Elliott Iain S, Rane Ajinkya A, DeKeyser Graham J, Kellam Patrick J, Dowdle Phillip T, Safaee Tommy M, Marchand Lucas S, Haller Justin M
Department of Orthopaedics, Harborview Medical Center, Seattle, WA, USA.
Kaiser Permanente San Jose Medical Center, San Jose, CA, USA.
Arch Orthop Trauma Surg. 2023 Mar;143(3):1237-1242. doi: 10.1007/s00402-021-04192-5. Epub 2021 Nov 10.
In patients with rotational ankle fracture, we compare the rate of venous thromboembolism development between patients who received chemoprophylaxis vs those patients that received none.
Retrospective cohort study.
Level I trauma center.
PATIENTS/PARTICIPANTS: Between 2014 and 2018, we identified 483 patients with rotational ankle fracture that had no VTE risk factors, were under 70 years of age, and had an isolated injury.
Chemoprophylaxis vs no chemoprophylaxis after open reduction internal fixation of a rotational ankle fracture.
Development of VTE was the primary outcome. Secondary outcomes included wound problems, infection, hematoma, or non-union.
There were 313 patients that received no prophylaxis and 170 patients that received chemoprophylaxis after operative fixation of an isolated ankle fracture. Demographics including age, gender, body mass index, and ASA class were similar between groups. The rate of DVT/PE was 3.5% in those without DVT prophylaxis, and 4.1% in those on DVT prophylaxis with no significant differences found (p = 0.8). There was no significant difference in wound complication (no VTE prophylaxis-3.7% vs VTE prophylaxis-2.5%, p = 0.7) or infection rates (no VTE prophylaxis-3.8% vs VTE prophylaxis 4.1%, p = 1.0) between groups.
No difference was detected in the rate of symptomatic DVT or PE in patients based on chemoprophylaxis. Our results support the conclusion that the use of chemoprophylaxis may remain surgeon preference and based on patient risk factors for VTE development.
Level III-retrospective cohort study.
在旋转型踝关节骨折患者中，我们比较接受化学预防的患者与未接受化学预防的患者发生静脉血栓栓塞的比率。
回顾性队列研究。
一级创伤中心。
患者/参与者：在2014年至2018年期间，我们确定了483例旋转型踝关节骨折患者，这些患者没有静脉血栓栓塞风险因素，年龄在70岁以下，且为单纯损伤。
旋转型踝关节骨折切开复位内固定术后进行化学预防与不进行化学预防。
静脉血栓栓塞的发生是主要结局。次要结局包括伤口问题、感染、血肿或骨不连。
在单纯踝关节骨折手术固定后，有313例患者未接受预防措施，170例患者接受了化学预防。两组之间的人口统计学特征，包括年龄、性别、体重指数和美国麻醉医师协会分级相似。未进行深静脉血栓预防的患者中深静脉血栓/肺栓塞的发生率为3.5%，进行深静脉血栓预防的患者中发生率为4.1%，未发现显著差异（p = 0.8）。两组之间在伤口并发症（未进行静脉血栓栓塞预防-3.7% vs 进行静脉血栓栓塞预防-2.5%，p = 0.7）或感染率（未进行静脉血栓栓塞预防-3.8% vs 进行静脉血栓栓塞预防4.1%，p = 1.0）方面没有显著差异。
根据化学预防措施，患者发生有症状的深静脉血栓或肺栓塞的比率未发现差异。我们的结果支持以下结论：化学预防措施的使用可能仍取决于外科医生的偏好，并基于患者发生静脉血栓栓塞的风险因素。
三级回顾性队列研究。
