Is thromboprophylaxis really justified among Indian population with femur shaft fractures treated with IM nailing?

Abstract

Introduction: Venous thromboembolism (VTE), which consists of deep vein thrombosis (DVT) and pulmonary embolism, is one of the most common preventable cause of morbidity and mortality after trauma. Though most of the western countries have their guidelines for thromboprophylaxis in these patients, India still does not have these. The increasing detection of VTE among Indian population, lack of awareness, underestimation of the risk, and fear of bleeding complications after chemical prophylaxis have made deep vein thrombosis (DVT) a serious problem, hence a standard guideline for thromboprophylaxis after trauma is essential. There are many studies for thromboprophylaxis in patients underwent Joint replacement surgery. But there are no clear guidelines regarding the prophylaxis for VTE for trauma surgeries. Amongst all fracture pattern femur shaft is most notorious for incidence of fat embolism. Materials and Methods: We carried out a Prospective Randomised study to determine the incidence of DVT. Present study included 105. Patients having Diaphyseal fracture of Femur undergoing intramedullary Interlocking Nailing. All the patients underwent duplex ultrasonography between preoperatively, 3rd Postoperative day and 6 weeks postoperative. Results: Only six patients (7.8%) showed sonographic evidence of DVT and the majority of them resolved without treatment. There were 2 case of pulmonary embolism out of which one patient died because of Pulmonary embolism. Conclusion: DVT following fractures of Femur in Indian patients is not as common as reported in the Western literature. A high level of suspicion and close clinical monitoring is mandatory, routine chemoprophylaxis is perhaps not justified in every patient undergoing femur fracture surgeries. More trials involving a larger number of patients and at multi centers, in future, would be required to confirm the findings of our study.