A 55-year-old woman develops fat embolism syndrome 48 hours after intramedullary nailing of a femoral shaft fracture. The Gurd and Wilson criteria for diagnosis include which combination?
- A Major: petechiae; Minor: hypoxia (PaO2 <60), anaemia, thrombocytopenia, tachycardia >110
- B Major: respiratory failure (PaO2 <60), CNS dysfunction, petechiae; Minor: fever >38.5°C, tachycardia, anaemia, thrombocytopenia, high ESR, fat macroglobulinemia ✓
- C Major: thrombocytopenia; Minor: petechiae, respiratory distress, CNS dysfunction
- D Major: systemic hypotension; Minor: petechiae, acute respiratory distress
Correct answer: B. Major: respiratory failure (PaO2 <60), CNS dysfunction, petechiae; Minor: fever >38.5°C, tachycardia, anaemia, thrombocytopenia, high ESR, fat macroglobulinemia
Explanation
Gurd and Wilson's criteria for fat embolism syndrome require (≥1 major criterion + ≥4 minor criteria, or ≥2 major criteria): Major criteria: respiratory insufficiency (PaO2 <60 mmHg on room air), cerebral involvement (CNS dysfunction — confusion, stupor), petechial rash (pathognomonic triad). Minor criteria: fever >38.5°C, tachycardia >120/min, retinal changes (fundal fat emboli), anaemia (Hb drop >20%), thrombocytopenia (platelet drop >50%), high ESR, fat macroglobulinemia. Petechiae on conjunctiva, axilla, and neck occur in <50% of cases but are pathognomonic.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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