Summary:Pulmonary failure is a common complication in poly-traumatized patients with long-bone injuries. Current treatment protocols include early osteosynthesis of these fractures. This has been shown to decrease pulmonary complications, including fat embolization and the development of adult respiratory distress syndrome. Currently there is controversy over whether the fat embolization that occurs as a result of reamed femoral intramedullary nailing may be harmful, especially to poly-traumatized patients with thoracic trauma. This article will review the literature on fat embolization and fat embolization syndrome and will review studies examining possible associations between intramedullary fixation of long-bone fractures and the development of respiratory failure.