Incidence and Prevention of Venous Thromboembolism in Severely Injured Patients with Lower Extremity Fracture

Ji Wan Kim; Ji Ho Choi; Jung Jae Kim

doi:10.4055/jkoa.2012.47.6.403

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Kim, Choi, and Kim: Incidence and Prevention of Venous Thromboembolism in Severely Injured Patients with Lower Extremity Fracture

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(6): 403-409.

Published online: 28 December 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.6.403

Incidence and Prevention of Venous Thromboembolism in Severely Injured Patients with Lower Extremity Fracture

Ji Wan Kim, M.D., Ph.D.^*, Ji Ho Choi, M.D., Jung Jae Kim, M.D., Ph.D.

Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

^*Department of Orthopaedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea.

Correspondence to: Jung Jae Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. TEL: +82-2-3010-3530, FAX: +82-2-488-7877, jjkim2@amc.seoul.kr

Received 2 April 2012 Revised 7 June 2012 Accepted 19 July 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the incidence of venous thromboembolism (VTE) in severely injured patients with lower extremity fracture in a prophylactic group with that in a non-prophylactic group during a retrospective study.

Materials and Methods

Severely injured patients with lower extremity fracture were enrolled in this study and were divided into the following two groups: Group I, non-prophylactic group, and Group II, prophylactic group using anticoagulants and mechanical prophylaxis.

Results

Symptomatic VTE occurred in 5 cases (16.1%) among the 31 cases in Group I; i.e., deep vein thrombosis in one case and pulmonary embolism (PE) in four cases, including life threatening PE 2 cases. There were no patients with symptomatic VTE among the 32 cases in Group II.

Conclusion

The incidence of symptomatic VTE without the use of prophylaxis was 16.1%. This rate dramatically decreased with the use of prophylaxis. Therefore, we believe that prophylaxis with anticoagulants and mechanical device is necessary in order to prevent VTE in severely injured patients with lower extremity fracture.

Keywords: severely injured trauma patients, lower extremity fracture, venous thromboembolism, deep vein thrombosis, pulmonary embolism

Figures and Tables

Figure 1

(A) Initial pelvis antero-posterior (AP) radiograph of a 55-year-old man with injury severity score 22; liver laceration, T12 compression fracture, right acetabular fracture and 2^nd degree burn on the right arm. (B) Immediate postoperative radiograph 10 days after injury. (C) Preoperative chest AP radiograph. (D) Postoperative chest AP radiograph showing haziness at the left lower lobe with PaO₂ 71.5 mmHg under FiO₂ 50% application of external fixation. (E) Chest computed tomography image showing large thrombus (arrow) in the right main pulmonary artery. The patient was transferred to intensive care unit for ventilator care immediately.

Figure 2

A) Initial left tibia antero-posterior and lateral radiographs of a 63-year-old man with injury severity score 22; hemopneumothorax right, left proximal tibia open fracture, cerebral contusion. (B) Application of external fixation. (C) Chest computed tomography image showing focal linear thrombus (arrow) in the posterior segmental branch of right pulmonary artery with PaO₂ 82.0 mmHg under nasal prong O₂ 5 L at the postoperative 6 days. (D) Inferior vena cava filter insertion. (E) Postoperative radiographs after definitive surgery.

Table 1

Summary of Clinical Data

ICU, intensive care unit.

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