title: Symptomatic venous thromboembolism following circular frame treatment for tibial fractures.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a significant cause of morbidity and mortality following tibial fractures. The risk is as high as 77% without prophylaxis and around 10% with prophylaxis. Within the current literature there are no figures reported specifically for those individuals treated with circular frames. Our aim was to evaluate the VTE incidence within a single surgeon series and to evaluate potential risk factors.
  
  
  METHODS
  We retrospectively reviewed our consecutive single surgeon series of 177 patients admitted to a major trauma unit with tibial fractures. All patients received standardised care, including chemical thromboprophylaxis within 24h of injury until independent mobility was achieved. We comprehensively reviewed our prospective database and medical records looking at demographics and potential risk factors.
  
  
  RESULTS
  Seven patients (4.0% ± 2.87%) developed symptomatic VTE during the course of frame treatment; three deep vein thrombosis (DVTs) and four pulmonary embolisms (PEs). Those with a VTE event had significantly increased body mass index (BMI) (p = 0.01) when compared to those without symptomatic VTE. No differences (p > 0.05) were observed between the groups in age, gender, smoking status, fracture type (anatomical allocation or open/closed), delay to frame treatment, weight bearing status post-frame, inpatient stay or total duration of frame treatment.
  
  
  CONCLUSIONS
  This study suggests that increased BMI is a statistically significant risk factor for VTE, as reported in current literature. In addition, we calculated the true risk of VTE following circular frame treatment for tibial fracture in our series is from 1.13% to 6.87%, which is at least comparable to other forms of treatment.
authors.affiliation: Orthopaedics, Hull Royal Infirmary, Hull, United Kingdom. Electronic address: s.vollans@me.com.
authors.forename: S
authors.initials: S
authors.lastname: Vollans
authors.affiliation: Orthopaedics, Hull Royal Infirmary, Hull, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Chaturvedi
authors.affiliation: Orthopaedics, Hull Royal Infirmary, Hull, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Sivasankaran
authors.affiliation: Orthopaedics, Hull Royal Infirmary, Hull, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Madhu
authors.affiliation: Ilizarov Nursing, Hull Royal Infirmary, Hull, United Kingdom.
authors.forename: Y
authors.initials: Y
authors.lastname: Hadland
authors.affiliation: Statistics, University of York, Health Sciences, York, United Kingdom.
authors.forename: V
authors.initials: V
authors.lastname: Allgar
authors.affiliation: Consultancy in Orthopaedic Surgery, Hull Royal Infirmary, Hull, United Kingdom.
authors.forename: H K
authors.initials: HK
authors.lastname: Sharma
mesh_terms: D015992:Body Mass Index; D018890:Chemoprevention / Q000379:methods; D005592:Fracture Fixation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013978:Tibial Fractures / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control
keywords: Deep vein thrombosis DVT; External fixation; Ilizarov; Incidence; Pulmonary embolism PE; Taylor spatial frame TSF; Tibial fracture; Venous thromboembolism VTE