Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: General Orthopaedics
Abstract number: 23384
FATAL ACUTE PULMONARY EMBOLISM FOLLOWING CONSERVATIVELY
MANAGED ACHILLES TENDON RUPTURE
Santosh VENKATACHALAM, Kenneth WRIGHT
University Hospitals North Durham, Newcastle (UNITED KINGDOM)
Tendoachilles ruptures are commonly encountered in the orthopaedic/sports
medicine practice. We report a rare case of fatal pulmonary embolism (PE) following
conservatively treated tendoachilles rupture. A 34 year old healthy young adult male
presented inability to weight bear while playing football. He was a non smoker and no
previous history of DVT/risk factors. Clinical examination confirmed tendoachilles
rupture. He preferred non operative treatment and was given A/K cast for 2 weeks
and then planned for B/K plaster for 2 weeks. He presented 10 days later
complaining that plaster felt tight. His calf was soft, non tender with no increase in
girth. He was given a new below knee plaster. He represented 4 days later
complaining of some breathlessness. Examination revealed no DVT signs/
tachypnoea/reduced oxygen saturation. He was getting some chest pain
occassionally and felt it was secondary to using axillary crutches causing pectoral
muscle strain. In view of his symptoms, D dimers, Chest radiograph and ECG were
organised and was referred to physicians. Calf doppler revealed a popliteal vein
thrombus. D dimers were high with normal clotting profile, ECG and chest
radiograph. He was treated empirically for PE with therapeutic enoxaparin and CT
angiogram was organised next day. That evening, he had cardiopulmonary arrest
and resuscitation attempts failed. Postmortem revealed a massive pulmonary
embolus at the bifurcation of pulmonary vessels. Our case report highlights the
importance of keeping DVT/PE as possible diagnosis in patients with cast inspite of
absence of risk factors.
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