title: Pulmonary thromboembolism after operation for bilateral open distal radius fractures: a case report.
abstract: BACKGROUND
  Pulmonary thromboembolism after upper extremity operation is rare. We report a patient with thromboembolism after debridement open reduction and internal fixation for bilateral open distal radius fractures.
  
  
  METHODS
  The Japanese patient was an 80-year-old previously healthy female who was able to walk on her own. She fell down and was taken to our hospital. She was diagnosed with bilateral open distal radius fractures and we performed debridement open reduction and internal fixation on the same day. Although she could not walk and was depressed, she was discharged on the ninth postoperative day. However, on the eleventh postoperative day, she returned to our emergency department with complaints of dyspnea and cold sweat. Her serum D-dimer level was 19.0 μg/dl, troponin T was positive, and urgent contrast computed tomography scan of her thorax revealed thrombosis in the bilateral main pulmonary artery. She was diagnosed with pulmonary thromboembolism and admitted to our hospital again. On the second admission, although she had breathing problems, she did not require a respirator. Oxygen was supplied as well as anticoagulants. On the seventh day after being diagnosed with embolism, thrombosis in the bilateral main pulmonary arteries had disappeared.
  
  
  CONCLUSIONS
  The patient did not have any "strong" risk factors as reported in the Japanese Orthopedic Association Clinical Practice Guideline on the Prevention of Venous Thromboembolism in Patients Undergoing Orthopedic Treatments. In general, upper extremity operation carries a low risk for pulmonary thromboembolism. For patients with decreased activity of daily living and depression, we should consider postponing discharge and performing rehabilitation until activity of daily living is improved.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Igeta
authors.affiliation: Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan. knaito@juntendo.ac.jp.
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Naito
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Sugiyama
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kaneko
authors.forename: Osamu
authors.initials: O
authors.lastname: Obayashi
mesh_terms: D000058:Accidental Falls; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001510:Bed Rest / Q000009:adverse effects* / Q000523:psychology; D001860:Bone Plates; D003131:Combined Modality Therapy; D003646:Debridement; D003863:Depression / Q000150:complications; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000601:surgery*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009104:Multiple Trauma / Q000601:surgery*; D010102:Oxygen Inhalation Therapy; D010359:Patient Readmission; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D011885:Radius Fractures / Q000601:surgery*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin