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

Lv, Bo; Xue, Feng; Shen, Yu-Chun; Hu, Fangbao; Pan, Mingxin

doi:10.12998/wjcc.v9.i1.197

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…In contrast, Widmer et al, found no thromboembolic events in 50 patients, receiving VTE prophylaxis, after proximal humerus fracture 88 . In addition to the aforementioned studies, there are sporadic case reports of the occurrence of UEDVT and PE and upper extremity fracture or osteosynthesis [89][90][91][92][93][94][95] . Two reviews around the topic of the need for thromboprophylaxis of upper limb surgery were identified.…”

Section: % (Strong Consensus)mentioning

confidence: 99%

Recommendations from the ICM-VTE: Shoulder & Elbow

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Shoulder & Elbow Delegates* Question: 1 -Concerning VTE risk, which surgeries can be considered major, and which surgeries can be considered non-major in shoulder and elbow surgery?Response/Recommendation: Shoulder arthroscopy, nonfracture related shoulder arthroplasty, and all elbow procedures can be considered non-major venous thromboembolism (VTE) risk. Fracture related shoulder procedures can be considered major VTE risk.Strength of Recommendation: Limited.Delegates vote: Agree 93.94% Disagree 6.06% Abstain 0.00% (Strong Consensus)Rationale: VTE following shoulder and elbow surgery are rare events. One study reported for all upper extremity deep venous thromboses (DVT) to represent 1% to 4% of all DVT 1 . In the shoulder, surgeries can be divided into arthroscopic, non-fracture shoulder arthroplasty, and fracture related surgeries. In the elbow, surgeries can be divided into arthroscopy, fracture related, and arthroplasty. With respect to these surgeries, several studies have reported VTE rates, however, a majority of this information comes from a collection of level 3 and level 4 evidence along with registry studies.In shoulder arthroscopy, VTE rates are low with reported rates ranging from 0.011% to 0.38% 2-6 . Kuremsky et al., in a retrospective study of 2,872 patients undergoing shoulder arthroscopy reported VTE rate of 0.24% 2 . Jameson et al., in a registry study out of the United Kingdom reported 0.011% VTE rate in a retrospective review of 65,302 shoulder arthroscopy cases 3 . Similarly, Brislin et al., reported VTE rate of 0.38% in a consecutive series of 263 arthroscopic rotator cuff repairs (RCR) 4 . These VTE rates following arthroscopic RCR were similar to rates reported by Hoxie et al., (0.26%) 5 . Additionally, open instability surgeries also comprise higher VTE risk than their arthroscopic counterparts. Goodloe et al., in a registry study compared arthroscopic Bankart repair, open Bankart repair, and Latarjet-Bristow procedure with reported VTE rates of 0.1%, 0.0%, and 0.8%, respectively 7 . Thus, shoulder arthroscopy procedures can be considered non-major concerning VTE risk.

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Section: % (Strong Consensus)mentioning

confidence: 99%

Recommendations from the ICM-VTE: Shoulder & Elbow

2022

Journal of Bone and Joint Surgery

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“…The exact degree to which mobility needs to be reduced has not been established, although one study found reduced mobility for 3 days or more was associated with an increased risk of symptomatic lower limb DVT 371 . Recently, Lv et al 372 , reported a case of PE after an external and internal fixation procedure of distal radius and ulna with DVT in bilateral posterior tibial veins. However, the procedure was prolonged (4 hours), an iliac graft was harvested, and they described that the patient was reluctant to move out of bed for 3 days because of pain.…”

Section: - Should Patients Undergoing Hardware Removal Of Upper Extre...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Trauma

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Trauma Delegates* 1 -What is the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries?Response/Recommendation: Although multiple forms of prophylaxis against venous thromboembolism (VTE) with variable effectiveness are available for patients with multiple orthopedic injuries, low-molecular-weight heparin (LMWH) is considered the most optimal choice based on available literature.Strength of Recommendation: Acceptable.Delegates vote: Agree 86.36% Disagree 9.09% Abstain 4.55% (Strong Consensus).Rationale: VTE events following multiple orthopaedic injuries are associated with significant morbidity and mortality 1,2 . The prevalence of deep venous thrombosis (DVT) in trauma patients without prophylactic treatment can reach up to 60%. Pulmonary embolism (PE) can be a fatal form of VTE with prevalence ranging between 2 -16% 3,4 . VTE can be prevented using different mechanical and chemical prophylaxis agents, therefore, significantly lower the burden on healthcare systems worldwide 1 . The aim of this review is to find the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries.Multiple orthopaedic injuries rarely happen without extraskeletal injuries, therefore, no studies in the current literature addressed VTE prophylaxis in patients with multiple orthopaedic injuries but without extra-skeletal injuries. Most of the available literature is addressing this patient population under different groups including, patients with trauma, poly-trauma, high energy fractures and lower extremity injuries [1][2][3][5][6][7] . The level of evidence varies among the reviewed literature, however, randomized controlled clinical trials in this subject are limited 3,4 .Based on our review, LMWH is considered the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries 1,3,5,6,[8][9][10][11][12][13][14] . Ley et al., recommends using LMWH due to its increased bioavailability, acceptably low bleeding complications and longer plasma half-life 1 . Rogers et al., published in their guidelines for prevention of VTE in trauma patients that LMWH has superior bioavailability when compared to lowdose heparin (LDH) 5 . Knudson et al., concluded in a prospective, randomized trial that LMWH is an extremely effective *A list of the ICM-VTE Trauma Delegates is included in a note at the end of the article. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G855).

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

Cited by 2 publications

References 11 publications

Recommendations from the ICM-VTE: Shoulder & Elbow

Recommendations from the ICM-VTE: Shoulder & Elbow

Recommendations from the ICM-VTE: Trauma

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