SLR - January 2013 - Oase
Reference: Pelet, St'ephane, Marie-Eve Roger, Etienne Belzile, and Marc Bouchard. "The Incidence of Thromboembolic Events in Surgically Treated Ankle Fracture." The Journal of Bone and Joint Surgery 94 (2012): 502-06. JBJS Online - The Journal of Bone and Joint Surgery. Web. 1 Sept. 2012.
Scientific Literature Review
Reviewed by: Brian Oase, DPM
Residency program: DVA- New Mexico
Podiatric Relevance:
This study quantifies the risk of thromboembolic events after surgical repair of ankle fractures.
Methods:
This is a retrospective study examining the incidence of thromboembolic events (deep vein thrombosis [DVT] or pulmonary embolus [PE]) after surgically treated ankle fracture. The current recommendations of the American College of Chest Physicians state that no thromboprophylaxis is warranted on the routine patient after a lower extremity fracture. The authors performed a retrospective chart review of 2,093 charts from three university hospitals looking for ICD-9 codes (824.0 to 824.8) for patient inclusion. Exclusion criteria included pilon fractures, polytrauma, if they lived in an outlier area from the hospital, and patients already on thromboprophylaxis medications. A total of 385 charts were not available for review because of access issues.
Results:
A total of 1,540 patients met inclusion criteria. The median age was 46 and an equal distribution of males (49 percent) and females (51 percent) was noted. Fracture types consisted of 45.3 percent unimalleolar fractures, 30.7 percent bimalleolar fractures, and 24.0 percent trimalleolar fractures. Risk factors for thromboembolic events were also studied as well as the use of aspirin prior to injury. Doppler ultrasonography, perfusion scintigraphy, and helical computed tomography were used to make the diagnosis of a thromboembolic event and were read as positive or negative. Thromboembolic events were reported in 2.99 percent or 46 of patients (2.66 percent DVT and 0.32 percent PE). Patients who received prophylaxis during their hospital stay and were discharged on either heparin or warfarin had reported events of 2.37 percent for DVT and 0.4 percent for PE. The use of thromboprophylaxis relative risk reduction was 9 percent. Forty-five-point-three percent (698) of the patients in the study had at least one or more risk factors and it was noted that this subset of patients was at an increased risk for a thromboembolic event but that throboprophylaxis and aspirin did not influence the rate of thromboembolic event. The relative risk factor for a thromboembolic event was 0.66.
Conclusion:
This study demonstrated that the risk for a thromboembolic event was 2.99 percent associated with surgical correction of ankle fracture and supported the American College of Chest Physicians recommendation for prophylaxis. The risk reduction with chemoprophylaxis was only 9 percent and could not be recommended based off the overall low risk of a thromboembolic event.