Saket Rahul, Aggarwal Sameer, Kumar Vishal, Kumar Prasoon, Patel Sandeep
Department of Orthopaedics, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, 160012, India.
J Clin Orthop Trauma. 2019 Sep-Oct;10(5):917-921. doi: 10.1016/j.jcot.2019.02.016. Epub 2019 Feb 27.
Venous Thromboembolism (VTE) has a variable incidence in trauma patients and fatal embolism can be the very first manifestation. Proximal femur fractures result from high velocity trauma in younger age groups and could require prolonged immobilisation, which is associated with increased risk of VTE. Therefore we sought to determine the occurrance of VTE in patients with proximal femur fractures.
The present study was initiated to assess the occurrance of deep vein thrombosis (DVT) or pulmonary embolism in isolated proximal femur fractures and identify the requirement of routine thromboprophylaxis in such patients.
It was a prospective study conducted over a period of one and a half years. All patients, presenting with isolated proximal femur fractures were included. Patients having any other known risk factors for DVT were excluded, so that the proximal femur fracture remained their only acquired risk for DVT. All the patients were evaluated clinically and with help of diagnostic modalities like Color Doppler with compression ultrasound, D-dimer assays and CT venogram, if indicated. Patients were followed up till 8 weeks post-operatively.
A total of 66 patients with fractures of proximal femur were assessed, out of which there were 42 males with mean age of 48.1 years and 24 females with mean age of 58.3 years. A total of 9 cases of radiologically proved DVT were observed. Clinical DVT was seen in 5 of these cases (54%). Complete resolution of thrombus was noted in all the patients, evaluated by Color Doppler at 6 weeks, post diagnosis. Although the majority of the cases (6) occurred in patients beyond 50 years of age, this was not statistically significant.
DVT is common in patients with proximal femur fractures and the provision for screening both clinically and radiologically, should be made routine in all such patients. In case of delay in surgery and patient being bed ridden, we recommend thromboprophylaxis in this subset of trauma patients.
静脉血栓栓塞症（VTE）在创伤患者中的发病率各不相同，致命性栓塞可能是其首发表现。年轻人群中，股骨近端骨折多由高速创伤导致，可能需要长期固定，这会增加VTE风险。因此，我们试图确定股骨近端骨折患者中VTE的发生率。
本研究旨在评估单纯股骨近端骨折患者深静脉血栓形成（DVT）或肺栓塞的发生率，并确定此类患者常规血栓预防的必要性。
这是一项为期一年半的前瞻性研究。纳入所有单纯股骨近端骨折患者。排除有任何其他已知DVT风险因素的患者，以便股骨近端骨折成为其唯一获得性DVT风险因素。所有患者均接受临床评估，并在必要时借助彩色多普勒加压超声、D - 二聚体检测和CT静脉造影等诊断手段进行评估。患者术后随访至8周。
共评估了66例股骨近端骨折患者，其中男性42例，平均年龄48.1岁，女性24例，平均年龄58.3岁。共观察到9例经放射学证实的DVT。其中5例（54%）出现临床DVT。诊断后6周通过彩色多普勒评估，所有患者血栓均完全溶解。虽然大多数病例（6例）发生在50岁以上患者中，但差异无统计学意义。
DVT在股骨近端骨折患者中很常见，应对所有此类患者进行常规临床和放射学筛查。对于手术延迟且需卧床的患者，我们建议对这部分创伤患者进行血栓预防。
