Prevention of deep vein thrombosis and pulmonary embolism in acetabular and pelvic fracture surgery.

In a prospective nonrandomized study, a protocol was examined for prophylaxis of deep venous thrombosis and pulmonary embolism in patients with operative treatment of acetabular and pelvic fractures. There were 197 patients in the study with 203 fractures, including 148 acetabular and 55 pelvic fractures. There were 2 cases of bilateral acetabular fractures and 4 cases with both acetabular and pelvic fractures. The protocol involved preoperative noninvasive screening of the lower extremities, intraoperative and postoperative use of mechanical antithrombotic devices, and chemical prophylaxis with warfarin for 3 weeks following removal of surgical drains. There were 11 cases (6%) of preoperative deep venous thrombosis detected. There were 6 cases of postoperative deep venous thrombosis and 2 cases of pulmonary embolism. The incidence of postoperative venous thrombosis and pulmonary embolism was 3% and 1%, respectively. The protocol was found to be effective for preoperative detection of venous thrombosis and prevention of deep venous thrombosis and pulmonary embolism in trauma patients with minimal bleeding complications and no morbidity from embolic disease.