Incidence of DVT and PE after surgical reconstruction for pelvic and acetabular fractures: Does routine duplex scanning
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ORIGINAL ARTICLE
Incidence of DVT and PE after surgical reconstruction for pelvic and acetabular fractures: Does routine duplex scanning affect management? Walid A. Elnahal1,2 · James Bassett1 · Mehool R. Acharya1 · Tim Chesser1 · Anthony J. Ward1 Received: 2 May 2020 / Accepted: 10 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Prevention and detection of thromboembolism with pelvic and acetabular fractures remains controversial. The aim of this study was to evaluate a protocol using LMWH prophylaxis and duplex screening both pre-operatively (if there is a delay > 72 h to surgery) and post-operatively at day 5–7. We assessed the incidence of thromboembolism and associated risk factors. Methods A total of 255 consecutive patients who underwent pelvic and/or acetabular reconstruction in a major trauma and tertiary referral centre between January 2013 and December 2015 were studied. Forty-three patients were excluded due to non-adherence to protocol leaving 212 patients included in the study. Results Patients were of mean age 49 years (15–94) and mean ISS 24.5 (4–66). Pre-operative screening detected two patients with asymptomatic above-knee DVT who then underwent pre-operative IVC filter insertion. Post-operative screening detected seven patients (3%) with lower limb DVTs (3 proximal and 4 below knee). The three patients with proximal DVTs were fully anticoagulated and did not develop symptomatic PE. Six patients (2.8%) developed post-operative PE, four of which were symptomatic and confirmed by CT angiography. Seven patients (3%) died in the post-operative period due to non-VTErelated causes. The overall rate of VTE was 6%, including DVT 4% and PE 2.8%. PE was associated with administration of tranexamic acid in ED (p > 0.03) and total amount of blood transfused during admission (p > 0.001). VTE was not associated with age, injury type, ISS, delay to surgery or associated injuries. Conclusion A protocol-based approach to VTE prophylaxis and screening in trauma patients with pelvic and/or acetabular reconstruction resulted in no VTE-related mortality. Pre- and post-operative screening for DVT changed the management in five patients, with none developing PE. Patients requiring more aggressive resuscitation had a higher rate of PE. The VTE rate was lower than previously reported. Keywords Pelvic and acetabular fractures · DVT · PE · VTE · DVT screening
Background and aim Venous thromboembolism (VTE) remains a major cause of morbidity and mortality following pelvic and acetabular trauma. The reported incidence of deep vein thrombosis (DVT) and pulmonary embolus (PE) varies depending on * Walid A. Elnahal [email protected] 1
Trauma and Orthopaedic Department, North Bristol NHS Trust, Westbury‑On‑Trym, Bristol BS10 5NB, UK
Trauma and Orthopaedic Department, Cairo University, Cairo, Egypt
2
the method used for diagnosis, with studies reporting rates of proximal DVT as high as 35% and symptomatic PE as high as 10% [1–3]. Many authors have suggest
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