జర్నల్ ఆఫ్ స్పైన్

Delayed Presentation of Patients with Acute Long Bone Fractures, Pelvic and Spinal Fractures in a Tertiary Hospital-Incidence of Deep Venous Thrombosis

Abstract

Maleho M. Maku*, Mandela Johnson Motsoari and MV Ngcelwane

Introduction: Venous Thromboembolism (VTE) can result in significant morbidity and mortality. Data indicate no significant change to the overall incidence and mortality from VTE. Incidence of Deep Venous Thrombosis (DVT) varies, it is as high as 80% in patients sustaining lower extremity trauma where prophylaxis is not used. All patients with delayed (>24 hours) presentation of an acute hip or femur fracture undergo preoperative Doppler ultrasound to rule out DVT. Preoperative DVT is shown to occur in as high as 9% to 62% of patients receiving prophylaxis. Despite all the attention given to preventing VTE in hospitalized trauma patients, still there are no strong evidence-based recommendations to guide the treating surgeon. The purpose of the present study was to establish the incidence of DVT in patients with delayed presentation after sustains long bone, pelvic and spine fractures.

Methods: A prospective observational study was performed over an 18-month period between November 2019 to May 2021. Data collected from patient’s hospital records. A chi square test with 4 degrees of freedom with a medium effect 0.30, an error probability α=0.10, and a power of 1- β=0.80, a sample size of 108 was required.

Results: A total of 90 patients were identified. Included in the study were 39 patients on whom Doppler studies were done, of these 22 were females (54%) and 17 were males (46%). Mean age of 76 years (30-90 yrs.). Low energy falls accounted for 30/39 (76.9%) with neck of femur fractures being the most common type at 25/39 (64.1%) followed by intertrochanteric fracture 8 (20.5%), One of the intertrochanteric fractures was a high energy fracture 1/39 (2.6%) and the other high energy fractures included the tibia fractures 4/39 (10.2%). None of these patients had a previous history of DVT. There were 4 patients (9.7%) diagnosed positive with a thrombus of which 2/4 (50%) were pre-operative DVT. Of the 4 positives with thrombus, 3/4 (75%) was in female patients, 1/4 (25%) was in a male patient. Mortality in this study was 2/39 (5.1%).

Conclusion: The incidence of deep venous thrombosis was identified as 10.6% in our population study group. Routine ultrasound screening in patients with delayed presentation to exclude deep venous thrombosis in asymptomatic patients may be deemed necessary.