INCIDENCE OF DEEP VENOUS THROMBOSIS AFTER HIP FRACTURE SURGERY DETERMINED BY DOPPLER ULTRASONOGRAPHY
Main Article Content
Keywords
Doppler Ultrasonography, Total Hip Replacement, Austin Moore Prosthesis, Dynamic Hip Screw, Interlocking Nail, Thromboprophylaxis
Abstract
Objective: This study aims to determine the incidence of Deep Venous Thrombosis after hip fracture surgery by using Doppler Ultrasonography.
Study Design: Descriptive observational.
Setting: This study was conducted in the Orthopedics Department at Mardan Medical Complex, Mardan - Pakistan.
Materials and Methods: This study was performed on 50 consecutive patients of 40 years and above with proximal femur fractures (fracture of femoral head, femoral neck fracture and inter- trochanteric fractures) who were fulfilling the inclusion criteria. Informed consent was taken and operated on regular operation list. During the study period all the patients undergoing major orthopaedic surgery for Total Hip Replacement, Austin Moore Prosthesis, AO Screw fixation and Proximal femur fracture fixation by Dynamic Hip Screw and Interlocking Nail were investigated by Doppler ultrasonography by the same radiologist and were assessed for the occurrence of DVT. These patients were followed for 6 weeks post-operatively. The statistical significance of the results was analyzed using SPSS computer program.
Results: The total numbers of patients were 50 with average age of 62 years +/- SD. Male to female ratio was 1.2:1. THR was performed in 3 (6%) patients, AMP in 11 (22%) patients, DHS was performed in 28 (56%) patients, AO screw was performed in 6 (12%) patients and Interlocking Nail was performed in 2 (4%) patients. Overall incidence of DVT in the entire study group was 4% (2 of 50 patients). None of the patient received any form of thromboprophylaxis during the entire study period.
Conclusion: Our results suggest that incidence of DVT in Pakistani patients is low and is not comparable with American and European populations. Routine Thromboprophylaxis is perhaps not justified in every patient undergoing hip surgery. However, prophylaxis for patients with higher risk may be considered individually.
References
2. Khan MA, Pal S, Chinoy MA, Ahmed SK.The frequency of Deep Vein Thrombosis in patients with hip fractures. J Pak Med Assoc. 2019 Feb;69(Suppl 1)(1):S21-S24.
3. Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, et al. Thromboembolism prophylaxis in orthopaedics: an update. EFORT Open Rev. 2018 Apr; 3(4): 136–148.
4. Pal C P, Goyal A, Kumar D, Shakunt R K, Dinkar K S, et al. Is it necessary to use chemoprophylaxis in Indian patients after hip surgery? J Clin Orthop Trauma. 2016 Jan-Mar; 7(1): 30–33.
5. Xing F, Li L, Long Y, Xiang Z. Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening. BMC Musculoskelet Disord 19, 444 (2018).
6. Pokharel B , Poudel S , Shah L L. Incidence of deep vein thrombosis following hip fracture surgery at Tribhuvan University Teaching Hospital. JCMC. 2018; 8(24):10-15. Down load
7. Lee S Y, Ro D H, Chung C Y, Lee K M, Kwon S S, et al. Incidence of Deep Vein Thrombosis after Major Lower Limb Orthopedic Surgery: Analysis of a Nationwide Claim Registry. Yonsei Med J. 2015 Jan 1; 56(1): 139–145.
8. Magetsari R, Dewo P, Lanodiyu A N. Deep Vein Thrombosis in Elderly Patients following Surgery for Fracture of the Proximal Femur. Malays Orthop J. 2014 Nov; 8(3): 7–10.
9. Agarwala S, Bhagwat A, Modhe J, Dastur FD, Patil S. Incidence of deep vein thrombosis in Indian patients, A prospective study in 104 patients. Indian J Orthop. 2003;37(2):5.
10. Salvati EA, Pellegrini VD Jr, Sharrock NE. Recent advances in venous thromboembolic prophylaxis during and after total hip replacement. J Bone Joint Surg. 2000;82:252-70.
