A Child comes in ED with a fracture of femur. Thomson traction is applied in the emergency department. Which possible complication may occur in the first 24 hours following fracture?

1. A

   Pulmonary embolism

2. B

   Thrombophlebitis

3. C

   All of the above

4. D

   Fat embolism

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

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• Fat embolism is a well-known early complication following fractures of long bones, such as the femur.
• The injury disrupts the bone marrow, releasing fat globules into the venous circulation.
• Fat Embolism Syndrome (FES) typically manifests within 12-72 hours post-injury, fitting the question's 'first 24 hours' timeframe.
• These fat emboli can travel to the lungs, brain, and skin, causing respiratory distress, neurological changes, and a petechial rash.

Why Other Options Were Wrong

• Option A: A pulmonary embolism (PE) is typically a thromboembolism, caused by a blood clot from a deep vein thrombosis (DVT).
• Option B: Thrombophlebitis is the inflammation of a vein with clot formation, often a precursor to DVT and PE.
• Option C: This option is incorrect because pulmonary embolism and thrombophlebitis are not the most likely complications within the first 24 hours.

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Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Early complications of long bone fractures as background academic context rather than a clinical decision trigger.
• A nurse's primary role is vigilant monitoring for early signs of FES in any patient with a long bone or pelvic fracture.
• Key assessments include monitoring respiratory status (rate, effort, oxygen saturation), neurological function (level of consciousness, orientation), and inspecting the skin for a petechial rash (especially on the upper torso and conjunctiva).
• Early recognition and reporting of symptoms are critical, as FES can progress rapidly to acute respiratory distress syndrome (ARDS) and be fatal.

How to Approach the Question

• First, identify the key elements in the question: the injury is a 'fracture of femur' (a major long bone) and the timeframe is the 'first 24 hours' (an early complication).
• Recall or look up the common complications of long bone fractures.
• Differentiate between early and late complications. Associate specific complications with their typical onset time.
• Evaluate each option based on this timeline. Fat embolism is known to occur early (12-72 hours).
• Contrast this with thromboembolic events (thrombophlebitis, PE), which are related to immobility and typically occur later.
• Conclude that fat embolism is the most fitting complication for the given scenario and timeframe.

Concept Tested & Keywords

• Concept Tested: Early complications of long bone fractures
• Stem keywords: fracture of femur, complication, first 24 hours
• Lead-in keywords: Which possible complication
• Clinical cues: Injury: Fracture of femur (long bone)
• Clinical cues: Timeframe: First 24 hours (early complication)

Question ID

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Reference Book

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 53-55

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 139-141