The Correlation between Lower Extremity Fracture and Subsequent Arterial Embolism and Thrombosis-A National Population Cohort Study.

Jian-Xun Chen,Shao-Yun Hsu,Pin-Keng Shih,Mei-Chen Lin

doi:10.3390/jcm10225312

Abstract

The hazard of subsequent arterial embolism and thrombosis (SAET) in patients with lower leg fractures is not yet well demonstrated. The purpose of this study is to determine the correlation between lower leg fracture and SAET in Taiwan. A total of 134,844 patients with lower leg fractures (ICD-9-CM: 823) and chronological diagnosis as SAET (ICD-9-CM: 444.22) was matched (1:1) to the non-fracture cohort according to their propensity score (data coming from the National Health Insurance database between January 2000 to December 2012). Patients were matched by age, gender, and comorbidities. The incidence of SAET and correlation between SAET development and lower leg fracture was statistically analyzed, and subgroup analysis categorized by characteristics and comorbidities was conducted as well. The cumulative incidence of SAET was calculated by Kaplan–Meier analysis. Kaplan–Meier analysis plot showed that, by the end of the ten-year follow-up period, the cumulative incidence of SAET was significantly higher for the lower leg fracture cohort than for the non-fracture cohort (log-rank test: p < 0.001). The lower leg fracture, male, elder age (45–64-year-old; ≥65-year-old), hypertension, diabetes mellitus, and gout were significantly associated with lower extremity SAET risk compared with the matched group. There was an inseparable correlation between the lower leg fracture group and the risks of SAET; subgroup analysis by gender (male, female), age (age < 40 years, age 40–64 years, and age > 65 years) and comorbidities (hypertension, diabetes mellitus, and gout) show compatible results as well. Patients with lower leg fracture have a significantly increased risk of SAET since then two years after the fracture. The hazard of SAET was significantly higher in patients with lower leg fracture than in the non-fracture cohort, and the high incidence was found since then two years after fracture. Further studies are warranted.

Highlights

Emerging evidence discloses that the lower leg fractures cause bone malalignment, soft tissue injury, and impairment of adjacent vessel patency [1–3]
Patients with tibia and fibula fracture, males, increased onset age, hypertension, diabetes, and gout showed a significantly high risk of developing lower extremity subsequent arterial embolism and thrombosis (SAET) after being adjusted with demographic and comorbidity factors
Patients with SAET are significantly correlated to risk factors including lower leg fracture, male gender, elder age (>45 years), and comorbidities (Table 2)

Summary

Introduction

Emerging evidence discloses that the lower leg fractures cause bone malalignment, soft tissue injury, and impairment of adjacent vessel patency [1–3]. Patients with vascular damage usually present with tibia-fibula, open and mid-shaft fractures [4]. The anterior tibial artery was the most commonly damaged vessel and manifested as complete arterial occlusion [5]. Artery insufficiency resulting from vessel damage may present either as acute limb ischemia or as non-union fracture or osteomyelitis in long-term follow-up [6,7]. The riskiest period of vessel impairment remains unknown. Routine angiographic survey after lower leg fracture remained a controversy

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