A 25-year-old man sustains a closed diaphyseal femur fracture. After intramedullary nailing, fat embolism syndrome (FES) develops 24–48 hours post-surgery. The Gurd criteria for clinical diagnosis of FES requires at least one major criterion. Which is a MAJOR Gurd criterion for FES?

• A Fever >38.5°C
• B Tachycardia >120 bpm
• C Fat globules in the urine (lipuria)
• D Petechial rash on the upper chest and conjunctivae ✓

Explanation

Gurd and Wilson criteria for fat embolism syndrome include Major criteria: petechial rash (pathognomonic, in axillae, chest, conjunctivae), respiratory insufficiency (PaO2 <60 mmHg on room air), and cerebral involvement (confusion/coma without head injury). Minor criteria include: fever >38.5°C, tachycardia >120, retinal fat/petechiae, lipuria, fat in CSF, thrombocytopenia, elevated ESR, anaemia. Diagnosis requires at least 1 major + 4 minor + fat macroglobulinaemia. Petechial rash is the most specific major criterion (occurs in 50–60% of clinical FES) though it appears late (12–36 hours after onset of respiratory/cerebral signs).

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.