Rare acute pulmonary thromboembolism after internal fixation for isolated multiple rib fractures: a case report

Abstract Background Multiple rib fractures are common in emergency trauma patients with high mortality. Acute pulmonary thromboembolism (PTE) is rare and has not been reported in patients with isolated multiple rib fractures after surgical stabilization of rib fractures (SSRF). We report a case of a 64-year-old patient presenting with PTE after SSRF due to non-standardized anticoagulant therapy; it should attract enough attention from thoracic surgeons. Case presentation A 64-year-old male was admitted to our hospital with multiple rib fractures, pulmonary contusion, bilateral pleural effusion, and incomplete right lung expansion. The patients were treated on the sixth day of their hospitalization with thoracoscopic exploration combined with internal fixation of the right fracture of the sixth to eighth ribs. He started anticoagulant therapy 48 h after the operation to prevent deep vein thrombosis with low molecular weight heparin 2500 units once daily. He gradually recovered from the operation, and his symptoms improved. The patient was diagnosed with acute PTE based on pulmonary artery angiography of CT on the fourth day after surgery; since that time, he has been treated with a subcutaneous injection of 60 mg enoxaparin every 12 h. After two weeks of anticoagulant therapy, they were discharged from the hospital and continued to receive oral anticoagulant therapy. The patient was followed up for three months after discharge, and everything was normal. Conclusion Acute PTE after isolated multiple rib fractures is rare; although SSRF is a relatively safe and effective treatment for multiple rib fractures with dislocation, perioperative deep vein thrombosis, including PTE and deep vein thrombosis, should be given sufficient attention by clinicians. The standardized prevention of perioperative venous thromboembolism for multiple rib fractures requires further research due to the lack of high-quality clinical evidence support.