A 22-year-old male is hospitalized with multiple extremity fractures including a comminuted fracture of the femur and multiple rib fractures. Which of the following statement(s) is/are true concerning his hospital course?

c. Early fracture fixation would decrease the incidence of fat emboli

Perhaps the most catastrophic post-injury complication is pulmonary embolism. All patients with orthopedic injury, particularly those with fractures of the lower extremities or pelvis, are at high risk for deep venous thrombosis and subsequent pulmonary embolism. Prophylaxis with sequential compression devices or low dose heparin has reduced the incidence of deep venous thrombosis in this group. Although concern for the use of heparin is appropriate, prospective studies demonstrate that low-dose heparin therapy can begin safely within 24 hours in 37% of patients and within 48 hours in 75%. Trauma patients who are paralyzed or immobilized by head injury, spine injury, or multiple orthopedic injuries should be considered for placement of a Greenfield filter. Fat embolism syndrome is a classic triad of acute respiratory failure; altered mental status, and petechiae of the head, torso and sclerae; and is frequently associated with long-bone and pelvic fractures. Less fulminant presentations, without petechiae and with lesser degrees of pulmonary dysfunction, are more common. At present, the only therapy for fat emboli syndrome is supportive care. Therefore, prevention is critical and numerous studies indicate that early fracture fixation decreases the incidence of this and other pulmonary complications. However, a subset of patients with femoral fractures and coexisting lung contusion has been recently found to have a higher incidence of ARDS if the fracture is repaired early than if repaired late.