Abstract
ObjectiveTo investigate the epidemiologic characteristics of deep venous thrombosis (DVT) in elderly patients with femoral neck fracture.MethodsRetrospective analysis was performed on elderly patients with femoral neck fractures admitted to two institutions from January 2016 to October 2019. Duplex ultrasonography (DUS) was used to detect DVT. Patients’ hospitalization medical records were retrieved to collect the data, which were related to demographics, comorbidities, injury and laboratory results on admission. Patients with preoperative DVT were defined as the case group and those without DVT as control group, and compared using the univariate analyses. Multivariate logistic regression analysis was used to identify the independent factors associated with DVT.ResultsTotally, 980 patients met the predefined criteria and were included. Sixty-seven patients were diagnosed to have preoperative DVT, with incidence of 6.8% for overall, 1.7% for proximal and 5.1% for distal DVT. The mean time from injury to diagnosis of DVT was 6.0 ± 4.7 days (median, 5.0). Most (76.1%) patients with DVT had thrombi solely in the injured extremity, in contrast with 14.9% (10/67) in the uninjured and 9.0% (6/67) in both injured and uninjured extremity. Multivariate analysis showed chronic renal insufficiency (OR, 3.37; 95%CI, 1.57 to 7.28), current smoking status (OR, 2.42; 95%CI, 1.23 to 5.63), time from injury to DUS (OR, 1.26; 95%CI, 1.07 to 1.61) and PLT > 220*109/L (OR, 1.94; 95%CI, 1.31 to 3.77) were independent factors for DVT.ConclusionPreoperative DVT is not very prevalent following elderly femoral neck fractures, but with a certain proportion in the uninjured extremity, necessitating the more attention. These identified risk factors aid in patient counseling, individualized risk assessment and risk stratification, and should be kept in mind.
Highlights
Femoral neck fracture is a typical osteoporotic fracture, accounting for 9–15% of overall fractures and 40–50% of the hip fractures in the elderly population [1, 2], with serious consequences that one-year mortality rate is 15.6–25.4% and rate of partial or complete loss of independence is 17.8–37% in survivors [2,3,4]
In 76.1% (51/67) of patients, Deep venous thrombosis (DVT) occurred in the injured extremity, 9.0% (6/67) in the bilateral and 14.9% (10/67) in the uninjured extremity
We found that the incidence of preoperative DVT following femoral neck fracture was 6.8%, with 1.7% for proximal and 5.1% for distal DVT
Summary
Femoral neck fracture is a typical osteoporotic fracture, accounting for 9–15% of overall fractures and 40–50% of the hip fractures in the elderly population [1, 2], with serious consequences that one-year mortality rate is 15.6–25.4% and rate of partial or complete loss of independence is 17.8–37% in survivors [2,3,4]. Different from intertrochanteric fracture that has a better bone healing and surgical outcome, femoral neck fracture has a 3–5% rate of avascular necrosis of the femoral head (ANFH) following internal fixation [5] and a considerate proportion of them necessitate hip arthroplasty. The current guidelines primarily focus on prevention of postoperative DVT in major orthopaedics surgeries (hip or knee arthroplasty, or hip fracture repairs), but pay less attention on the preoperative DVT or DVT at admission. It is predictable that the incidence of preoperative DVT may be much higher in Chinese patients with hip fracture. If patients who have already developed a DVT could be identified immediately at their admission and early therapeutic rather than prophylactic interventions are given, the surgical outcome or the prognosis might be different
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