title: Thromboprophylaxis in Ambulatory Trauma Patients With Foot and Ankle Fractures: Prospective Study Using a Risk Scoring System.
abstract: Lower-limb immobilization has been implicated as an etiological factor for venous thromboembolic events (VTEs). However, there is no patient-centered scoring system available for risk assessment in ambulatory trauma patients with temporary lower-limb immobilization. A patient questionnaire scoring system has been developed for ambulatory patients with foot and ankle fracture being managed nonoperatively as outpatients by temporary lower-limb immobilization. Patients are classed as either high or low risk for developing a VTE and offered low-molecular-weight heparin (LMWH) accordingly. This is a prospective study of 150 patients with a follow-up of 6 months. Only 3 patients developed VTEs: one was noncompliant with medicine, one was started on LMWH 2 days after getting a plaster cast, and the third was not started on LMWH in spite of family history of VTEs. This study showed that using this scoring system, LMWH can be used safely and effectively as a thromboprophylactic agent for ambulatory trauma patients requiring temporary lower-limb immobilization to manage foot and ankle fractures. It is a step toward developing a validated clinical prediction score to enable risk assessment in ambulatory trauma patients who are managed non-operatively with temporary lower limb immobilization.
  
  
  METHODS
  Prognostic, Level IV: Case series.
authors.affiliation: Kettering General Hospital, Kettering, UK syedhaque@doctors.org.uk.
authors.forename: Syed
authors.initials: S
authors.lastname: Haque
authors.affiliation: Kettering General Hospital, Kettering, UK.
authors.forename: Amit
authors.initials: A
authors.lastname: Bishnoi
authors.affiliation: Kettering General Hospital, Kettering, UK.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Khairandish
authors.affiliation: Kettering General Hospital, Kettering, UK.
authors.forename: Dipen
authors.initials: D
authors.lastname: Menon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D002370:Casts, Surgical; D005260:Female; D005529:Foot Bones / Q000293:injuries; D050723:Fractures, Bone / Q000628:therapy*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007103:Immobilization; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: ambulatory trauma patients; foot and ankle fracture; thromboprophylaxis