What is a disadvantage of open reduction and internal fixation (ORIF) of a fracture compared to closed reduction?

Choice A reason: A swollen calf is more indicative of deep vein thrombosis (DVT), not fat emboli syndrome. DVT results from venous stasis or clotting post-fracture, causing localized swelling, unlike fat emboli, which primarily affect systemic circulation, lungs, and skin with petechiae, requiring distinct diagnostic and treatment approaches to prevent complications like pulmonary embolism.

Choice B reason: Fever can occur in fat emboli syndrome due to systemic inflammation but is nonspecific, as it’s common in infections or post-fracture inflammation. It’s not a hallmark sign compared to petechiae, which are more specific. Including fever risks misdiagnosis, as it lacks the specificity needed for accurate patient education on fat emboli manifestations.

Choice C reason: Petechiae on the chest are a classic sign of fat emboli syndrome, occurring in 50-60% of cases. Fat globules embolize to small cutaneous vessels, causing pinpoint hemorrhages. This specific finding, often with respiratory distress and neurological changes, aids early diagnosis, guiding urgent interventions like oxygenation to prevent life-threatening complications.

Choice D reason: Paresthesia distal to the fracture suggests local nerve compression or injury, not fat emboli syndrome. Fat emboli cause systemic symptoms like pulmonary and cerebral dysfunction, not localized sensory changes. Misattributing paresthesia to fat emboli could delay treatment for nerve-related issues, compromising patient recovery and accurate symptom management.

Choice A reason: Using a blow dryer to dry a fiberglass cast is inappropriate, as casts should be kept dry to prevent skin maceration or infection. Fiberglass is water-resistant but not waterproof, and heat can damage the cast or skin. This instruction risks complications, misguiding patients on proper cast care and hygiene.

Choice B reason: Using a cotton swab under the cast to relieve itching is unsafe, as it may introduce debris or cause skin injury, increasing infection risk. Itching should be managed with elevation or antihistamines. This advice misaligns with cast care, potentially leading to complications like dermatitis or bacterial infection under the cast.

Choice C reason: Avoiding all movement of the affected leg is impractical and harmful. Controlled movement, as advised, prevents stiffness and muscle atrophy while maintaining circulation. Complete immobilization risks complications like contractures. This instruction misguides recovery, delaying rehabilitation and functional restoration in patients with a tibial fracture.

Choice D reason: Reporting worsening or unrelieved pain is critical, as it may indicate complications like compartment syndrome, infection, or cast pressure. Pain assessment ensures timely intervention, preventing serious outcomes like tissue necrosis or delayed healing. This instruction aligns with safe cast care, promoting patient safety and effective fracture management.