Internal jugular deep venous thrombosis after surgical treatment of a humeral nonunion: a case report and review of the literature

Is the occurrence of deep vein thrombosis related to the fracture site? A two-sample Mendelian randomization study

OBJECTIVE

Deep vein thrombosis (DVT) is a known complication of fractures. This study aimed to explore the genetic causal relationship between DVT and fracture sites.

RESEARCH DESIGN AND METHODS

The exposures analyzed in this study included fracture of femur (FFE), fracture of lower leg, including ankle (FLLA), fracture of shoulder and upper arm (FSUA), fracture of forearm (FFO), fracture of rib, sternum and thoracic spine (FRSTS) and fracture of lumbar spine and pelvis (FLSP). DVT as the outcome. A two-sample Mendelian randomization (MR) approach was employed to investigate the genetic causal relationship, and a series of sensitivity analyses were conducted.

RESULTS

The findings indicated no genetic causal relationship between FFE (p = 0.569, OR 95% CI = 1.001 [0.998-1.003]), FLLA (p = 0.371, OR 95% CI = 0.999 [0.995-1.002]), FSUA (p = 0.871, OR 95% CI = 1.000 [0.998-1.002]), FFO (p = 0.281, OR 95% CI = 1.001 [0.999-1.002]), FRSTS (p = 0.346, OR 95% CI = 0.999 [0.996-1.001]) or FLSP (p = 0.759, OR 95% CI = 1.000 [0.999-1.002]) and DVT. Sensitivity analyses reinforced the robustness.

CONCLUSIONS

This study indicate that no genetic causal relationship exists between DVT and fracture site, the observed association may be attributable to non-genetic factors.

Upper-extremity deep venous thrombosis following humeral shaft fracture

Upper-extremity deep venous thrombosis (DVT), although not as common as its lower-extremity counterpart, is a clinical entity with potentially devastating complications. Approximately 1% to 4% of all DVT cases involve the upper extremity, with 9% to 14% of these cases complicated by pulmonary embolism. Prompt diagnosis with duplex ultrasonography and subsequent anticoagulation are the gold standards for identification and treatment. The majority of these cases are secondary to medical comorbidities such as malignancy, hypercoagulable states, and indwelling catheters. Although rare, several case reports of orthopedic-related upper-extremity DVT are present in the literature. This article reports a case of upper-extremity DVT in a humeral shaft fracture treated nonoperatively. A 58-year-old man presented with right elbow pain after a fall from scaffolding. Radiographs demonstrated a distal humeral shaft fracture at the tip of a previously placed intramedullary nail. Initial treatment consisted of closed reduction in a coaptation splint. The patient re-presented 4 days later with increasing forearm pain and swelling. An ultrasound revealed an extensive thrombus of the right brachial vein. A coaptation splint was replaced and the patient was admitted to the hospital for therapeutic anticoagulation. After hematology consultation and a short hospitalization, the patient was discharged home on a 3-month course of Warfarin. The goal of treatment of upper-extremity venous thrombosis is to improve the patient's acute symptoms and prevent both pulmonary embolism and post-thrombotic syndrome. Post-thrombotic syndrome is a chronic, potentially debilitating condition that occurs in approximately 15% of upper-extremity DVT cases with symptoms consisting of pain, swelling, paresthesias, and functional limitation.