Thromboprophylaxis in Intramedullary Limb Lengthening Surgery

Abstract

Aim: The use of intramedullary lengthening devices is becoming increasingly popular. There are limited data regarding the incidence of venous thromboembolism following intramedullary lengthening surgery and no reports or guidance for current practice on use of thromboprophylaxis. Following a case of post-operative deep vein thrombosis in our institution, we felt that it is important to assess best practice. We conducted a national survey to collect data that would describe current practice and help develop consensus for treatment.

Materials and methods: We identified surgeons across the UK that perform adult intramedullary limb lengthening through the British Limb Reconstruction Society membership and a Precise Users database. Surgeons were contacted and asked to respond to an online survey. Responses to thromboprophylaxis regimes employed in their practice and cases of venous thromboembolism were collated.

Results: 24 out of 54 surgeons identified responded with a total of 454 cases of adult intramedullary lengthening (352 femoral and 102 tibial nails) performed over a five year period (January 2015-January 2020). Only one case of deep venous thrombosis (DVT) following femoral lengthening was reported. There is wide variability in practice both in terms of thromboprophylaxis risk assessment, choice of medications and duration of treatment. The vast majority of surgeons (85%) felt that there was insufficient evidence available to guide their practice.

Conclusions: Intramedullary lengthening is a surgical treatment growing in popularity. There are limited data available to guide decision-making regarding aspects of treatment such as thromboprophylaxis. This is reflected in the wide variation in practice reported in this study. There are both a need and a desire to gather data that will allow us to come to a consensus and to guide safe practice.

Clinical significance: Venous thromboembolism is a potential complication of lower limb lengthening surgery. We report on national incidence and current practices of thromboprophylaxis to allow for informed decision-making and help develop consensus for best practice.

How to cite this article: Iliadis AD, Timms A, Fugazzotto S, et al. Thromboprophylaxis in Intramedullary Limb Lengthening Surgery. Strategies Trauma Limb Reconstr 2020;15(3):151-156.

Keywords: Complication; Cosmetic limb lengthening; Internal lengthening nail; Intramedullary lengthening; Limb lengthening; PRECICE.

Fig. 1

Mechanical prophylaxis (TEDS) duration following femoral intramedullary lengthening nail insertion

Fig. 2

Chemical thromboprophylaxis choice and duration following femoral intramedullary lengthening nail insertion

Fig. 3

Mechanical prophylaxis (TEDS) duration following tibial intramedullary lengthening nail insertion

Fig. 4

Chemical thromboprophylaxis choice and duration following tibial intramedullary lengthening nail insertion

Fig. 5

Responses to question 13 Likert scale: “I feel that there is strong evidence/level of recommendation to support my practice regarding the use of thromboprophylaxis following intramedullary lengthening surgery”