Abstract
ObjectiveThis study aims to investigate the incidence, occurrence timing and locations of preoperative DVT and identify the associated factors in this group.MethodsA retrospective analysis of collected data in young and middle-aged (18–59 years) patients who presented with hip fracture between October 2015 and December 2018 was conducted. Before operation, patients were routinely examined for DVT by Duplex ultrasonography (DUS). Electronic medical records were retrieved to collect the data, involving demographics, comorbidities, injury and laboratory biomarkers after admission. Multivariate logistic regression analysis was performed to identify factors that were independently associated with DVT.ResultsEight hundred and fifty-seven patients were included, and 51 (6.0%) were diagnosed with preoperative DVT, with 2.5% for proximal DVT. The average age of patients with DVT is 48.7 ± 9.4 year, while that of patients without DVT is 45.0 ± 10.9 year. The mean time from injury to diagnosis of DVT was 6.8 ± 5.5 days, 43.1% cases occurring at day 2–4 after injury. Among 51 patients with DVT, 97 thrombi were found. Most patients had thrombi at injured extremity (72.5%), 19.6% at uninjured and 7.8% at bilateral extremities. There are significantly difference between patients with DVT and patients without DVT in term of prevalence of total protein (41.2% vs 24.4%, P = 0.008), albumin (54.9% vs 25.6%, P = 0.001), low lactate dehydrogenase (51.0% vs 30.3%, P = 0.002), lower serum sodium concentration (60.8% vs 29.9%, P = 0.001), lower RBC count (68.6% vs 37.0%, P = 0.001), lower HGB (51.0% vs 35.1%, P = 0.022), higher HCT (86.3% vs 35.1%, P = 0.022) and higher platelet count (37.3% vs 11.3%, P = 0.001). The multivariate analyses showed increasing age in year (OR 1.04, 95% CI; P = 0.020), delay to DUS (OR, 1.26; P = 0.001), abnormal LDH (OR, 1.45; P = 0.026), lower serum sodium concentration (OR, 2.56; P = 0.007), and higher HCT level (OR, 4.11; P = 0.003) were independently associated with DVT.ConclusionThese findings could be beneficial in informed preventive of DVT and optimized management of hip fracture in specific group of young and mid-aged patients.
Highlights
Among the elderly population, hip fracture is the most common and severe injury and often the most extensive and in-depth research topic in the clinical studies
These findings could be beneficial in informed preventive of Deep venous thrombosis (DVT) and optimized management of hip fracture in specific group of young and mid-aged patients
Full list of author information is available at the end of the article
Summary
Hip fracture is the most common and severe injury and often the most extensive and in-depth research topic in the clinical studies. Hip fractures in young and middle-aged population is not extensively and deeply studied, they represent approximately one third of the over hip fractures in the adults [6]. Young and middle-aged patients had hip fractures caused by higher-impact mechanism, with higher bone fracture severity and soft tissue damage, which probably introduces a stronger immune response or inflammatory reaction post-trauma [7]. We infer perioperative undesirable events relevant to hip fracture itself or secondary to systematic immune/inflammatory response in the young and middle-aged population might be different from in elderly patients. Regarding the perioperative factors that may predict the incident DVTs, the literature displayed the inconsistent or even contradictory results [9,10,11,12]. By far as we know, the attention on DVT after hip fracture specific in the young and middle-aged patients is not adequately focused, and the non-specific findings available in literature might not be applicable
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