Objective: Venous thromboembolism is an important complication of major orthopedic surgery. The aim of present study was to investigate the efficacy of the currently used thromboprophylaxis protocol, determine the incidence of VTE post operatively and the risk factors behind it in patients undergoing major orthopedic surgery. Methods: A retrospective descriptive study for 403 patients underwent major orthopedic surgery from July 2013 to July 2014 in main hospitals in Khartoum state where major orthopedic surgery performed. Data were collected using observation checklist and analyzed using SPSS version 22 to study the association between the type of surgery, patient’s risk factors, choice and duration of thromboprophylaxis and development of VTE after major orthopedic surgery. Results: Total 403 patients were incorporated the study, 2.73% were diagnosed with DVT developed within 5 days post operatively. 1.64% of the patients not received any type of thromboprophylaxis, 0.27% wore compression stocking. Pharmacological methods were used in the rest of the patients, 96.72% administered to them enoxaparine. 75.95% of the patients presented with one or more than one risk factors for VTE other than the orthopedic surgery. 4% of patients received thromboprophylaxis for more than 14 days while 96% received it for 3-5 days. The incidence of DVT was higher in diabetic patients (p- value= 0.03) and hypertensive (p- value= 0.046) who aged ≥60 years. Conclusion: Results showed that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis and the incidence was 2.73% in our study. Peer Review History: Received 13 June 2020; Revised 25 June; Accepted 6 July, Available online 15 July 2020 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Name: Dr. Michael Otakhor Erhunmwunse Affiliation: St. Philomena Catholic Hospital, Nigeria E-mail: dedoctor4life@gmail.com   Name: Francesco Ferrara  Affiliation: USL Umbria 1, Pharmacy Department, Perugia, Italy E-mail: francesco.ferrara@uslumbria1.it   Comments of reviewer(s): Similar Articles: PREVALENCE OF CYTOMEGALOVIRUS IGG ANTIBODIES, POTENTIAL RISK FACTORS AND AWARENESS OF CONGENITAL CYTOMEGALOVIRUS AMONG FEMALE DOCTORS