Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective coh
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(2020) 15:549
RESEARCH ARTICLE
Open Access
Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study Jinzeng Zuo1,2 and Yongcheng Hu3*
Abstract Objective: The purpose of this study was to investigate the incidence, location, and related factors of deep venous thrombosis (DVT) of the bilateral lower extremities after intertrochanteric fractures in the elderly. Methods: Retrospective analysis was performed on the elderly patients with intertrochanteric fracture who were admitted from January 2017 to December 2019. At admission, patients receive routine ultrasound Doppler scanning of bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patient data on demographics, comorbidities, injury-related data, and laboratory test results at admission were extracted. Logistic regression analyses were conducted to identify the independent risk factors associated with DVT. Results: Five hundred seventy-eight patients were included, among whom 116 (20.1%) had DVT. Among those with DV, 70.7% (82/116) had DVT of the distal type, 24 (29.6%) had DVT of the proximal type, and 10 (10.4%) had mixed DVT. In 76.7% (89/116) of patients, DVT occurred in the fractured extremity, 9.5% (11/116) in the bilateral and 13.8% (16/116) in the non-fractured extremity. Multivariate analyses identified obesity, delay to admission, increased D-dimer level (> 1.44 mg/L) and reduced albumin (< 31.7 g/L) as independent factors. Conclusions: Admission incidence of DVT was high in elderly patients with intertrochanteric fractures, especially the proximal DVT. Identification of associated risk factors is useful for individualized assessment risk of DVT and early targeted interventions. Keywords: Hip fracture, Deep vein thrombosis, Epidemiology, Risk factors, Individualized risk assessment
Introduction Intertrochanteric fracture is one of the most common fractures in the elderly, constituting 10~20% of all fractures and 50–65% of hip fractures [1, 2]. Intertrochanteric fractures are typical osteoporotic fractures and are most commonly caused by low-energy fall injury, with a 1-month mortality of 5–10% and 1-year mortality rate of * Correspondence: [email protected] 3 Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin 300211, P. R. China Full list of author information is available at the end of the article
8–31% [3]. After an intertrochanteric fracture occurs, the hypercoagulability of blood, post-trauma stress/inflammatory immune response of the body place the patients at a high risk of DVT. It was reported that intertrochanteric fracture itself was a risk factor for DVT, increasing 2.5-fold risk compared to femoral neck fracture [4]. In addition, the high prevalence of multiple comorbidities made elderly patients more susceptible to DVTs than younger patients [5]. Pulmonary embolism (PE) is the third leading cause of death within 24 hours after trauma, and DVT is a most predominant source of
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