damage control orthopedics (DCO) and optimizing reaming approaches have been the principal management solutions for individuals with long bone fractures. Although FES can be very dangerous, it is much less common [5].
Here we present a case of a 23-year-old male who suffered a left both bone closed fracture after an iron rod fell over his left lower limb. He eventually developed the classic triad of Fat embolism syndrome after being asymptomatic for 5 days following the trauma.