11. Dhillon KS, Askandar A, Daraisami S. Post operative DVT in Asian Patients is not a rarity. J Bone Joint Surg Br. 1996;78:427-30.
12. Bagaria V, Modi N, Panghate A, Vaidya S. Incidence and risk factors for development of venous thromboembolism in Indian patients undergoing major orthopaedic surgery. Postgrad Med J. 2006;82:136-39.
13. Chan YK, Chiu KY. The incidence of deep vein thrombosis in elderly Chinese suffering hip fracture is low without prophylaxis: A prospective study using serial duplex ultrasound. Journal of Orthopaedic Surgery. 2004;12(2):178-83.
14. Jain V, Dhaon BK, Pradhan G. Deep vein thrombosis after total hip arthroplasty in Indian patients with and without enoxaparin. Journal of Orthopaedic Surgery. 2004;12:173–77.
15. Khan K, Muhammad A, Pervaiz. Incidence of post operative DVT in our population using Doppler studies, SUR-279, Dissertation Index, College of Physicians and Surgeons of Pakistan. 1991;123-8.
16. Durani ZA, Rafiq Z, Mateen MA. Incidence of Deep Vein Thrombosis in hip, femur and knee surgery, The J Surg. 2003;26(1):10-6.
17. Atichartakarn V, Pathepchotiwong K, Keorochana S, Eurvilaichit C. Deep vein thrombosis after hip surgery among Thai. Arch Intern Med.1988;148:1349-53.
18. Bertina RM, Koeleman BP, Koster T, Rosendaal FR, Dirven RJ, de Ronde H, et al. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature. 1994;369:64–7.
19. Ridker PM, Miletich JP, Hennekens CH, Buring JE. Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening. J Am Med Assoc.1997;277:1305–7.
20. Harkess JW, Crockarell JR. Arthroplasty of the hip.Campbell’s Operative Orthopaedic.11th Ed.Philadelphia: Mosby.2008;312-481.
21. Napolitano LM, Garlapati VS, Heard SO, Silva WE, Cutler BS, O’Neill AM, et al. Asymptomatic deep venous thrombosis in the trauma patient: is an aggressive screening protocol justified? J Trauma. 1995;39:651–9.
22. Sudo A, Sano T, Horikawa K, Yamakawa T, Shi D, Uchida A. The incidence of deep vein thrombosis after hip and knee arthroplasties in Japanese patients: A prospective study. Journal of Orthopaedic Surgery. 2003;11(2):174–7.
23. Sharma H, Maini L, Agrawal N. Incidence of deep vein thrombosis in patients with fractures around hip joint: a prospective study. Indian J Orthop. 2002;36(3):5-9.
24. Yoo MC, Cho YJ, Ghanem E, Ramteke A, Kim KI. Deep vein thrombosis after total hip arthroplasty in Korean patients and D-dimer as a screening tool. Archives of Orthopaedic and Trauma Surgery. 2009;129:887-94.
25. Edmonds MJR, Crichton TJH, Runciman WB, Pradhan M. Evidence based risk factors for postoperative deep vein thrombosis. Aust N Z J Surg. 2004;74:1082-97.
26. Yentis SM. Anaesthetic technique and deep vein thrombosis.Br J Hosp Med.1990;43:83.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Zahir Khan
Assistant Professor Orthopaedic Surgery, MTI Mardan Medical Complex, Mardan - Pakistan
Dr Anwar Imran
Assistant Professor Orthopaedic Surgery, Jinnah Teaching Hospital, Peshawar -Pakistan
Dr Aimon Zia
Consultant Orthopaedic Surgery, MTI Mardan Medical Complex, Mardan - Pakistan
Dr. Sajid Akhtar
Assistant Professor Orthopaedic Surgery, Luqman International Hospital, Saidu Sharif Swat - Pakistan
Dr Haroon Yousaf
Postgraduate Trainee Orthopaedic Surgery, MTI Mardan Medical Complex, Mardan - Pakistan
Dr Alamgir Khan
Postgraduate Trainee Orthopaedic Surgery, MTI Mardan Medical Complex, Mardan - Pakistan