Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures
ABSTRACT Pelvic and acetabular fractures have been known as one of the high risk factors for developing deep vein thrombosis (DVT), but thromboprophylaxis for patients with such fractures remains underused despite its widely accepted benefits. Current guidelines have not been universally adopted in clinical practice. The purpose of this study is to introduce a Thrombotic Risk Assessment Questionary (assessment table) according to evidence-based guidelines and evaluate its impact on the use of thromboprophylaxis for patients with pelvic and acetabular fractures.
We retrospectively reviewed 305 consecutive patients with pelvic and acetabular fractures from August 1, 2008 through September 30, 2010. The control group without using the assessment table included 153 patients admitted during the first 13 months, and the assessment group using the assessment table included 152 patients admitted during the following months. Data on clinical outcomes of DVT, the number of patients receiving prophylaxis, and the time of the first dose of anticoagulant were collected.
Compared with the control group, Patients using the assessment table were more likely to be given DVT prophylaxis (84.2% vs. 37.3%, P < 0.05) and the time of the first dose of anticoagulant was reduced (4.32 days ± 4.78 days vs. 6.6 days ± 5.96 days, P < 0.05). Patients in the assessment group had lower risk of developing DVT (8.6% vs. 20.3%, P < 0.05).
The assessment table can significantly improve the use of thromboprophylaxis after pelvic and acetabular fractures, which will likely reduce the incidence of DVT. Developing individual hospital prophylaxis strategy is an effective way to determine whether hospitalized patients should receive pharmacologic and/or mechanical prophylaxis or not.
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ABSTRACT: The incidence of vascular injuries associated with total hip arthroplasty (THA) is low. However, several vascular structures are at risk of injury within the pelvis. These include the external iliac, femoral, and obturator vessels. Both reaming of the acetabulum and drilling of the acetabular screw holes may place these structures at risk. If left untreated, injuries to these vessels may be associated with severe morbidity and mortality. In this report, an acute vascular complication that had an unusual presentation is highlighted. A 72-year-old woman presented to the emergency department following a road traffic accident in which she sustained a combined fracture of the right acetabulum and femoral head. Her treatment involved a combination of THA and pelvic open reduction and internal fixation. The immediate perioperative recovery period was uncomplicated. However, the patient developed a deep venous thrombus in her right calf 7 days after surgery. Further investigation revealed a second thrombus, occluding the right common femoral vein. Surgical exploration revealed that a screw placed during the initial surgery was pressing against the vessel and occluding it. The discrepancy in incidence between the development of deep venous thrombosis and vascular compression or injury means that the association between the 2 events is unlikely to be made. The author highlights this unusual presentation to improve early recognition and prompt management of similar cases. The importance of adequate preoperative planning and intraoperative imaging with a C-arm is also stressed.Orthopedics 04/2014; 37(4):e407-9. DOI:10.3928/01477447-20140401-66 · 0.98 Impact Factor
- Indian Journal of Orthopaedics 03/2013; 47(2):115-6. DOI:10.4103/0019-5413.108870 · 0.62 Impact Factor