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Case Reports
. 2021 Sep 11:36:100534.
doi: 10.1016/j.tcr.2021.100534. eCollection 2021 Dec.

Disseminated intravascular coagulation following femoral nailing in a metastatic prostate carcinoma patient - A case report

Jeremy Wei Sern Lim  1 , Wei Zhang  1 , Derek Howard Park  1 , Antony Xavier Rex Premchand  1
Affiliations
Case Reports

Disseminated intravascular coagulation following femoral nailing in a metastatic prostate carcinoma patient - A case report

Jeremy Wei Sern Lim et al. Trauma Case Rep. .

Erratum in

Abstract

Introduction: Disseminated intravascular coagulation (DIC) is a rare condition that is known to affect patients with metastatic prostate adenocarcinoma. In an unsuspecting orthopaedic surgeon, DIC could lead to significant morbidity and mortality. This article highlights another such case and discusses management strategies to help improve clinical outcomes for these patients.

Case: A 70-year-old male with metastatic prostate adenocarcinoma underwent prophylactic intramedullary nailing of an impending right femur pathological fracture. Surgery was uneventful, however postoperatively he was haemodynamically unstable with heavily soaked dressings. Laboratory investigations revealed DIC. Supportive treatment and correction of coagulopathy were undertaken. Ketoconazole was also initiated by Urology Services to treat the underlying condition of metastatic prostate carcinoma. Unfortunately, the patient responded poorly and passed away.

Conclusion: DIC is rarely encountered in orthopaedic surgery, but carries significant morbidity and mortality risks. Patients with risk factors, in particular metastatic cancer, should be screened for non-overt pre-DIC state and coagulopathies corrected preoperatively. Initiating treatment of underlying condition can be considered preoperatively in established non-overt DIC. Operative technique can also be modified to minimise risk of fat or tumour emboli. Early recognition, prompt resuscitation and timely treatment of underlying condition may be able to improve the outcomes in these patients.

Keywords: Disseminated intravascular coagulation; Femoral nailing; Metastatic cancer; Prophylactic intramedullary nailing; Prostate cancer.

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Figures

Fig. 1
Fig. 1
X-ray showing sclerotic bony metastasis in the right proximal femur and adjacent pelvis.
Fig. 2
Fig. 2
MRI of patient's right hip showing extensive metastatic involvement of the region of the head, neck, trochanters and proximal shaft of the right femur.
Fig. 3
Fig. 3
Postoperative radiograph after prophylactic surgical fixation of the right femur with the TFN-A nail and cement augmentation.
See this image and copyright information in PMC

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