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Sudden death due to pulmonary embolism after minor ankle surgery
  1. Maryam Mukhtar1,
  2. Mohsin Hamid2,
  3. Muhammad Atique Alam Khan3 and
  4. Waqas Ullah2
  1. 1 Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
  2. 2 Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
  3. 3 King Edward Medical University, Lahore, Pakistan
  1. Correspondence to Dr Waqas Ullah, waqasullah.dr{at}


Venous thromboembolism prophylaxis guidelines are clear for major orthopaedic surgeries, but data regarding ankle surgery are insufficient. Death from pulmonary embolism (PE) after ankle surgery is rare with the frequency of less than 0.037%.1 We present a case of a fatal PE after ankle surgery to raise awareness about this rare but potentially fatal complication. Our patient had a left ankle fracture status postsurgical fixation and was discharged without venous thromboembolism (VTE) prophylaxis. Twenty days later, she presented with a sudden onset of dyspnoea and palpitations and was diagnosed to have extensive right-sided PE. Intravenous heparin and thrombolytics were given, but she had multiple pulseless electrical activity arrests, developed disseminated intravascular coagulation and died. Our case depicts an unusual complication of ankle surgery and highlights the importance of considering VTE as one of the complications. Medical personnel should evaluate the need for VTE prophylaxis after ankle surgery on a case to case basis.

  • pulmonary embolism
  • orthopaedics
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  • Contributors MM and WU wrote the manuscript. MH wrote the case presentation and Muhammad Atique did the literature search.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.

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