A pulmonary embolism secondary to fracture tibia: a clinical case report
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20250468Keywords:
Deep vein thrombosis, Tibial fracture, Thromboembolism, Virchows triadAbstract
Pulmonary thromboembolism (PTE) occurs when a thrombus, typically originating from venous thromboembolism, obstructs the pulmonary arteries, disrupting blood flow to the lungs. The thrombus often becomes lodged at the bifurcation of the main pulmonary artery or within the lobar branches, causing hemodynamic instability. Although the thrombus most commonly originates in the lower extremities as deep vein thrombosis (DVT), it can occasionally arise from the pelvic veins, renal veins, upper extremity veins, or the right side of the heart. Various factors can contribute to the development of deep vein thrombosis, but in the context of long bone fractures, it Deep vein thrombosis (DVT) typically develops 7 to 10 days after an injury. However, in rare cases, pulmonary thromboembolism (PTE) has been observed within 72 hours of the trauma. Several theories have been proposed to explain the mechanisms behind the early onset of PTE in such instances. Presenting a case which involves a 34-year-old male who developed pulmonary thromboembolism (PTE) following a roadside accident, and had segmental closed fracture of the right tibial shaft.
Metrics
References
Benns M, Reilly P, Kim P. Early pulmonary embolism after injury: a different clinical entity. Injury. 2014;45(1):241-4. DOI: https://doi.org/10.1016/j.injury.2013.02.026
Coleman JJ, Zarzaur BL, Katona CW, Plummer ZJ, Johnson LS, Fecher A, et al. Factors associated with pulmonary embolism within 72 hours of admission after trauma: a multicentre study. J Am Coll Surg. 2015;220(4):731-6. DOI: https://doi.org/10.1016/j.jamcollsurg.2014.12.032
Brakenridge SC, Toomay SM, Sheng JL, Gentilello LM, Shafi S. Predictors of early versus late timing of pulmonary embolus after traumatic injury. The American Journal of Surgery. 2011;201(2):209-15. DOI: https://doi.org/10.1016/j.amjsurg.2009.12.005
Kazemi Darabadi F, Jafari Zare MA, Torabi Goodarzi Z, Namdar P. Prevalence and main determinants of early post-traumatic thromboembolism in patients requiring ICU admission. Euro J Trauma Emerg Surg. 2018;44:133-6. DOI: https://doi.org/10.1007/s00068-017-0770-1
Owings JT, Kraut E, Battistella F, Cornelius JT, O'Malley R. Timing of the occurrence of pulmonary embolism in trauma patients. Arch Surg. 1997;132(8):862-7. DOI: https://doi.org/10.1001/archsurg.1997.01430320064010
Sing RF, Camp SM, Heniford BT, Rutherford EJ, Dix S, Reilly PM, Holmes JH, Haut E, Hayanga A. Timing of pulmonary emboli after trauma: implications for retrievable vena cava filters. J Trauma and Acute Care Surg. 2006;60(4):732-5. DOI: https://doi.org/10.1097/01.ta.0000210285.22571.66
Menaker J, Stein DM, Scalea TM. Pulmonary embolism after injury: more common than we think. J Trauma Acute Care Surg. 2009;67(6):1244-9. DOI: https://doi.org/10.1097/TA.0b013e31818c173a
Menaker J, Stein DM, Scalea TM. Incidence of early pulmonary embolism after injury. J Trauma Acute Care Surg. 2007;63(3):620-4. DOI: https://doi.org/10.1097/TA.0b013e31812f60aa
Cambien B, Wagner DD. A new role in hemostasis for the adhesion receptor P-selectin. Trends Mol Med. 2004;10(4):179-86. DOI: https://doi.org/10.1016/j.molmed.2004.02.007
Lentz SR. Thrombosis in the setting of obesity or inflammatory bowel disease. Hematology 2014, the American Society of Hematology Education Program Book. 2016;2(1):180-7. DOI: https://doi.org/10.1182/asheducation-2016.1.180
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiol. 2005;25(3):135-43. DOI: https://doi.org/10.1159/000086678
Blokhin IO, Lentz SR. Mechanisms of thrombosis in obesity. Curr Opin Hematol. 2013;20(5):437-44. DOI: https://doi.org/10.1097/MOH.0b013e3283634443
Donzé JD, Ridker PM, Finlayson SR, Bates DW. Impact of sepsis on risk of postoperative arterial and venous thromboses: large prospective cohort study. BMJ. 2014;3:49. DOI: https://doi.org/10.1016/S0735-1097(14)62050-7
Levine RL, LeClerc JR, Bailey JE, Monberg MJ, Sarwat S. Venous and arterial thromboembolism in severe sepsis. Thrombosis Haemostasis. 2008;99(11):892-8. DOI: https://doi.org/10.1160/TH08-01-0004
Brill GL Suidan DD Wagner. Hypoxia, such as that encountered at high altitudes, promotes deep vein thrombosis in mice. J Thromb Haemost. 2013;119:17-9.
Blaisdell FW, Graziano CJ. Assessment of clotting by the determination of fibrinogen catabolism. Am J Surg. 1978;135(3):436-43. DOI: https://doi.org/10.1016/0002-9610(78)90081-8
Chakroun-Walha O, Samet A, Jerbi M, Nasri A, Talbi A, Kanoun H, et al. Benefits of the tranexamic acid in head trauma with no extracranial bleeding: a prospective follow-up of 180 patients. Euro J Trauma Emerg Surg. 2019;45:719-26. DOI: https://doi.org/10.1007/s00068-018-0974-z
Schreiber MA, Differding J, Thorborg P, Mayberry JC, Mullins RJ. Hypercoagulability is most prevalent early after injury and in female patients. J Trauma and Acute Care Surg. 2005;58(3):475-81. DOI: https://doi.org/10.1097/01.TA.0000153938.77777.26
Velmahos GC, Spaniolas K, Tabbara M, Abujudeh HH, De Moya M, Gervasini A, et al. Pulmonary embolism and deep venous thrombosis in trauma: are they related. Arch Surg. 2009;144(10):928-32. DOI: https://doi.org/10.1001/archsurg.2009.97
HB Moore EE Moore BR Huebner M Dzieciatkowska GR Stettler GR Nunns Fibrinolysis shutdown is associated with a fivefold increase in mortality in trauma patients lacking hypersensitivity to tissue plasminogen activators. J Trauma Acute Care Surg. 2017;83(6)1014-22. DOI: https://doi.org/10.1097/TA.0000000000001718
Downloads
Published
How to Cite
Issue
Section
