Disseminated intravascular coagulation following femoral nailing in a metastatic prostate carcinoma patient – A case report

INTRODUCTION: Disseminated intravascular coagulation (DIC) is a rare condition that is known to affect patients with metastatic prostate adenocarcinoma. In an unsuspecting orthopaedic surgeon, DIC could lead to significant morbidity and mortality. This article highlights another such case and discusses management strategies to help improve clinical outcomes for these patients. CASE: A 70-year-old male with metastatic prostate adenocarcinoma underwent prophylactic intramedullary nailing of an impending right femur pathological fracture. Surgery was uneventful, however postoperatively he was haemodynamically unstable with heavily soaked dressings. Laboratory investigations revealed DIC. Supportive treatment and correction of coagulopathy were undertaken. Ketoconazole was also initiated by Urology Services to treat the underlying condition of metastatic prostate carcinoma. Unfortunately, the patient responded poorly and passed away. CONCLUSION: DIC is rarely encountered in orthopaedic surgery, but carries significant morbidity and mortality risks. Patients with risk factors, in particular metastatic cancer, should be screened for non-overt pre-DIC state and coagulopathies corrected preoperatively. Initiating treatment of underlying condition can be considered preoperatively in established non-overt DIC. Operative technique can also be modified to minimise risk of fat or tumour emboli. Early recognition, prompt resuscitation and timely treatment of underlying condition may be able to improve the outcomes in these patients.