Symptomatic venous thromboembolism following circular frame treatment for tibial fractures

Vollans, S.R.; Chaturvedi, Ashutosh; Sivasankaran, K; Madhu, T.; Hadland, Y; Allgar, Victoria; Sharma, Hemant

doi:10.1016/j.injury.2015.04.003

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…4) However, these recommendations were only for those undergoing LE procedures, and there is no recommendation for patients with isolated UE fractures. Although VTE is thought to be rare in the setting of UE fractures, these incidence rates are comparable to those documented in other injuries in patients who received thromboprophylaxis, including those with isolated fractures of the UE (overall rate of 1.2%), 9) proximal humerus (0.64%), 10) hip (2.2%-2.6%), 9,11) pelvis (0.7%-4.2%), 9,12) tibia (1.1%-6.9% with circular frame treatment), 13) ankle (0.22%, PE only), 14) and vertebra (3.6%). 12) Incidence rates at the authors' institution may be higher than those in the NSQIP database because this large tertiary center may treat patients with more comorbidities and more severe trauma.…”

Section: Discussionsupporting

confidence: 61%

Venous Thromboembolism in Upper Extremity Fractures

Nayar

Kuwabara

Flores

et al. 2018

J Hand Surg Asian-Pac Vol

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Background: Venous thromboembolism (VTE) has been studied in lower extremity fractures but little is known of its relation with upper extremity (UE) fractures. As an often overlooked but serious complication, VTE may compromise patient outcomes. Methods: Using data on inpatients (aged ≥ 18 years) at a level-I trauma center and patients in the National Surgical Quality Improvement Program database who sustained UE fractures (clavicle, humerus, or radius/ulna) and VTE in the same hospitalization between 2007 and 2014, the authors analyzed data on demographic characteristics, fracture type, VTE location (pulmonary embolism, lower extremity, or UE), VTE onset, polytrauma, operative or nonoperative management, comorbidities, and mortality.Results: Of 1984 inpatients with UE fractures at 1 instution, 9 experienced VTE on admission, and 17 (15 received thromboprophylaxis) experienced VTE during hospitalization, for an overall VTE rate of 1.3%. VTE occurred most often in patients with fractures of the proximal humerus (3.0%) followed by the clavicle (2.0%), midshaft humerus (1.9%), distal radius/ulna (0.95%), and distal humerus/elbow (0.36%) (p = 0.0035). There were no significant trends in the incidence of PE (p = 0.33) over the study period, but there was a sharp rise since 2011. In the national database, 42 of 11570 (0.36%) patients with UE fracture had VTE, with incidence by fracture location ranging from 0.14% (radius/ulna) to 0.98% (proximal humerus) (p = 0.00001). Predictors were chronic steroid use (odds ratio [OR] = 6.22, p = .030), inpatient status (OR = 4.09, p = .002), and totally disabled functional status (OR = 3.31, p = .021). Conclusions: VTE incidence was highest following proximal humerus or clavicle fractures and are rarely associated with radius/ ulna fractures. There may have been a rise in the incidence of PE since 2007, warranting further investigation.

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Section: Discussionsupporting

confidence: 61%

Venous Thromboembolism in Upper Extremity Fractures

Nayar

Kuwabara

Flores

et al. 2018

J Hand Surg Asian-Pac Vol

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“…In non-operative fractures, literature from emergency medicine suggests that immobilization combined with non-weight-bearing are a risk factor for VTE events, but the quality of the evidence is low 402,403 . In orthopaedic trauma, limited evidence suggests that weight-bearing status is not a predictor of VTE events with fracture fixation 404,405 .…”

Section: - What Is the Optimal Choice For Vte Prophylaxis Following T...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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“…Following surgery of lower limb, deep venous thrombosis (DVT) could be the potential reason of pulmonary embolism and associated morbidity and mortality in hospitalized patients especially in patients with trauma. The overall incidence of tibial shaft fracture, 16.9/1000,000/years, tibial diaphyseal fracture accounts for 40%, and tibial plateau fractures accounts for 1-2% of all adult fractures and almost 32% of periknee fractures [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors Associated with Post Tibial Plateau Fracture Deep Venous Thrombosis: A Prospective Cohort Study

Qureshi

Khan

Ali

et al. 2021

JPRI

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Objective: The purpose behind this study was to determine the incidence and risk factors associated with post tibial plateau fracture deep venous thrombosis (DVT) Materials and Methods: A prospective study was conducted in a tertiary care hospital, Indus Medical College & Hospital, Tando Muhammad Khan to recruit those patients who were undergoing orthopedic surgeries during the periods of eighteen months. All the adult patients of both gender planned for surgery due to tibial plateau fracture were enrolled under this study. Duplex ultrasound was performed to detect the presence of underlying postoperative DVT. Post-operatively patients were assessed for potential risk factors associated with higher incidence of DVT. Results: For the final analysis, 344 patients were included among them majority were males (n = 219, 63.66%) with overall mean age and SD was 47.52±12.02 years. The most common cause of fracture was road traffic accident (n = 178, 51.74%). The overall incidence of post-operative DVT observed in our study was 9.30% (n = 32). Mean age 40.19±6.10 years, increased mean duration of operation 3.01±.078 hours, increased mean duration of post-hospitalization 18.49±7.37 days, raised mean WBC counts 20.12±5.64, and increased mean D-dimer levels 3.24±3.09 (laboratory cut off value 0.5mg/L) were significantly associated with higher incidence of DVT in patients operated for tibial plateau fractures. Conclusion: This prospective analysis has identified the potential modifiable risk factors associated with DVT. Consideration should be given to the preventable and treatable risk factors to prevent from the DVT associated complications.

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Symptomatic venous thromboembolism following circular frame treatment for tibial fractures

Cited by 6 publications

References 30 publications

Venous Thromboembolism in Upper Extremity Fractures

Venous Thromboembolism in Upper Extremity Fractures

Recommendations from the ICM-VTE: Hip & Knee

Incidence and Risk Factors Associated with Post Tibial Plateau Fracture Deep Venous Thrombosis: A Prospective Cohort Study

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