A 35-year-old patient develops fat embolism syndrome (FES) 48 hours after stabilization of bilateral femoral shaft fractures. Which clinical triad is pathognomonic of FES?

• A Hypoxia, pyrexia, and confusion
• B Tachycardia, coagulopathy, and metabolic acidosis
• C Hemoptysis, pleuritic chest pain, and pleural effusion
• D Respiratory distress, petechiae (axilla/conjunctiva), and cerebral dysfunction ✓

Explanation

The classic Gurd's criteria for fat embolism syndrome include major features: respiratory insufficiency (PaO2 < 60 mmHg on air), cerebral involvement (confusion, agitation, or coma), and petechial rash (pathognomonic — appearing as petechiae in the axillae, conjunctivae, and anterior chest due to fat emboli in dermal capillaries). Of these, the petechial rash is most specific. Minor criteria include fever, tachycardia, fat globulinuria, and thrombocytopenia. Treatment is supportive with oxygen/ventilation; early fracture fixation reduces risk.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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