title: Pulmonary embolism following an ankle fracture in a 9-year-old boy: a case report.
abstract: Venous thromboembolism following trauma is an uncommon event in childhood and associated pulmonary embolus after routine lower extremity fracture is exceedingly rare. We present a case report of postoperative pulmonary embolus following an open reduction and internal fixation of a Salter-Harris IV medial malleolus fracture in a 9-year-old boy. Four days after open reduction and percutaneous pin fixation of the ankle fracture, the child began to experience chest pain and shortness of breath. Computed tomographic angiography demonstrated a pulmonary embolus, and he was started on anticoagulation therapy. The child had no medical history, family history, nor known risk factors for venous thromboembolism other than the fracture, and a thrombophilic work-up revealed no coagulopathies or other blood disorders. He was treated with Coumadin for three months. His orthopedic course was uneventful; the fracture healed and he returned to normal function. This appears to be the first case reported in the literature of a significant pulmonary embolus after a routine ankle fracture in a child. While insufficient to warrant deep venous thrombosis prophylaxis in all children, this case report suggests that a venous thromboembolic event can occur even in uncomplicated fractures in children.
authors.affiliation: Division of Paediatric Orthopaedic Surgery, Center for Paediatric Orthopaedics, Phoenix Children's Hospital Phoenix, Arizona 85016, USA. mwshrader@phoenixchildrens.com
authors.forename: M Wade
authors.initials: MW
authors.lastname: Shrader
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Ho
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.forename: Lee S
authors.initials: LS
authors.lastname: Segal
mesh_terms: D016512:Ankle Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D016896:Treatment Outcome