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Thromboembolic event rates reach about 3% following ankle fracture ORIF
Thromboembolic events are rare after open reduction and internal fixation (ORIF) of ankle fractures, although patients with ankle fractures treated surgically who have certain risk factors may have a higher risk of a thromboembolic event with ORIF, according to a study conducted by Canadian researchers.
They also found that thromboprophylaxis did not affect the incidence of thromboembolic events in this population.
The researchers sought to study the correlation between thromboembolic events and ORIF of ankle fractures through a retrospective review of the charts of 2,478 patients who underwent ORIF at three university hospitals between 1997 and 2005.
The researchers identified 540 patients who met the inclusion criteria. The mean age of the patients was 46 years, and there were similar numbers of men and women included in the study.
Investigators reviewed the patients’ charts for thromboprophylaxis use and thromboembolic risk factors, including neoplasia, hormone use, pregnancy, blood dyscrasia, history of previous thromboembolic events, smoking, obesity, dyslipidemia, atherosclerotic vascular disease and paralysis.
“A thromboembolic event was defined as symptomatic when deep venous thrombosis (DVT) was confirmed with the use of Doppler ultrasonography or when pulmonary embolism (PE) was confirmed with use of ventilation and perfusion scintigraphy or helical computed tomography,” the researchers wrote.
Researchers found a 2.99% thromboembolic event incidence with a 2.66% DVT rate and a 0.32% non-fatal PE rate, according to a press release. Risk factors such as hormone use, pregnancy, cancer, smoking or obesity were associated with a 3.59% DVT incidence and a 2.38% PE incidence, according to the release.
“Patients with risk factors appear to be at higher risk for these events, but there is a need for prospective studies to determine the efficacy of thromboprophylaxis after surgical treatment of ankle fractures,” the researchers wrote.
Perspective
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This is an overdue heads-up from our orthopedic colleagues. I have opined in two recent malpractice cases and discovered in some orthopods a rather sluggish interest in prophylacting postoperative ankle fracture patients — this, of course, in great distinction to their rigorous concerns promulgated in tibia and femur fracture patients. Poor technical Doppler exploration of calf vessels underlies much of this false and legally risky behavior. Because medical devices used to diminish DVT formation are difficult in ankle injury patients, dependence on anticoagulants is necessary. It is important that we hematologists share our expertise in the use of newer anticoagulant agents in these patients.
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Pelet S. J Bone Joint Surg Am. 2012;21;94:502-506.