[Thromboembolism complications in orthopedics and traumatology. A prospective study of 598 operated patients].

From 1.10.-31.12. 1989, 598 patients who underwent orthopaedic surgery in the Staatliche Orthopädische Klinik were examined by a pre-, intra- and postoperative questionnaire up to 3 months from the date of operation. All patients were separated into 4 groups corresponding to the calculated risk and duration of the operation. 46 patients in Group I, who underwent minor surgery, received 3 x 5000 I.E. Heparin subcutaneously. 243 patients in Group II received besides 3 x 5000 I.E. Heparin, 500 ml HAES 6% preoperatively. They underwent operations of greater intensity and duration at the upper and lower extremities. 302 patients of Group III were given 3 x 5000 I.E. heparin and 500 ml 6% dextrane 60 preoperatively because of severe operations (pelvis, hip). 7 high-risk patients received apart from 3 x 5000 I.E. Heparin subcutaneously 500 ml 6% dextrane 60 preoperatively and 250ml 10% dextrane 40 postoperatively for 5 days. In Group I we had 2.2% thromboembolic complications, whereas in Group II 1.7% and in Group III 3.3% complications with thrombosis and pulmonary embolism occurred. This was proved by pulmonary scintigraphy and phlebography. No such complications were seen in Group IV. The total incidence of deep vein thrombosis was 2.0% and of pulmonary embolism 0.5%. These results show the importance of preoperative risk check and individual prophylaxis of thromboembolic complications in orthopaedic and traumatologic surgery.