Coroner's Finding: Combes, Margot Janeece

47y · Female·pulmonary thromboembolus

A 47-year-old nurse suffered a workplace fall resulting in a left ankle fracture requiring below-knee immobilisation. She was managed conservatively with a temporary cast for one week, then a permanent plaster cast applied. Seven days after cast removal, she developed a fatal pulmonary embolism while at home. The coroner found her medical care was of good standard. However, the case highlights the clinical lesson that patients requiring below-knee immobilisation with additional risk factors—particularly morbid obesity—warrant individualised risk assessment for thromboprophylaxis. While anticoagulation debate exists in the literature, high-risk patients may benefit from pharmacologic prophylaxis. The coroner recommended clinicians apply individualised DVT/PE risk assessment in each case of below-knee immobilisation, rather than a one-size-fits-all approach.