Case Report
Year: 2021 | Month: October-December | Volume: 6 | Issue: 4 | Pages: 42-51
DOI: https://doi.org/10.52403/ijshr.20211007
High D-dimer Level in Fracture Patient with Asymptomatic Covid-19: Dilemmatic Surgery Decision-A Serial Case Report
I Made Wira Kusuma1, I Made Iman Antariksa2, Ida Bagus Gde Darma Wibawa2, Made Wahyu Dharmapradita2, Kadek Yuris Wira Artha2, Ni Gst Putu Arini Junita Putri Kardinal3
1Intern of Orthopaedic and Traumatology Department, Mangusada Hospital.
2Orthopaedic and Traumatology Specialist of Orthopaedic and Traumatology Department, Mangusada Hospital.
3Consultant of Hematology and Oncology, Internal Medicine Departement, Mangusada Hospital.
Corresponding Author: I Made Wira Kusuma
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.