A 30 year old man had road traffic accident and sustained fracture of femur. Two days later he developed sudden breathlessness. The most probable cause can be –
Correct Answer: Fat embolism
Description: FAT EMBOLISM SYNDROME Fat embolism is a common phenomenon following limb fractures. Circulating fat globules larger than 10 mm in diameter occur in most adults after closed fractures of long bones and histological traces of fat can be found in the lungs and other internal organs. A small percentage of these patients develop clinical features similar to those of ARDS; this was recognized as the fat embolism syndrome long before ARDS entered the medical literature. Whether the fat embolism syndrome is an expression of the same condition or whether it is an entirely separate entity is still unceain. The source of the fat emboli is probably the bone marrow, and the condition is more common in patients with multiple fractures. Clinical features Early warning signs of fat embolism (usually within 72 hours of injury) are a slight rise of temperature and pulse rate. In more pronounced cases there is breathlessness and mild mental confusion or restlessness. Pathognomonic signs are petechiae on the trunk, axillae and in the conjunctival folds and retinae. In more severe cases there may be respiratory distress and coma, due both to brain emboli and hypoxia from involvement of the lungs. The features at this stage are essentially those of ARDS. REF:Apley&;s system of ohopaedics- 9th edn - pg no 681.
Category:
Orthopaedics
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