Clinical Snapshot
The Successful Prevention of a Thromboembolic Event with an Inferior Vena Cava Filter in a Patient with Fracture-Dislocation of the Tibial Head
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A man in his forties sustained an open fracture of the tibial shaft and head (AO 41C3.3) due to crushing by a metal plate weighing 300 kg. A compartment syndrome developed. He was treated with closed repositioning, provision of an external fixation system spanning the knee joint, and dermatofasciotomy. After consolidation of the soft tissues, secondary wound closure, and antithrombotic prophylaxis, an ultrasound examination before definitive osteosynthesis revealed deep venous thrombosis. The authors’ previous studies suggest that the symptoms of thrombosis are often misinterpreted as consequences of the trauma itself and can lead to unexpected thromboembolic disease, particularly perioperatively. In accordance with our interdisciplinary SOP, the patient was therapeutically anticoagulated with tinzaparin for ten days. Control duplex ultrasonography thereafter revealed persistent thrombosis, and a risk-benefit analysis yielded an indication for the temporary implantation of an inferior vena cava filter, which was then performed. The patient went on to undergo definitive osteosynthesis, followed by removal of the filter on postoperative day 1. A large thromboembolic conglomerate was found in the filter (Figure). We view this as proof that a potentially life-threatening pulmonary embolism was successfully prevented.
Dr. med. Simon Yacoub, Prof. Dr. med. Christian Kleber, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, simon.yacoub@medizin.uni-leipzig.de
Dr. med. Katja S. Mühlberg, Klinik und Poliklinik für Angiologie, Universitätsklinikum Leipzig
Conflict of interest statement: The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, M.D.
Cite this as: Yacoub S, Mühlberg KS, Kleber C: The successful prevention of a thromboembolic event with an inferior vena cava filter in a patient with fracture-dislocation of the tibial head. Dtsch Arztebl Int 2025; 122: 454. DOI: 10.3238/arztebl.m2025.0075
