Deep-vein thrombosis in high-energy skeletal trauma despite thromboprophylaxis.
We report the incidence and location of deep-vein thrombosis in 312 patients who had sustained high-energy, skeletal trauma. They were investigated using magnetic resonance venography and Duplex ultrasound. Despite thromboprophylaxis, 36 (11.5%) developed venous thromboembolic disease with an incidence of 10% in those with non-pelvic trauma and 12.2% in the group with pelvic trauma. Of patients who developed deep-vein thrombosis, 13 of 27 in the pelvic group (48%) and only one of nine in the non-pelvic group (11%) had a definite pelvic deep-vein thrombosis. When compared with magnetic resonance venography, ultrasound had a false-negative rate of 77% in diagnosing pelvic deep-vein thrombosis. Its value in the pelvis was limited, although it was more accurate than magnetic resonance venography in diagnosing clots in the lower limbs. Additional screening may be needed to detect pelvic deep-vein thrombosis in patients with pelvic or acetabular fractures.
University of Alabama at Birmingham Hospitals, 510 S 20th St., FOT 960 Birmingham, Alabama 35294-3409, USA. James.Stannard@ortho.uab.edu
J P
JP
Stannard
A K
AK
Singhania
R R
RR
Lopez-Ben
E R
ER
Anderson
R C
RC
Farris
D A
DA
Volgas
G R
GR
McGwin
J E
JE
Alonso
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries; D017984:Enoxaparin / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging; D010388:Pelvis / Q000000981:diagnostic imaging / Q000293:injuries; D010690:Phlebography / Q000379:methods; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D013314:Stress, Mechanical; D018608:Ultrasonography, Doppler / Q000379:methods; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
D017984:Enoxaparin; D005343:Fibrinolytic Agents