title: Pediatric orthopaedic lower extremity trauma and venous thromboembolism.
abstract: OBJECTIVE
  Research on venous thromboembolism events (VTE), such as deep venous thrombosis (DVT) and pulmonary embolism (PE), in pediatric orthopaedic trauma patients is sparse. We describe the incidence in the USA of VTE associated with pediatric lower extremity orthopaedic trauma, and characterize injury patterns and VTE treatment methods.
  
  
  METHODS
  The Pediatric Health Information System (PHIS) was queried from 2004 to 2013 using ICD-9 codes for lower extremity fractures (pelvis, femur, tibia, ankle, foot) and dislocations (hip, knee, ankle, subtalar) and VTE. Records were queried for age, diagnoses, and VTE treatment.
  
  
  RESULTS
  During the study period 285,611 clinical encounters reported lower extremity trauma. Of those, 167 patients were simultaneously coded with VTE (99 DVT, 50 PE, 18 combined DVT/PE), to give an incidence of VTE associated with pediatric lower extremity trauma of 0.058 %. Patients were from 39 centers, with an average age of 12.9 years (range 0-19). There were 249 fractures and 21 dislocations, with 25 (15 %) patients sustaining more than one lower extremity injury. The most common fracture locations were the femur/femoral neck (95), tibia/ankle (92), and pelvis (44). 72 % (121/167) of patients were treated with anticoagulation medication, of which the most common was low-molecular-weight heparin (111/167, 66 %).
  
  
  CONCLUSIONS
  The incidence of VTE events associated with lower extremity orthopaedic trauma is 0.058 %. Adolescents and polytrauma patients with injuries of the femur/femoral neck, tibia/ankle, and pelvis are more commonly affected. Low-molecular-weight heparin is commonly used to treat VTE in pediatric and adolescent patients.
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Hunnewell 221, Boston, MA, 02115, USA. murphy.r.f@gmail.com.|Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina, 29425, USA. murphy.r.f@gmail.com.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Murphy
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Hunnewell 221, Boston, MA, 02115, USA.
authors.forename: Manahil
authors.initials: M
authors.lastname: Naqvi
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Hunnewell 221, Boston, MA, 02115, USA.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Miller
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Hunnewell 221, Boston, MA, 02115, USA.
authors.forename: Lanna
authors.initials: L
authors.lastname: Feldman
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Hunnewell 221, Boston, MA, 02115, USA. benjamin.shore@childrens.harvard.edu.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Shore
keywords: Fracture; Lower extremity; Pediatric orthopaedics; Trauma; Venous thromboembolism