Background and aims Deep vein thrombosis (DVT) is a known cause of morbidity in elderly patients requiring proximal femur fracture surgery. These patients exhibit all risk factors of Virchow’s triad: immobilization; advanced age; comorbidity. Surgery later than 24 hours post-injury increases mortality secondary to DVT complications. Current guidelines recommend mechanical and pharmaceutical prophylaxis; however, preoperative DVT is still known to occur in 9–62% of patients receiving prophylaxis. The purpose of this study is to determine the preoperative incidence of DVTs in our cohort of proximal femur fracture patients.
Methods After audit committee approval, consecutive patients >60 years on the principal investigators’ proximal femur fixation list were studied. Ultrasound scan of femoral vessels was done bilaterally, prior to (unilateral) fascia iliaca block (FIB). Data collected included demographics, comorbidities, and current DVT prophylaxis. The scan determined the compressibility and flow in the femoral veins (fully compressible, good flow: no DVT; not fully compressible, suggestion of DVT).
Results From January to April 2019, 27 patients were studied. The mean time to procedure post-injury was 31 hours. Almost half of patients received interim DVT prophylaxis. 2 (7.4%) patients had a positive result for a DVT. However, no patient had preexisting signs or symptoms suggesting DVTs. No patient developed pulmonary embolism 24 hours postoperatively.
Conclusions The incidence of DVT after proximal femur fracture is relatively low at Broomfield Hospital. We surmise that a simple ultrasound observation of the femoral vessels at FIB will determine the true prevalence of DVTs in this cohort of patients.
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