Mechanical prophylaxis against deep-vein thrombosis after pelvic and acetabular fractures

Background: Deep-vein thrombosis is a common complication following pelvic and acetabular fractures. The hypothesis of this study was that pulsatile m echanical compression is superior to standard sequential mechanical compres sion for decreasing the prevalence of deep-vein thrombosis in patients with pelvic or acetabular fracture. Methods: A prospective, randomized, blinded study of two methods of mechani cal prophylaxis against deep-vein thrombosis was conducted. One hundred and seven patients were randomized into either Group A (fifty-four patients), in which a thigh-calf low-pressure sequentiial-compression device was used, or Group B (fifty-three patients), in which a calf-foot high-pressure puls atile-compression pump was used. All patients underwent duplex ultrasonogra phy and magnetic resonance venography The two groups were comparable with r egard to demographics, fracture type, fracture treatment, time from the inj ury to the prophylaxis, and patient compliance. Results: Deep-vein thrombosis developed in ten patients (19%) in Group A, w ith seven (13%) having a large or occlusive clot and one (2%) having a docu mented pulmonary embolism. Deep-vein thrombosis developed in five patients (9%) in Group B, with two (4%) having a large or occlusive clot and none ha ving a documented pulmonary embolism. Nine of the nineteen detected thrombo ses were in the deep pelvic veins. The difference in the prevalence of larg e or occlusive clots between the two groups demonstrated a trend but, with the numbers available, was not significant (p = 0.16). Increased patient ag e and the time elapsed from the injury to the surgery were found to be asso ciated with higher rates of thrombosis. Conclusions: Pulsatile compression was associated with fewer deep-vein thro mboses than was standard compression, with the difference representing a tr end but not reaching significance with the number of patients studied.