Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 197-203
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.197
Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review
Bo Lv, Feng Xue, Yu-Chun Shen, Fang-Bao Hu, Ming-Mang Pan
Bo Lv, Feng Xue, Yu-Chun Shen, Ming-Mang Pan, Department of Orthopaedics, Shanghai Fengxian District Central Hospital, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai 201499, China
Fang-Bao Hu, Intensive Care Unit, Shanghai Fengxian District Central Hospital, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, Shanghai 201499, China
Author contributions: Xue F designed the case report; Lv B and Pan MM analyzed all the data and wrote the manuscript; Shen YC operated on the patient; Hu FB and Shen YC gave anticoagulant treatment to the patient. All authors read and approved the final manuscript.
Supported by Shanghai Fengxian District Osteoarthropathy Clinical Diagnosis and Treatment Center, China, No. fxlczlzx-a-201704.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Xue, MD, Doctor, Department of Orthopaedics, Shanghai Fengxian District Central Hospital, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital South Campus, No. 6600 Nanfeng Road, Fengxian District, Shanghai 201499, China. xuefengmd@163.com
Received: May 27, 2020
Peer-review started: May 27, 2020
First decision: November 25, 2020
Revised: November 25, 2020
Accepted: December 6, 2020
Article in press: December 6, 2020
Published online: January 6, 2021
Abstract
BACKGROUND

Pulmonary thromboembolism (PTE) is a serious postoperative complication that can occur after a fracture. Generally, PTE is caused by the falling off of lower extremity deep vein thrombosis (LEDVT) after lower limb fracture surgery. LEDVT and PTE after upper extremity fracture surgery are very rare. PTE is one of the most common clinical causes of sudden death. Venous thromboembolism includes PTE and DVT. We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery. The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery, and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.

CASE SUMMARY

We report a 51-year-old Chinese male who had severe fractures of the left distal ulna, radius and little finger after a motorcycle accident. The patient underwent external fixation, open reduction and internal fixation. On the third post-operative day, computed tomographic pulmonary angiography showed PTE. Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins. After a period of anticoagulation therapy, on the 25th d after the PTE, computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared. Furthermore, about 4 mo after the PTE, thrombosis in the deep veins of the lower limbs disappeared. About 1 year after the surgery, X-rays showed good fracture healing, and the function of the wrist joint recovered well.

CONCLUSION

Though rare, PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.

Keywords: Distal ulna and radius fracture, Pulmonary thromboembolism, Deep venous thrombosis, External fixation, Open reduction and internal fixation, Case report

Core Tip: We report a 51-year-old Chinese male who had severe fractures in the left distal ulna, radius and little finger after a motorcycle accident. The patient underwent external fixation, open reduction and internal fixation. On the third postoperative day after the second surgery, he was diagnosed with pulmonary thromboembolism and lower extremity deep vein thrombosis. After 25 d of anticoagulation therapy, computed tomographic pulmonary angiography showed that the thrombus in the pulmonary artery disappeared. This case raises awareness for orthopedics that pulmonary thromboembolism can occur after upper extremity surgery, and that patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.