Fat embolism syndrome (FES) following long bone fractures classically presents 24–72 hours post-injury with the triad of:
- A Respiratory insufficiency, neurological dysfunction, and petechial rash over the upper trunk, axillae, and conjunctivae ✓
- B Fever, hypotension, and petechiae over the anterior chest wall
- C Sudden onset massive haemoptysis, right heart strain, and hypoxia
- D Progressive thrombocytopaenia, DIC, and jaundice
Correct answer: A. Respiratory insufficiency, neurological dysfunction, and petechial rash over the upper trunk, axillae, and conjunctivae
Explanation
The Gurd criteria for fat embolism syndrome include major criteria: respiratory failure (PaO2 < 60 mmHg on air), neurological dysfunction (confusion, decreased consciousness), and petechial rash (pathognomonic in axillary folds, conjunctivae, upper trunk — present in 50–60%). Minor criteria include fever, tachycardia, fat macroglobulinaemia, anaemia, and thrombocytopaenia. Early fracture stabilisation (IMN within 24 hours) significantly reduces FES incidence by reducing fracture motion and fat release.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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