Anatomical distribution and change of distal deep venous thrombosis in patients with hip fracture

Abstract

Objective To investigate the anatomical distribution and change of distal deep venous thrombosis in patients with hip fracture, to provide evidence for prevention and treatment of deep vein thrombosis in patients with hip fracture and lower limb deep vein ultrasound examinatio. Methods The clinical data of 383 patients with hip fractures who were admitted in Department of Orthopaedics Trauma, Xi′an Jiaotong University Medical College Red Cross Hospital from July 2014 to April 2018 were analyzed retrospectively. There were 122 males and 261 females, the age range was 17 to 94 years, the median was 78 years, and the interquartile range was 12 years. There were 154 cases of femoral neck fracture, 208 cases of femoral intertrochanteric fracture, and 21 cases of femoral subtrochanteric fracture. Deep venous thrombosis was assessed by ultrasonography before and 3-5 days after operation, and the anatomical location and changes of deep vein thrombosis were analyzed. The skewed distribution data were represented by the median and interquartile range. The proportion of the number of deep venous thrombosis case in the anatomical position of the lower extremities was expressed as a percentage. Results Of the 383 patients with hip fracture who had distal deep venous thrombosis before surgery, isolated distal deep vein thrombosis (IDDVT) accounted for 89.30% (342/383), and multivessel thrombosis accounted for 10.70% (41/383). In IDDVT, intermuscular venous thrombosis was the most common, and no anterior venous thrombosis occurred. In multivessel thrombosis, two or three of the intermuscular vein, the posterior tibial vein, and the iliac vein were more common. Twenty-eight (7.31%) patients had distal thrombus extension to the proximal end (including 21 cases involving the iliac vein and 7 cases involving the superficial femoral vein), IDDVT accounted for 61.88% (237/383). The involvement of multiple venous thrombosis accounted for 16.19% (62/383), 62.40%(239/383) of the distal thrombus position did not change, and 14.62%(56/383) of the distal thrombus disappeared. Conclusions For patients with hip fracture, the intermuscular vein is the most common site of distal deep venous thrombosis, ultrasound examination of anterior tibial vein is not necessary. Under anticoagulation, 7.31% of distal deep venous thrombosis may extend to the proximal and 14.62% of distal deep venous thrombosis disappear. For patients with hip fracture complicated with distal deep venous thrombosis in hospital, patients without contraindication of anticoagulation should be treated with anticoagulation at an early stage to prevent the proximal progression or fall off of thrombosis and reduce the risk of distal deep venous thrombosis. Key words: Hip; Venous thrombosis; Dissection