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I've never understood this subject properly. A colleague who'd spent a lot of time in Johannesburg told me that there they saw a lot of fat embolus form rib fractures, but it was comparatively rare with long bone fractures. This is not in accordance with what I've read elsewhere (although this may be because some definitions of FES exclude multiple trauma and chest injuries). Has anyone else heard of this? It was also felt there that FES was commoner at altititude (again, not in any book I've read). BTW, Lindique et al from Pretoria published what seems to be the only RCT on FES (JBJS, 69B, 128- 31)- they showed early methylprednisolne reduced the incidence of FES (but in a group with low morbidity from FES in any case). I don't have anything about timing of surgery. It would be an interesting audit if anyone is having enough FES to do it. Matt Dunn %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%