gms | German Medical Science

Objectives: Thrombo-prophylaxis is routinely indicated in pelvic and femoral fractures, due to the high incidence of thrombo-embolic complications following these injuries; nevertheless, the question whether thrombo-prolylaxis should be prescribed for patients sustaining below-the-knee injuries came up as this type of complications have been described with increasing frequency. The authors present this paper in order to propose a different approach focused on the risk factors of the patient, and not on the type of the injury.

Methods: A retrospective study was performed, including 130 patients operated between 01.01.2013–01.01.2016 for below-the-knee injuries, with complete medical records and follow up for 18 months available; the fractures affected: tibia (proximal-10, shaft-30, distal-12), ankle (54), talus (2), calcaneus (6), foot (8) and achillean tendon ruptures (8). All the patients received LMWH with dosing according to the manufacturer's instructions. The patients followed the same evaluation protocol- besides the routine visits following the recommendations at discharge, the patients were instructed to present at the hospital for any alarm signs for DVT (Deep Venous Thrombosis) and PE (Pulmonary Embolism). Doppler Compression ultrasound and pulmonary CT scan were used for the positive diagnosis of DVT and PE. The incidence of VTE (Venous Thrombo-Embolism) was evaluated in correlation with: type of injury, type of stabilisation, time from injury to surgery, type surgery, method and duration of thrombo-prophylaxis, Caprini risk score

Results: The incidence of VTE in the study group was 7.7 %, with 1.5% incidence of fatal PE; there were no significant correlations in the study group between the incidence of VTE and the following parameters: type of injury, type of stabilization (for the same type of injury), time from trauma to surgery in the study group. The incidence of VTE was significantly higher in patients with higher Caprini scores and in patients receiving lower doses of LMWH.

Conclusions: Although this is a retrospective study, it supports the idea the VTE risk should be assessed according primarily to the characteristics of the patient, and not to those of the injury, especially that the features of the treatment included as parts of the thrombotic scores; although it was not the main purpose of this paper, the problem of dosing the LMWH arose as current recommendations seem to be sometimes inadequate, as they do not refer to thrombotic risk, but to type of interventions. Finally, the authors suggest that personalised thrombo-prophylactic regimens should be established based on information resulted from further prospective studies evaluating the global thrombo-embolic risk of the patients