A client has a fracture with an open reduction internal fixation (ORIF). What is the client at most risk for?

• A. Infection
• B. Fat embolism
• C. Nerve injury
• D. Compartment syndrome

Answer: (B)

Fat embolism is a major early risk after a fracture treated with ORIF because marrow fat can be released into torn blood vessels during injury or surgical manipulation and travel to the lungs and brain. This fat embolism syndrome often appears within 24–72 hours and presents with sudden respiratory distress (shortness of breath, tachypnea, hypoxemia), possible neurologic changes (confusion, agitation), and sometimes a petechial rash. Management is mainly supportive: ensure adequate oxygenation, monitor vitals and labs, and provide appropriate respiratory support as needed. While infection, nerve injury, and compartment syndrome are real concerns with fractures and surgery, fat embolism is the systemic complication most directly linked to marrow fat entering the circulation after a fracture, making it the most likely risk in this scenario.