gms | German Medical Science

Objectives: Desaturation after nailing procedures of long bones is a well-known potential postoperative complication, which has been described since the introduction of nailing. As reaming has become more popular, the incidence of fat embolism increased, including in young, healthy individuals.

Nonetheless, other differential diagnosis of desaturation after nailing procedure exist and should be taken into consideration.

Methods: We report on the case of a 17 year old, healthy female patient with a fractured proximal femur in August 2022 following a motorbike accident. The patient was 3x vaccinated against Covid-19.

The temperature on admission was of 37.6° C and the patient had no signs of dyspnoea.

The patient is from a farming community and was haying with her family the whole day in mid summer temperatures of around 34°C. Therefore, we did not think the low grade fever was infect-related on admission.The patient had no symptoms of Covid.

Nonetheless, due to the ongoing pandemic a Covid Swab was done, which returned positive on the late evening of the 1st postoperative day.

The fracture was treated immediately during the night after the accident with intramedullary nailing without intraoperative complications. Haemoglobin on first postoperative day 90 g/l, praeop 120 g/l. The surgery was closed reduction and nailing with minimal blood loss (100 ml).

The patient was still symptom-free and well in the morning of the first postoperative day; she developed low blood pressure (86/53 mmHg) and tachycardia of 116 BPM during mobilisation in the first postoperative day. The first incident of desaturation was registered during physical effort; then again at rest when trying to take her off the oxygen, the patient showed also significantly low O2 saturation (below 80%).

After her ongoing discomfort, dyspnoea and desaturation we decided to rule out pulmonary embolism via CT-angiography of the thorax instead of testing arterial blood gases.

The CT-angiography showed significant ground-glass-opacity like lesions leading to COvid pneumonia as the reason for desaturation and dyspnoea.

The patient was then put on oral steroids for 4 days (Dexamethason 6mg per day) while in hospital and reduced dose for another 4 days while at home. She was discharged as soon as the surgical site was dry and the saturation did not drop below 90% without oxygen.

The healing of the fracture after this incident was uneventful.

Results and conclusion: In the current pandemic situation, desaturation after nailing should still keep us looking for pulmonary embolism, but even in young, healthy, vaccinated patients it also could be the first symptom of an otherwise asymptomatic COVID infection.