Acute venous thromboembolism in Indian patients of isolated proximal femur fractures.

INTRODUCTION

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.