Risk of postoperative venous thromboembolism in Indian patients sustaining pelvi-acetabular injury

Abstract

Most surgeons believe that Asians have a low risk of developing venous thromboembolism (VTE) and routine thromboprophylaxis therapy is not required after major orthopaedic trauma. This study evaluates the postoperative risk of VTE in Indian patients sustaining pelvi-acetabular injury. Fifty-six patients with pelvi-acetabular injury, who underwent open reduction and internal fixation, were prospectively evaluated for VTE in the postoperative period. They were evaluated, both clinically and radiologically (pulmonary CT angiography and indirect venography of lower limb and pelvis veins), until six weeks after surgery. A total of 16 patients developed VTE, of which 12 had proximal deep vein thrombosis (DVT), ten had pulmonary embolism (PE) and only two had distal DVT. Six patients with proximal DVT had associated PE. The risk of development of VTE among Indian patients after pelvi-acetabular injury is high (28.6%) with increasing chances of proximal DVT and PE; hence, administration of routine thromboprophylaxis is fully justified in them.

Fig. 1

Radiographs of a 58-year-old male showing left posterior wall acetabulum fracture that was treated by open reduction and internal fixation with recon plate. Postoperative CT pulmonary angiography and indirect venography shows bilateral femoral vein thrombi and pulmonary embolus in left lung segmental artery (arrow)

Fig. 2

Radiographs of a 42-year-old male showing left acetabulum fracture that was treated by open reduction and internal fixation with recon plates. Postoperative CT pulmonary angiography and indirect venography shows saddle embolus at the left pulmonary trunk compared with normal pulmonary trunk on right side