Fat embolism syndrome (FES) classically occurs 24–72 hours after long bone or pelvic fractures. The diagnostic triad of FES (Gurd's criteria) comprises:

• A Hypotension, tachycardia, and altered consciousness
• B DVT, pulmonary embolism, and arterial occlusion
• C Petechiae (axillae/conjunctivae), respiratory insufficiency, and cerebral dysfunction ✓
• D Fever, tachycardia, and positive blood cultures

Explanation

Gurd and Wilson criteria for FES require one major and four minor criteria. Major criteria: petechial rash (pathognomonic when in axillary folds/conjunctivae), respiratory failure (PaO2 <60 mmHg), cerebral dysfunction (confusion/coma). Minor criteria include pyrexia, tachycardia, retinal changes, jaundice, and renal dysfunction. Petechiae occur in only 20–50% but are pathognomonic when present, caused by fat globules in dermal capillaries triggering thrombocytopenia. Methylprednisolone prophylaxis and early operative fracture stabilization reduce FES incidence.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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