Rate of Venous Thromboembolism after Complex Lower-Limb Fracture Surgery without Pharmacological Prophylaxis

Abstract

Purpose. To evaluate the rate of venous thromboembolism (VTE) after complex lowerlimb fracture surgery without pharmacological prophylaxis. Methods. Between July 2005 and April 2009, 11 men and 6 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 3 femoral and 20 tibial fractures. Patients were screened for VTE using contrastenhanced computed tomography (CT) when the D-dimer value was beyond normal range. Between May 2009 and December 2012, 18 men and 4 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 8 femoral and 20 tibial fractures. Patients were routinely screened for deep vein thrombosis (DVT) using ultrasonography and for pulmonary embolism (PE) using contrast-enhanced CT (in high-risk patients with multiple injuries or pelvic and acetabular fractures). In both groups, pharmacological prophylaxis was not Rate of venous thromboembolism after complex lower-limb fracture surgery without pharmacological prophylaxis used; only mechanical prophylaxis was used.Results. The 2 groups were comparable in terms of age, sex, and proportion of bilateral external fixation, open fracture, and associated injury, except that the duration of external fixation was longer in the early group (29.8±28.0 vs. 11.6±4.0 days, p=0.001). Of the 17 patients in the early group, 5 developed VTEs (3 DVTs and 2 PEs) at a mean of 13.6 (range, 6-20) days after injury; 2 of whom developed VTE during the external fixation period. Of the 22 patients in the later period, 10 developed VTEs (10 DVTs and 4 PEs) at a mean of 13 (range, 5-33) days after injury; 7 of whom developed VTE during the external fixation period. Conclusion. The rate of VTE was high in patients undergoing complex lower-limb fracture surgery without pharmacological prophylaxis.

Perioperative symptomatic venous thromboembolism after immediate chemoprophylaxis in patients with pelvic and lower-extremity fractures

“…Goel et al performed a randomised controlled trial of treating 238 patients who had undergone operative fixation for fractures of below-the-knee lower extremity with placebo or low-molecular-weight heparin (LMWH) and reported no significant difference in the incidence of DVT (8.7% in LMWH group vs 12.6% in placebo group) as detected by screening venography 17 . Niikura et al studied the rate of VTE after complex lower-extremity fracture surgery consisting of temporary external fixator application followed by definitive internal fixation, and found a high incidence of VTE (38.5%, 15 out of 39 patients) was detected by contrast-enhanced CT without pharmacological prophylaxis, although no PEs were fatal 18 . In the present study, pelvic and lower-extremity fractures were assessed for symptomatic VTEs.…”

“…Because DVT in the pelvis and lower extremities proximal to the popliteal artery is the most frequent source of emboli in the pulmonary artery 30 , fracture location was further classified as proximal to the fracture in an area proximal to a knee joint (e.g., acetabulum, pelvis, and femur) and as distal when the fracture was limited to an area distal to a knee joint (e.g., tibia and ankle). The injury severity score (ISS) scale was used to represent the severity of the injuries, which were categorised as mild (<9), moderate (9-15), or severe (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) 38 . Gustilo open-fracture classification was used to grade open fractures 39 .…”

“…Prophylaxis of VTE is based mainly on physical therapy and chemotherapy [11][12][13][14] , and chemotherapy is more efficacious than physical therapy in terms of lowering the incidence of VTE 15 . Most studies of the incidence of VTE in post-traumatic patients include various patterns and severity of trauma, and it is difficult to estimate the true incidence of VTE in specific types of fractures or provide an optimal guideline for prophylaxis of VTE in this subgroup of patients [16][17][18] . Furthermore, identification of risk factors has proven useful in defining high-risk patients and corresponding prophylaxis appears mandatory for all trauma patients.The purpose of this study was to investigate the incidence of symptomatic VTE after chemoprophylaxis in patients with pelvic and lower-extremity fractures.…”

Risk of Venous Thromboembolic Events in Patients with Osteonecrosis of the Femoral Head Undergoing Primary Hip Arthroplasty

“…Endothelial cell injury or dysfunction is well known as one of the fundamental risk factors for venous thromboembolic events (VTE) [17]. Undoubtedly, surgery, especially of lower extremities, substantially increases the risk of VTE [18]. Hence, anticoagulant or intermittent pneumatic compression for thromboprophylaxis in patients receiving surgery to reduce perioperative thromboembolism is recommended by clinical guidelines [19].…”

Comparison of clear effect and the complications, and short and mid-term effects between ultrasound-guided and non-guided catheter-directed thrombolysis in the treatment of deep venous thrombosis of lower extremity

“…7 , 8 The diagnostic accuracy of color Doppler ultrasound on DVT is higher than 95%. 9 Peripheral DVT can be diagnosed by experienced doctors by compressing the probe to check if the blood vessels are deformed. If there is no blood flow in blood vessels under CDFI it can almost diagnose lowerI extremity venous thrombosis.…”