title: Thromboembolic events are uncommon after open treatment of proximal humerus fractures using aspirin and compression devices.
abstract: BACKGROUND
  Thromboembolic phenomena have long been recognized as a major cause of morbidity and mortality in hospitalized patients, especially those undergoing reconstructive surgery. We have been empirically treating patients with aspirin, early ambulation, and mechanoprophylaxis after operative management of proximal humerus fractures. However, we have not established the incidence of postoperative deep vein thrombosis and pulmonary embolism in this population.
  
  
  OBJECTIVE
  We determined the incidence of deep vein thrombosis and pulmonary embolism in patients having surgery for displaced proximal humerus fractures treated with our thromboprophylactic regimen.
  
  
  METHODS
  We prospectively followed 50 patients with proximal humerus fractures who underwent fixation with plate osteosynthesis (n = 40) or hemiarthroplasty (n = 10) between August 2005 and December 2008. Deep vein thrombosis prophylaxis consisted of oral enteric-coated aspirin, pneumatic calf compression pumps, and early ambulation in all patients unless medically contraindicated. Color-flow Doppler ultrasound of the affected arm and both lower extremities was performed at a mean of 14 days (range, 7-21 days) postoperatively to evaluate for deep vein thrombosis. All patients clinically suspected to have suffered a pulmonary embolism underwent a CT angiogram.
  
  
  RESULTS
  We identified no patients with deep vein thrombosis or pulmonary embolism in this population.
  
  
  CONCLUSIONS
  Deep vein thrombosis and pulmonary embolism are not uncommon after major reconstructive surgery about the shoulder in untreated patients. Our data suggest these events can be low after surgery for proximal humerus fractures followed by a thromboprophylactic regimen including aspirin, mechanical devices, and early mobilization.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: University of Pennsylvania Health System, 3B Orthopaedics, Pennsylvania Hospital/Lankenau Hospital, 800 Spruce Street, 8th Floor Preston, Philadelphia, PA 19107, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Widmer
authors.forename: Rocco
authors.initials: R
authors.lastname: Bassora
authors.forename: William J
authors.initials: WJ
authors.lastname: Warrender
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abboud
mesh_terms: D001241:Aspirin / Q000627:therapeutic use*; D015897:Comorbidity; D004434:Early Ambulation; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D015994:Incidence; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control; D012784:Shoulder Fractures / Q000453:epidemiology / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin