A systematic review of thromboprophylaxis for pelvic and acetabular fractures.
OBJECTIVE
Pelvic and acetabular fractures have been identified as risk factors for deep venous thrombosis (DVT) and thromboembolic complications. A systematic review was performed to evaluate the effectiveness of thromboprophylactic strategies to prevent DVT or pulmonary embolism (PE) after pelvic or acetabular fractures.


METHODS
Relevant articles were identified by searching MEDLINE, MEDLINE In Process & Other Non-indexed Citations, EMBASE, CENTRAL, and the Cochrane Database of Systematic Reviews. All languages and years indexed were searched.


METHODS
Manuscripts were included if (1) the study included an intervention or strategy aimed at preventing thromboembolic disease, (2) the subjects in the study had suffered a pelvic or acetabular fracture, and (3) the primary outcome of the study was DVT or PE.


METHODS
The intervention, sample size, DVT, and/or PE incidence, and method of diagnosis were recorded for each study.


RESULTS
Eleven studies with 1760 subjects were included. Included studies were grouped into 5 types of interventions: mechanical compression devices, inferior vena cava filters, low-molecular weight heparins, ultrasound screening, and magnetic resonance venography screening. Most studies were observational designs with minimal control data for comparison. Quantitative pooling was not possible based on significant study heterogeneity.


CONCLUSIONS
Although several strategies have been used to prevent thromboembolism in pelvic and acetabular fracture patients, our results suggest that clinicians have limited data to guide their prophylactic decisions. Well-designed clinical trials to prevent and detect venous thromboembolism in pelvic and acetabular trauma are still needed.
Slobogean
Gerard P
GP
Department of Orthopaedics, University of British Columbia, BC, Canada.
Lefaivre
Kelly A
KA
Nicolaou
Savvas
S
O'Brien
Peter J
PJ
D000077:Acetabulum / Q000293:injuries*; D015897:Comorbidity; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010384:Pelvic Bones / Q000293:injuries*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents