High D-dimer Level in Fracture Patient with Asymptomatic Covid-19: Dilemmatic Surgery Decision - A Serial Case Report

Abstract

Introduction: SARS-CoV-2 is highly transmittable virus. D-dimer associated with high fatality rate in COVID-19 with pneumonia and fractures. COVID-19 make surgical decision more challenging. Thrombosis plays an important mechanism in severity of COVID-19 and could be measured through D-dimer level. Case illustrations: We report 4 fracture cases with asymptomatic COVID-19. 1st case diagnosed close fracture in right 1/3 distal cruris without pneumonia, D-dimer 2420 ng/dl. Surgery 20 days after trauma with decreased D-dimer level. 2nd case, was diagnosed with close fracture in the left cruris and right 1/3 middle of clavicle with pneumonia, D-dimer level 6670 ng/dl, decision obtained in 27 days after hospitalization with decreased D-dimer. 3rd case diagnosed open fracture in left 1/3 distal humerus with pneumonia, D-dimer level 1020 ng/dl. Surgery 32 days after trauma with decreased D-dimer. 4th case diagnosed open fracture in left 1/3 proximal humeral and left medial phalanx index finger with pneumonia. The D-dimer level 2830 ng/dl. Surgery was obtained 17 days after trauma with decreased D-dimer. Discussion: Pandemic creates gray zone in orthopedic surgery. D-dimer found increased in COVID-19 and fracture patients. Asymptomatic case can be operated on 10th day post positive result as long as the general condition is optimal. D-dimer also important in making the decision to perform surgery. D-dimer over 2500 ng/mL have greater risk for being VTE in fracture patients. Conclusion: The pandemic has creates a large gray zone. The strategies for decision making includes general condition and severity COVID-19 also D-dimer level. Keywords: D-dimer, COVID-19, Fracture, Surgery.