INCIDENCE OF DEEP-VEIN THROMBOSIS IN PATIENTS WITH FRACTURES OF THE LOWER-EXTREMITY DISTAL TO THE HIP

Our purpose was to determine the incidence of deep-vein thrombosis (DV T) in patients who have had early operative fixation of fractures of t he lower extremity distal to the hip. There is a high incidence of dis tal thrombosis in patients who have undergone early operative fixation of lower-extremity fractures. The incidence of DVT is higher with pro ximal extremity fractures than with distal extremity fractures. Most c lots are occult and do not progress clinically. Given the high inciden ce of DVT with femoral and tibial plateau fractures, older age, and lo nger operating times, anticoagulation prophylaxis may be indicated. Ou rs was a prospective incidence study. All patients who had had early o perative fixation of lower-extremity fractures were eligible (n = 176) . Seventy-four were excluded based on specific criteria. The remaining 102 patients underwent lower-extremity venography an average of 9 day s after operative fixation of their fractures (range 3-22 days). Eight patients had bilateral lower-extremity fractures. The patients were f ollowed clinically for 6 weeks to identify complications related to ve nous disease. The overall incidence of clinically occult DVT was 28%. Of the represented fractures, 40% were of the femoral shaft (eight of 20), 43% of the tibial plateau (12 of 28), 22% of the tibial shaft (12 of 54), and 12.5% of the tibial plafond (one of eight). Four of the t hrombi were proximal to the popliteal fossa. Four of the patients had clinical evidence of pulmonary embolism while in the hospital. One of them had objective confirmation on further testing. No patient had cli nical evidence of pulmonary emboli as an outpatient by follow-up crite ria. The incidence of DVT has not been determined for patients with ea rly stabilization of lower-extremity fractures. This study suggests a higher DVT incidence in more proximal fractures, but little risk of em bolization. Thrombus formation proximal to the popliteal fossa is rare . Older age, longer operating times, and longer times before fracture fixation all correlate with an increased incidence of DVT.