Rate of venous thromboembolism after complex lower-limb fracture surgery without pharmacological prophylaxis.
OBJECTIVE
To evaluate the rate of venous thromboembolism (VTE) after complex lower-limb fracture surgery without pharmacological prophylaxis.


METHODS
Between July 2005 and April 2009, 11 men and 6 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 3 femoral and 20 tibial fractures. Patients were screened for VTE using contrast-enhanced computed tomography (CT) when the D-dimer value was beyond normal range. Between May 2009 and December 2012, 18 men and 4 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 8 femoral and 20 tibial fractures. Patients were routinely screened for deep vein thrombosis (DVT) using ultrasonography and for pulmonary embolism (PE) using contrast-enhanced CT (in high-risk patients with multiple injuries or pelvic and acetabular fractures). In both groups, pharmacological prophylaxis was not used; only mechanical prophylaxis was used.


RESULTS
The 2 groups were comparable in terms of age, sex, and proportion of bilateral external fixation, open fracture, and associated injury, except that the duration of external fixation was longer in the early group (29.8±28.0 vs. 11.6±4.0 days, p=0.001). Of the 17 patients in the early group, 5 developed VTEs (3 DVTs and 2 PEs) at a mean of 13.6 (range, 6-20) days after injury; 2 of whom developed VTE during the external fixation period. Of the 22 patients in the later period, 10 developed VTEs (10 DVTs and 4 PEs) at a mean of 13 (range, 5-33) days after injury; 7 of whom developed VTE during the external fixation period.


CONCLUSIONS
The rate of VTE was high in patients undergoing complex lower-limb fracture surgery without pharmacological prophylaxis.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Takahiro
T
Niikura
Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Yoshitada
Y
Sakai
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Sang Yang
SY
Lee
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Takashi
T
Iwakura
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Ryosuke
R
Kuroda
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Masahiro
M
Kurosaka
D000328:Adult; D018890:Chemoprevention; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects*; D006801:Humans; D035002:Lower Extremity / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology
external fixators; fractures, comminuted; pulmonary embolism; venous thromboembolism