Blanco Jose A, Slater Gemma, Mangwani Jitendra
Post-CCST Paediatric Orthopaedic Fellow, Trauma and Orthopaedic Department, University Hospitals of Coventry and Warwickshire, Coventry, UK.
Senior Fracture Clinic Sister, Trauma and Orthopaedic Department, Leicester Royal Infirmary, Leicester, UK.
J Foot Ankle Surg. 2018 May-Jun;57(3):484-488. doi: 10.1053/j.jfas.2017.10.036. Epub 2018 Mar 2.
The incidence of venous thromboembolic (VTE) events (deep vein thrombophlebitis [DVT] or pulmonary embolism [PE]) in foot and ankle trauma has been low, and the risk/benefit ratio associated with chemoprophylaxis is controversial. We compared the 90-day incidence of VTE events in 3 cohorts: group 1, tendo-Achillis (TA) ruptures managed with full weightbearing in a walker boot; group 2, ankle fractures immobilized non-weightbearing in a below-the-knee cast; and group 3, ankle fractures managed surgically, followed by non-weightbearing in a below-the-knee cast. Data were extracted from 2 prospectively collected trust databases for acute TA ruptures and ankle fractures. VTE risk was assessed using a U.K. national assessment tool. Chemoprophylaxis was prescribed for high-risk patients. The 90-day incidence of symptomatic VTE events was drawn from a trust-wide radiology database. In group 1 (n = 291), the incidence of VTE events was 4.8% (11 [3.8%] DVT, 3 [1.0%] PE) at a mean of 16.1 ± 6.8 days. In group 2 (n = 227), the incidence of VTE events was 2.2% (5 [2.2%] DVT) at a mean of 33.4 ± 11.3 days. In group 3 (n = 199), the incidence of VTE events was 3.0% (5 [2.5%] DVT, 1 [0.5%] PE) at a mean of 37.2 ± 14.2 days. Patients with symptomatic VTE events presented significantly earlier after acute TA rupture compared with after ankle fracture (p = .002). We found the overall incidence of VTE events in foot and ankle trauma was low, with a relatively greater incidence of symptomatic VTE events, which occurred earlier, in acute TA ruptures compared with ankle fractures.
足踝创伤中静脉血栓栓塞（VTE）事件（深静脉血栓性静脉炎[DVT]或肺栓塞[PE]）的发生率一直较低，且化学预防的风险/效益比存在争议。我们比较了3个队列中VTE事件的90天发生率：第1组，跟腱（TA）断裂采用步行靴完全负重治疗；第2组，踝关节骨折采用膝下石膏非负重固定；第3组，踝关节骨折采用手术治疗，随后采用膝下石膏非负重固定。数据从2个前瞻性收集的急性TA断裂和踝关节骨折的信托数据库中提取。使用英国国家评估工具评估VTE风险。为高危患者开具化学预防药物。有症状VTE事件的90天发生率来自全信托范围的放射学数据库。在第1组（n = 291）中，VTE事件的发生率为4.8%（11例[3.8%]DVT，3例[1.0%]PE），平均发生时间为16.1±6.8天。在第2组（n = 227）中，VTE事件的发生率为2.2%（5例[2.2%]DVT），平均发生时间为33.4±11.3天。在第3组（n = 199）中，VTE事件的发生率为3.0%（5例[2.5%]DVT，1例[0.5%]PE），平均发生时间为37.2±14.2天。与踝关节骨折后相比，急性TA断裂后出现有症状VTE事件的患者明显更早（p = 0.002）。我们发现足踝创伤中VTE事件的总体发生率较低，与踝关节骨折相比，急性TA断裂中有症状VTE事件的发生率相对较高，且发生时间更早。
