Bilateral pulmonary emboli after elective elbow arthroscopy: a case report

Abstract

Elbow arthroscopy is an expanding area of upper extremity orthopedic surgery. As the evidence supporting the utility of elbow arthroscopy continues to accumulate, the indications for and complexity of the procedures continue to increase. Despite this, relatively little has been published on complications related to arthroscopic elbow surgery. A recent systematic review of available retrospective case series noted the overall complication rate for arthroscopic procedures involving the elbow to range from 6% to 11%. The associated complications include neurovascular injury, compartment syndrome, intra-articular infections, articular cartilage damage, synovial fistula, loss of motion, instrument breakage, and tourniquet-related complications. The work of Dattani et al focused on complications of venous thromboembolism (VTE) in shoulder and elbow surgery. They found that 0.25% of elbow arthroplasty is complicated by VTE, but they found no studies reporting on elbow arthroscopy complicated by VTE. A prospective study by Takahashi et al found the incidence of clinically asymptomatic deep venous thrombosis (DVT) in patients undergoing shoulder arthroscopy to be 5.7%; no patients in that study were determined to have a symptomatic DVT or pulmonary embolism. In a large retrospective review, the work of Kuremsky and colleagues showed the incidence of symptomatic VTE (DVT and pulmonary embolism) after arthroscopic shoulder surgery to be 0.31%. In other areas of orthopedic surgery, particularly hip and knee arthroplasty and lower extremity fracture care, VTE is