A patient develops fat embolism syndrome (FES) 24–48 hours after closed bilateral femoral shaft fractures. The Gurd and Wilson criteria for diagnosis of FES require which combination?
- A One major criterion: petechial rash; plus two minor criteria ✓
- B Two major criteria alone are sufficient
- C One major criterion plus one minor plus fat macroglobulinemia
- D One major criterion plus any minor criteria totaling one or more
Explanation
Gurd and Wilson criteria: Major criteria include (1) petechial rash, (2) respiratory insufficiency (PaO2 <60 mmHg), (3) cerebral involvement unexplained by head injury. Minor criteria include fever, tachycardia, retinal emboli, jaundice, renal changes, fat macroglobulinemia, anemia, thrombocytopenia. Diagnosis requires one major + four minor criteria (some sources quote one major + one minor + fat macroglobulinemia). The petechial rash is pathognomonic, appearing in the axilla, conjunctiva, and upper chest, resulting from microemboli in dermal capillaries. Early intramedullary nailing of femoral fractures reduces FES incidence by eliminating the fracture haematoma source.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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