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The embolization of intramedullary fat into the circu-lation has been shown to occur routinely in pelvic and long bone fractures, and with a variety of orthopedic procedures. 1 Fat embolism syndrome, which appears in less than 1% of the occurrences of circulating intramedullary fat, classically presents with pulmonary, neurologic, and cutaneous symptoms, and can result in severe morbidity and mortality. 1, 2 Not all symptoms occur together, with respiratory distress present in 75% of cases, neurologic symptoms in 86%, and petechial rash in 50%. 1–3 Associated findings include early pyrexia, anemia, thrombocytopenia, retinal emboli, tachycardia, elevated erythrocyte sedimentation rate, renal changes, and jaundice. 3 The incidence of fat embolism syndrome can be increased up to 30% by multiple fractures and delays of more than 24 hours before surgical fixation. 1, 2 Because of the complexity of presentation, the …