Incidence of DVT and PE after surgical reconstruction for pelvic and acetabular fractures: Does routine duplex scanning affect management?

Elnahal, Walid A.; Bassett, James; Acharya, Mehool; Chesser, Tim; Ward, Anthony J. I.

doi:10.1007/s00590-020-02795-z

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…The overall rate of DVT and PE in our institution has been published before as 3% each. 7 These results were comparable with the previously published cohort treated by conventional plates. 6 The overall number of nerve dysfunction was 14 patients, 11 of them were LFCN palsy.…”

Section: Discussionsupporting

confidence: 89%

“…The standard practice of the department, including preoperative workup, surgical approach, and postoperative care, has been well documented previously. 6,7 The only difference in our practice in this series was the routine use of the approach-specific acetabular fixation system and anatomical precontoured plates. The AIP approach was the standard for all fractures; the decision to extend using lateral and/or middle window of ilioinguinal was decided intraoperatively based on the ability to achieve anatomical reduction.…”

Section: Methodsmentioning

confidence: 99%

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Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up

Khalefa

Nahal

Karim

et al. 2022

Journal of Orthopaedic Trauma

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Patients and intervention:A consecutive series of acetabular fractures treated using only anterior approach and anatomical plates, at one tertiary specialist unit, were reviewed. The fracture patterns, incisions used, intraoperative and postoperative complications, reduction achieved (measured on postoperative radiographs and computed tomography scans), and early postoperative results (minimum 1-year follow-up) were recorded.Main Outcome measurement: Postoperative reduction (measured by postoperative plain radiographs and computed tomography).Results: Thirty-three patients (mean age, 57 years) underwent reconstruction with the anatomical plates using anterior approaches. Associated both columns and anterior column posterior hemitransverse represented most of the patients (85%). The fracture pattern was complex with quadrilateral plate involvement in 79% of cases. Overall, anatomic reduction was seen in 82% on plain radiographs and CT scan evaluation. Increasing age was a statistically significant variable in obtaining anatomical reduction with an age cutoff value of 70 years (P 0.012). Associated both column fractures were associated with a lower incidence of anatomical reduction (P = 0.038). Complication rates were comparable with the literature. 22 patients (71%) were symptom free, with 20 patients (62.5%) having excellent radiographic outcomes at the latest follow-up. Conclusions:The results suggested that using approach-specific instruments and anatomical plates through anterior approaches in a specialized unit led to anatomical reconstruction in 82% with patients demonstrating satisfactory early radiological and functional outcomes at 1 year.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up

Khalefa

Nahal

Karim

et al. 2022

Journal of Orthopaedic Trauma

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“…A retrospective analysis involving 212 patients with a pelvic or acetabular fracture showed a similar preoperative incidence of DVT (3.4% vs 3.1% in this study), but with a lower postoperative incidence (3.3% vs 22%), which is hard to explain. 19 some authors have reported the detection of proximal thrombi using DUS. Wang et al 7 reported 21 proximal DVTs out of a total of 32 DVTs in 110 patients, Moed et al 17 reported 35 proximal dvts out of a total of 229 patients undergoing surgery for a pelvic fracture, Ostrowka et al 5 reported two proximal dvts out of a total of three in a cohort of 120 patients with a pelvic fracture, and elnahal et al 19 found two preoperative and three postoperative proximal DVTs, out of a total of nine DVTs in 212 patients.…”

Section: Discussionmentioning

confidence: 99%

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

Cerbasi¹,

Bernasconi

Balato

et al. 2022

The Bone & Joint Journal

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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.

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“…For non-major orthopaedic surgery in the lower limb, included achilles tendon repair, surgery involving the tibial plateau or femoral diaphysis, tibial or ankle fractures or tibial osteotomy, arthrodesis of the knee, ankle, or hindfoot, among others, symptomatic DVT rates have resulted in 0,66% with the use enoxaparin or rivaroxaban 327 .Acetabular or pelvic reconstruction in a major trauma has an overall symptomatic DVT rate of 4% using low-molecular-weight heparin (LMWH) 328 .…”

Section: - Do All Orthopaedic Procedures Have the Same Risk Profile F...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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Incidence of DVT and PE after surgical reconstruction for pelvic and acetabular fractures: Does routine duplex scanning affect management?

Cited by 8 publications

References 15 publications

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up

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

Recommendations from the ICM-VTE: General

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