Deep venous thrombosis following different isolated lower extremity fractures: what is known about prevalences, locations, risk factors and prophylaxis?

Abstract

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. 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. 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 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. Low molecular weight heparin is favoured by many authors, however, warfarin and acetylsalicylic acid are also used. Clear recommendations are still missing. 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.