Perioperative incidence and locations of deep vein thrombosis following specific isolated lower extremity fractures.
PURPOSE
To determine perioperative incidence and locations of deep vein thrombosis (DVT) in injured and uninjured lower extremities following isolated lower extremity fractures (ILEFs).


METHODS
Retrospective analysis of a prospectively collected data of a consecutive patient series with ILEFs who underwent surgical treatment between September 2014 and September 2017 was performed. Patients' bilateral lower extremities were screened for DVT with duplex ultrasonography (DUS) before and after surgery. DVT occurrence was analyzed by location of DVT and fracture site. All patients received pharmacologic thromboprophylaxis while hospitalized. Data on demographics, time to surgery, time of DUS examinations, length of hospital stay and symptomatic pulmonary embolism (PE) was collected.


RESULTS
1825 patients were included in the study. The incidence of symptomatic PE was 1.6%. All patients were screened with DUS of the bilateral lower extremities in a mean of 3.5 days (range: 0-18 days) after injury, and a mean of 3.6 days (range: 1-11 days) after surgery. Preoperative DUS detected DVT in 547 patients (30.0%), including 3.7% of patients with proximal DVT. 792 patients (43.4%) were found to have a DVT postoperatively, but only 6.2% of patients with proximal DVT. Proximal DVT was detected postoperatively of the represented fractures: 6.5% of the hip, 14.5% of the femoral shaft, 4.5% of the tibial plateau, 4.6% of the tibial shaft, 1.7% of the patellar, and 2.0% of the peri-ankle. Interestingly, the rate of DVT in an uninjured lower limb was significantly higher postoperatively compared to preoperatively (16.4% vs. 4.9%), however, only 0.2% of patients had proximal DVT.


CONCLUSIONS
While the perioperative incidence of overall DVT is high following ILEFs, the majority were distal DVT, and the rate of symptomatic PE was low. Femoral shaft fractures were associated with the highest incidence for proximal DVT. The incidence was lower in more distal fractures. The majority of patients diagnosed with DVT postoperatively had already shown symptoms of DVT prior to surgery. DVT can occur in both the injured and uninjured leg, with an obviously higher incidence in the injured leg. The incidence of proximal DVT in an uninjured leg is rare.
['Wang|Hu|H|', 'Kandemir|Utku|U|', 'Liu|Ping|P|', 'Zhang|Hong|H|', 'Wang|Peng-Fei|PF|', 'Zhang|Bin-Fei|BF|', 'Shang|Kun|K|', 'Fu|Ya-Hui|YH|', 'Ke|Chao|C|', 'Zhuang|Yan|Y|', 'Wei|Xing|X|', 'Li|Zhong|Z|', 'Zhang|Kun|K|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002681:China D005260:Female D005264:Femoral Fractures D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D059035:Perioperative Period D011183:Postoperative Complications D012189:Retrospective Studies D013978:Tibial Fractures D014463:Ultrasonography D020246:Venous Thrombosis D055815:Young Adult
Isolated lower extremity fracture Surgical treatment Pulmonary embolism Deep venous thrombosis