Venous Thromboembolism in Upper Extremity Fractures

Considerations for Perioperative Thromboembolic Risk Mitigation in Actively and Recently COVID-19-Positive Patients Undergoing Hand Surgery

Coronavirus Disease 2019 (COVID) induces a hypercoagulable state causing an increased risk of venous and arterial thromboses. Distal limb and microvascular circulation are critical to the success of many hand surgeries, and patients who are actively or recently infected with COVID may be at a higher risk for perioperative thrombotic events. Little information is available regarding how to handle actively or recently infected COVID patients, including preoperative risk assessment, intraoperative decision making, and postoperative considerations regarding thrombotic risk. Our aim was to review the literature to determine how the hand surgeon can best prepare for and manage the actively or recently COVID-positive patients undergoing hand surgeries.

[Arm Swelling with a Camouflaged Cause]

Arm Swelling with a Camouflaged Cause Abstract. We report on a 72-year-old patient who presented to the emergency department due to a proximal multiple-fragment humeral fracture on the left. Despite correct therapeutic approaches, there was no improvement in the left arm swelling. Further investigations showed a provoked arm vein thrombosis on the left with a post-humeral fracture on the left. After therapeutic anticoagulation, the swelling regressed immediately, but with persistent lymphedema of the left hand.

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

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 25^th 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.