Assessment of deep vein thrombosis using routine pre- and postoperative duplex Doppler ultrasound in patients with pelvic trauma

Abstract

Aims The aims of this study were to assess the pre- and postoperative incidence of deep vein thrombosis (DVT) using routine duplex Doppler ultrasound (DUS), to assess the incidence of pulmonary embolism (PE) using CT angiography, and to identify the factors that predict postoperative DVT in patients with a pelvic and/or acetabular fracture. Methods All patients treated surgically for a pelvic and/or acetabular fracture between October 2016 and January 2020 were enrolled into this prospective single-centre study. The demographic, medical, and surgical details of the patients were recorded. DVT screening of the lower limbs was routinely performed using DUS before and at six to ten days after surgery. CT angiography was used in patients who were suspected of having PE. Age-adjusted univariate and stepwise multiple logistic regression analysis were used to determine the association between explanatory variables and postoperative DVT. Results A total of 191 patients were included. A DVT was found preoperatively in 12 patients (6.3%), of which six were proximal. A postoperative DVT was found in 42 patients (22%), of which 27 were proximal. Eight patients (4.2%) had a PE, which was secondary to a DVT in three. None of the 12 patients in whom a vena cava filter was implanted prophylactically had a PE. Multivariate logistic regression analysis indicated that the association with the need for spinal surgery (odds ratio (OR) 19.78 (95% confidence interval (CI) 1.12 to 348.08); p = 0.041), intramedullary nailing of a long bone fracture (OR 4.44 (95% CI 1.05 to 18.86); p = 0.043), an operating time > two hours (OR 3.28 (95% CI 1.09 to 9.88); p = 0.035), and additional trauma surgery (OR 3.1 (95% CI 1.03 to 9.45); p = 0.045) were statistically the most relevant independent predictors of a postoperative DVT. Conclusion The acknowledgement of the risk factors for the development of a DVT and their weight is crucial to set a threshold for the index of suspicion for this diagnosis by medical staff. We suggest the routine use of the DUS screening for DVT in patients with a pelvic and/or acetabular fracture before and six to ten days after surgery. Cite this article: Bone Joint J 2022;104-B(2):283–289.

Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism

“…3 Our results revealed that mechanical injuries and traffic accidents were the main acquired factors, especially in the victims aged 40 to 59 years. Numerous clinical studies have been reported that fractures of long bones of lower limbs and pelvis are the most common fractures that contribute to deep venous thrombosis, 12,13 which was consistent with our results that lower extremity long bones and pelvic fractures were the commonest fractures related to PTE. It is worth to note that other accompanied factors, such as postinjury surgical intervention and prolonged bed rest, would also facilitate the formation of thrombus in victims with fractures.…”

Combination of Ultrasound and Molecular Markers in Evaluating Isolated Distal Deep Vein Thrombosis in Lower Limbs

“…However, it is easily influenced by factors such as vascular variation, obesity, anatomical structure, and doctors' experience, which can lead to missed diagnoses. 12,13 In recent years, researchers have begun to explore the feasibility of a combination of imaging examination and serological indicators in the diagnosis of DVT and have achieved good results. In this study, patients with IDDVT were examined using a combination of the Doppler ultrasound and the thrombus molecular markers.…”

“…Color Doppler ultrasound is the most common examination method in diagnosing DVT clinically as it is non‐invasive, safe, low‐cost, has good repeatability, and is convenient for observing the development of the disease. However, it is easily influenced by factors such as vascular variation, obesity, anatomical structure, and doctors' experience, which can lead to missed diagnoses 12,13 . In recent years, researchers have begun to explore the feasibility of a combination of imaging examination and serological indicators in the diagnosis of DVT and have achieved good results.…”