OTA 2006 Posters
Scientific Poster #6 Polytrauma
Incidence of Deep Venous Thrombosis after Spanning External Fixation
for Complex Lower Extremity Injuries
Bruce A. Levy, MD1 (n); S. Andrew Sems, MD2 (n);
Diego A. Herrera, MD1 (n); Peter A. Cole, MD1
(n);
David C. Templeman, MD3 (n); Minnesota Orthopaedic Trauma Group;
1Regions Hospital, University of Minnesota, St. Paul, Minnesota,
USA;
2Mayo Clinic, Rochester, Minnesota, USA;
3Hennepin County Medical Center, University of Minnesota, Minneapolis,
Minnesota, USA
Purpose: The purpose of this study was to review the incidence of
deep venous thrombosis (DVT) in a prospective protocol of early spanning
external fixation with the concurrent use of low molecular weight heparin
(LMWH).
Methods: Between January 2005 and April 2006, 78 consecutive patients
with 87 complex lower extremity injuries were treated with a protocol of
spanning external fixation application, LMWH administration within 24 hours
of admission, and early patient mobilization at two level 1 trauma centers.
LMWH prophylaxis was maintained while the patient was in the external fixator.
There were 50 males and 28 females with a mean age of 42 years (range, 20-73).
There were 36 proximal tibia fractures (27 41-C3, one 41-C2, four 41-B3,
three 41-B1, and one 41-A3), 27 pilon fractures (16 43-C3, eight 43-B3,
and three 43-A3), seven femur fractures (three 33-A3, three 33-C3, one 32-C3),
six calcaneus fractures (73-C3), eight knee dislocations, and three talus
fracture dislocations (one 71-D, one 72-D, and one complete talus extrusion).
32% of the fractures were open. All patients underwent spanning external
fixation within 24 hours of admission. The average length of time from injury
to definitive fixation was 21 days. All patients underwent duplex ultrasound
examination of the injured limb within five days of scheduled definitive
fixation. This series represents our preliminary data.
Results: Duplex ultrasonography was negative for DVT in all but one
patient. There were no bleeding complications while the temporary external
fixator was in place.
Conclusions: The incidence of DVT in extremities immobilized with
temporary spanning external fixation has not been previously reported. Although
this study is limited by a small sample size and heterogenous injury patterns,
we recommend a protocol of early spanning external fixation, initiation
of LMWH within 24 hours, and early patient mobilization. We hypothesize
that restoring limb alignment and allowing early patient mobilization may
decrease the risk of DVT in these complex injuries.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.