Case: A 26-year-old man with a minimally displaced tibial shaft fracture after an all-terrain vehicle crush injury rapidly developed fat embolism syndrome (FES), leading to diffuse alveolar hemorrhage (DAH) preoperatively. He was treated with an intramedullary rod 10 days after injury after a complicated clinical course and went on to full union with no long-term mental or systemic sequelae.
Conclusions: FES is a known complication of long bone fractures, frequently presenting with hypoxemia. DAH is a rare complication of the condition. This case demonstrates the need for a high index of suspicion both for FES and DAH as complications of orthopaedic trauma.
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