Der Orthopäde

, Volume 47, Issue 4, pp 341–346 | Cite as

Elderly patients with intertrochanteric fractures after intramedullary fixation

Analysis of risk factors for calf muscular vein thrombosis
Originalien

Abstract

Objective

Calf muscular vein thrombosis (CMVT) has been known for approximately 40 years and many research studies for CMVT have been conducted but many opinions about the incidence and risk factors are still controversial. The objective of this retrospective study was to investigate the incidence and analyze the risk factors for CMVT in elderly patients with isolated intertrochanteric fractures that were managed surgically.

Material and methods

The medical documents of patients suffering from intertrochanteric fractures who were treated in the traumatic orthopaedics department of our hospital from January 2009 to August 2017 were reviewed. The patients were allocated to the CMVT group and non-CMVT group basing on color Doppler flow imaging examination, according to the inclusion and exclusion criteria. The clinical data such as age, gender, body mass index (BMI) and the Working Group on Osteosynthesis Questions/American Orthopaedic Trauma Association (AO/OTA) classification of fractures were collected. Logistic regression analysis was used to determine the independent risk factors for CMVT.

Results

In total, 312 patients were included in this study of which 31 patients were diagnosed with CMVT and allocated to the CMVT group and 281 patients were excluded from suffering from CMVT and included in the non-CMVT group. The incidence of CMVT was 9.94% in our study. The multivariate logistic regression showed that a fracture classification of A3, diabetes, time between injury and operation greater than 48 h are independent risk factors for CMVT in elderly patients with intertrochanteric fractures after intramedullary fixation.

Conclusion

Complicated fractures, diabetes and prolonged time from injury to surgery are risk factors for CMVT in elderly patients with intertrochanteric fractures treated with intramedullary fixation.

Keywords

Retrospective study Complications Incidence Deep vein thrombosis Prophylaxis 

Abbreviations

AO/OTA

Working Group on Osteosynthesis Questions/American Orthopaedic Trauma Association

ASA

American Society of Anaesthesiologists

BMI

Body mass index

CDFI

Color Doppler flow imaging

CI

Confidence interval

CMVT

Calf muscular vein thrombosis

DCVT

Deep calf vein thrombosis

DVT

Deep vein thrombosis

LMWH

Low molecular weight heparin

OR

Odds ratio

PE

Pulmonary embolism

Ältere Patienten mit intertrochantärer Fraktur nach intramedullärer Fixation

Analyse der Risikofaktoren für eine tiefe Beinvenenthrombose in der Wadenmuskulatur

Zusammenfassung

Ziel

Tiefe Beinvenenthrombosen in der Wadenmuskulatur („calf muscular vein thrombosis“, CMVT) sind seit rund 40 Jahren bekannt, und viele wissenschaftliche Studien zu CMVT wurden durchgeführt, aber noch immer gibt es viele kontroverse Meinungen bezüglich Inzidenz und Risikofaktoren einer CMVT. Ziel dieser retrospektiven Studie war es, die Inzidenz der CMVT zu untersuchen und die Risikofaktoren für CMVT bei älteren Patienten mit isolierter intertrochantärer Fraktur, die operativ versorgt wurden, zu analysieren.

Material und Methoden

Zunächst erfolgte eine Begutachtung der Patientenakten von Patienten mit intertrochantären Frakturen, die in der traumatisch-orthopädischen Abteilung unserer Klinik von Januar 2009 bis August 2017 behandelt wurden. Die Patienten wurden entsprechend der Ein- und Ausschlusskriterien einer CMVT-Gruppe und einer Nicht-CMVT-Gruppe zugeteilt, basierend auf der Flussuntersuchung mittels farbkodierter Dopplersonographie. Die klinischen Daten, wie Alter, Geschlecht, Body-Mass-Index (BMI) und die AO/OTA-Klassifikation (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) für Frakturen, wurden gesammelt. Zur Bestimmung der unabhängigen Risikofaktoren für CMVT wurde eine logistische Regressionsanalyse durchgeführt.

Ergebnisse

Insgesamt 312 Patienten wurden in diese Studie eingeschlossen. Bei 31 Patienten wurde eine CMVT diagnostiziert; diese wurden der CMVT-Gruppe zugeteilt. Die 281 Patienten, bei denen eine CMVT ausgeschlossen worden war, wurden der Nicht-CMVT-Gruppe zugeteilt. Die Inzidenz einer CMVT lag in unserer Studie bei 9,94 %. Die multivariate logistische Regressionsanalyse zeigte, dass eine A3-Fraktur laut Klassifikation, Diabetes sowie die Zeit zwischen Verletzung und Operation > 48 h unabhängige Faktoren für eine CMVT bei älteren Patienten mit intertrochantären Frakturen nach intramedullärer Fixation sind.

Schlussfolgerung

Komplizierte Frakturen, Diabetes und eine längere Zeit zwischen Verletzung und Operation sind Risikofaktoren für eine CMVT bei älteren Pateinten mit intertrochantären Frakturen, bei denen eine intramedulläre Fixation durchgeführt wurde.

Schlüsselwörter

Retrospektive Studie Komplikationen Inzidenz Tiefe Venenthrombose Prophylaxe 

Notes

Compliance with ethical guidelines

Conflict of interest

H. Su, H. Liu, J. Liu and X. Wang declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki (and its current revised form). This study was approved by the medical ethics committee of the affiliated Yantai Yuhuangding hospital of Qingdao university. Informed consent was obtained from all patients.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Traumatic OrthopaedicsThe Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantaiChina
  2. 2.Yantai Center for Disease Control and PreventionYantaiChina

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