A 25-year-old man with an isolated closed femoral shaft fracture from a road traffic accident develops breathlessness, confusion, and a fever 36 hours after admission. SpO2 is 88 percent on room air and a petechial rash is noted over the anterior chest wall and axillae. Urine shows free fat globules. The most likely diagnosis is:

• A Pulmonary embolism from deep vein thrombosis
• B Massive haemothorax from occult rib fractures
• C Fat embolism syndrome ✓
• D Transfusion-related acute lung injury

Explanation

Fat embolism syndrome classically appears 24 to 72 hours after a long bone fracture, with respiratory distress, cerebral confusion, fever, and a characteristic petechial rash over the chest, axillae, conjunctivae, and oral mucosa. Pulmonary embolism typically occurs later and lacks petechiae. Early stabilisation of long bone fractures reduces its incidence, a point frequently examined.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.