Deep Venous Thrombosis and its Associated Specific Risk Factors in Surgically Treated Proximal Femoral Fractures: An Institutional Study

Abstract

Introduction:Lower limb fractures are commonly encounterd in orthopaedic practice and usually have a good prognosis.But as we know that bone healing is a complex process, it can be associated with complications as well.Deep vein thrombosis (DVT) is also one of the worrisome complications.

Aim:To evaluate the incidence of deep venous thrombosis and its associated specific risk factors in surgically treated proximal femoral fracture patients.

Material and methods:This observational study was conducted including patients of either sex, aged more than 40 years,who presented to the department within last 1 year and had undergone surgical treatment for proximal femoral fractures.A detailed history regarding various parameters including clinical signs to suggest DVT (swelling and tenderness over calf, skin discoloration, neurovascular status of the limb and prominence of superficial veins), risk factors like habits of smoking and alcohol consumption and presence of various other comorbid conditions like diabetes mellitus and hypertension were obtained.The venous doppler ultrasound examinations were carried out in all cases.

Results:During the last 1 year of study period, we observed 82 cases were of proximal femoral fracture.The mean age of the study population was 54.32 years which comprised of 66 males (80.48%) and 16 (19.5%) females. Cause of the fracture in 41 patients (54.8%) was high-energy trauma while in 37 (45.1%) had low energy trauma. Preoperative immobilisation of more than 5 days was observed in 92.68% cases.Doppler-ultrasound examination of the study patients showed that 6 (7.3%) patients developed DVT with common femoral vein (3/6 cases) was the most common one.Out of all the reported risk factors of DVT studied by us,both smoking and obesity were found to have a positive correlations.

Conclusion:DVTis an important complication of proximal limb fractures and is associated with increased morbidity and mortality. Smoking and obesity appeared to be noteworthy comorbid conditions in our study. Routinethromboprophylaxis in such patients with coexisting comorbid conditions and preoperative immobilisation for more than a week helps in decreasing  the risk of development of deep venous thrombosis.

Keywords: Deep vein thrombosis (DVT), Comorbidity, risk factors, immobilization, thromboprophylaxis