TITLE:
Fatal pulmonary embolism after surgery for a clavicle fracture: A case report
AUTHORS:
Shogo Sobue, Takefumi Kaketa, Katsutoshi Noike, Toshihito Onda, Yoshimasa Tomita, Sung Gon Kim, Masahiko Nozawa
KEYWORDS:
Pulmonary Embolism; Clavicle Fracture
JOURNAL NAME:
Open Journal of Clinical Diagnostics,
Vol.2 No.4,
December
7,
2012
ABSTRACT: Patients undergoing upper extremity surgery generally have a low risk of pulmonary embolism. We encountered a rare case of fatal pulmonary embolism after surgical treatment of a clavicle fracture. A 46-year-old man fell off the roof of his car and suffered fractures of the left clavicle, temporal bone and ribs, as well as cerebral and lung contusions. He was admitted to a local hospital, and was later transferred to our hospital for surgical treatment of the clavicle fracture at 6 days after injury. He had no dyspnea and was ambulant. On day 7 after the injury, open reduction and internal fixation of the clavicle fracture using a plate and screws were performed under general anesthesia. Although surgery was uneventful, the patient had bradycardia postoperatively that progressed to cardiopulmonary arrest, which required resuscitation and intubation. Spontaneous cardiac output was restored 10 minutes after cardiac arrest, but the GCS score was E1V1M2. Enhanced CT of the chest revealed a 15 mm defect in the right pulmonary artery, leading to a diagnosis of pulmonary embolism. Thrombolytic therapy was started immediately. However, the patient’s condition worsened and he died 20 days postoperatively. We suggest that use of mechanical and chemical thromboprophylaxis should be considered for clavicle surgery.