Deep venous thrombosis following different isolated lower extremity fractures: what is known about prevalences, location
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REVIEW ARTICLE
Deep venous thrombosis following different isolated lower extremity fractures: what is known about prevalences, locations, risk factors and prophylaxis? S. Decker • M. J. Weaver
Received: 10 October 2011 / Accepted: 28 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Introduction Deep venous thrombosis (DVT) offers a high risk of morbidity and mortality, especially in case of pulmonary embolism. Precise data as to DVT after isolated lower extremity fractures (ILEFs) are rare. Even organizations like the American Academy of Orthopaedic Surgeons or the American College of Chest Physicians do not state exact recommendations as to optimal DVT prophylaxis (ppx) after ILEFs. Prevalence The incidence of DVT ranges from 5 to 86 % depending on the fracture whereas femur fractures offer the highest risk for clotting. The incidence seems to decrease in more distal fractures. Location: The risk to develop proximal clots is likely low, however, especially these are feared by surgeons. DVT can occur in both the injured and uninjured leg with a trend for higher incidences in the injured leg. Risk factors Risk factors for DVT after ILEF seem to be similar to risk factors for DVT development after orthopaedic surgery and in general. Risk factors caused by surgeons are the use of a tourniquet, prolonged operative time and a delay from injury to surgery. Prophylaxis Low molecular weight heparin is favoured by many authors, however, warfarin and acetylsalicylic acid are also used. Clear recommendations are still missing. S. Decker M. J. Weaver The Partners Orthopaedic Trauma Service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA S. Decker (&) Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany e-mail: [email protected]
Conclusion The rate of morbidity caused by DVT after ILEF is poorly understood so far. Exact data on prevalences are missing and optimal DVT prophylaxis still has to be defined. Keywords Deep venous thrombosis DVT prophylaxis Fracture Isolated lower extremity fracture Risk factor
Introduction Numerous studies have identified a significant incidence of deep venous thrombosis (DVT) in the setting of fracture surgery of the hip, elective arthroplasty of the hip, knee and ankle, as well as a high rate of DVT in the polytrauma patient population [1–8]. While there are published guidelines by both the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) regarding DVT prophylaxis (ppx) in both the polytrauma and arthroplasty patient population, there is little or no guidance regarding routine prophylaxis in patients with isolated lower extremity fractures [9, 10]. The same applies to British guidelines published by the National Institute for Health and Clinical Excellence (NICE). NICE suggests pharmacological ppx for patients wearing lower limb plaster casts; however, there is no precise recommendation in respect of the reason for the plaster cast, e.g. different
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