Hermel Henriette, Yacoub Simon, Souleiman Firas, Kohlmann Friederike, Kühnapfel Andreas, Kleber Christian, Mühlberg Katja S, Henkelmann Ralf
Department of Orthopedics, Trauma and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany.
Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Haertelstrasse 16-18, 04107 Leipzig, Germany.
J Clin Med. 2025 May 16;14(10):3490. doi: 10.3390/jcm14103490.
In patients with leg injuries, typical symptoms of thrombosis such as painful swelling may be misinterpreted as a consequence of the trauma. This has the potential to result in an unexpected embolism, especially during the perioperative period. This study investigates the incidence of unapparent preoperative deep-vein thrombosis (DVT) in patients with traumatic intraarticular tibial plateau fracture (TPF). A comprehensive analysis was conducted to identify possible risk factors, with particular attention paid to fracture severity and soft tissue injury. This retrospective single-centre study evaluated patient data from November 2021 to November 2024. It included 72 patients with traumatic intraarticular TPF who underwent surgery and received a preoperative compression ultrasonography screening. The incidence of preoperative DVT was 23.6% (n = 17). Among these, 5.6% (n = 4) exhibited proximal thrombosis, while 18.1% (n = 13) demonstrated distal thrombosis. The fibular veins were predominantly affected (12/17). Patients with DVT suffered high-energy traumata, dislocations, compartment syndromes, and complex fractures (AO/OTA type C3: 82.4% vs. 52.7%) more often than patients without DVT and were more often immobilised with an external fixator. In 47.1% of DVT cases (n = 8), surgery could no longer be postponed, and an inferior vena cava filter was temporarily employed. The removal of the filter was successful in all cases, with no major complications encountered. This study reveals a high incidence (23.6%) of unapparent preoperative DVT in patients with traumatic intraarticular TPF despite prophylactic anticoagulation, particularly in those with severe fractures and soft tissue injuries. Systematic DVT screening and early anticoagulation are crucial to avoid potentially life-threatening complications.
在腿部受伤的患者中，血栓形成的典型症状（如疼痛性肿胀）可能会被误解为创伤的结果。这有可能导致意外的栓塞，尤其是在围手术期。本研究调查了创伤性关节内胫骨平台骨折（TPF）患者术前隐匿性深静脉血栓形成（DVT）的发生率。进行了全面分析以确定可能的风险因素，特别关注骨折严重程度和软组织损伤。这项回顾性单中心研究评估了2021年11月至2024年11月期间的患者数据。它纳入了72例接受手术并接受术前加压超声筛查的创伤性关节内TPF患者。术前DVT的发生率为23.6%（n = 17）。其中，5.6%（n = 4）表现为近端血栓形成，而18.1%（n = 13）表现为远端血栓形成。腓静脉受影响最为明显（12/17）。与无DVT的患者相比，DVT患者遭受高能创伤、脱位、骨筋膜室综合征和复杂骨折（AO/OTA C3型：82.4%对52.7%）的情况更常见，并且更常使用外固定器固定。在47.1%的DVT病例（n = 8）中，手术无法再推迟，因此临时使用了下腔静脉滤器。所有病例中滤器的取出均成功，未遇到重大并发症。本研究表明，尽管进行了预防性抗凝，但创伤性关节内TPF患者术前隐匿性DVT的发生率仍很高（23.6%），尤其是在那些伴有严重骨折和软组织损伤的患者中。系统性DVT筛查和早期抗凝对于避免潜在的危及生命的并发症至关重要。
