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
  • Hao Su
  • Hongzhi Liu
  • Juan Liu
  • Xin Wang



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.


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.


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.


Retrospective study Complications Incidence Deep vein thrombosis Prophylaxis 



Working Group on Osteosynthesis Questions/American Orthopaedic Trauma Association


American Society of Anaesthesiologists


Body mass index


Color Doppler flow imaging


Confidence interval


Calf muscular vein thrombosis


Deep calf vein thrombosis


Deep vein thrombosis


Low molecular weight heparin


Odds ratio


Pulmonary embolism

Ältere Patienten mit intertrochantärer Fraktur nach intramedullärer Fixation

Analyse der Risikofaktoren für eine tiefe Beinvenenthrombose in der Wadenmuskulatur



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.


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.


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.


Retrospektive Studie Komplikationen Inzidenz Tiefe Venenthrombose Prophylaxe 


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.


  1. 1.
    Carpintero P, Caeiro JR, Carpintero R et al (2014) Complications of hip fractures: a review. World J Orthop 5(4):402–411CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Beaupre LA, Jones CA, Saunders LD et al (2005) Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med 20(11):1019–1025CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Decker S, Weaver MJ (2013) Deep venous thrombosis following different isolated lower extremity fractures: what is known about prevalences, locations, risk factors and prophylaxis? Eur J Trauma Emerg Surg 39(6):591–598CrossRefPubMedGoogle Scholar
  4. 4.
    De Maeseneer MG, Bochanen N, van Rooijen G et al (2016) Analysis of 1,338 patients with acute lower limb deep venous thrombosis (DVT) supports the inadequacy of the term “proximal DVT”. Eur J Vasc Endovasc Surg 51(3):415–420CrossRefPubMedGoogle Scholar
  5. 5.
    Henry JC, Satiani B (2014) Calf muscle venous thrombosis: a review of the clinical implications and therapy. Vasc Endovascular Surg 48(5–6):396–401CrossRefPubMedGoogle Scholar
  6. 6.
    Kovar FM, Endler G, Wagner OF et al (2015) Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture—a twenty year observation study. Injury 46(6):1018–1022CrossRefPubMedGoogle Scholar
  7. 7.
    Simons GR, Skibo LK, Polak JF et al (1995) Utility of leg ultrasonography in suspected symptomatic isolated calf deep venous thrombosis. Am J Med 99:43–47CrossRefPubMedGoogle Scholar
  8. 8.
    Falck-Ytter Y, Francis CW, Johanson NA et al (2012) Prevention of VTE in orthopedic surgery patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):e278S–e325SCrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hill J, Treasure T (2010) National Clinical Guideline Centre for Acute and Chronic Conditions. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ 27(340):c95CrossRefGoogle Scholar
  10. 10.
    Cotton LT, Clark C (1965) Aantomical localization of venous thrombosis. Ann R Coll Surg Engl 36:214–224PubMedPubMedCentralGoogle Scholar
  11. 11.
    Ludbrook J, Loughlin J (1964) Regulaion of volume in postarteriolar vessels of the lower limb. Am Heart J 67:493–507CrossRefPubMedGoogle Scholar
  12. 12.
    Lijfering WM, Rosendaal FR, Cannegieter SC (2010) Risk factors for venous thrombosis—current understanding from an epidemiological point of view. Br J Haematol 149(6):824–833CrossRefPubMedGoogle Scholar
  13. 13.
    Schwarz T, Langenberg K, Oettler W et al (2002) Deep vein and isolated calf muscle vein thrombosis following long-haul flights: pilot study. Blood Coagul Fibrinolysis 13(8):755–757CrossRefPubMedGoogle Scholar
  14. 14.
    Mato DT (1998) The natural history of calf vein thrombosis: lysis of thrombi and development of reflux. J Vasc Surg 28:67–73CrossRefGoogle Scholar
  15. 15.
    Ohgi S, Tachibana M, Ikebuchi M et al (1998) Pulmonary embolism in patients with isolated soleal vein thrombosis. Angiology 49(9):759–764CrossRefPubMedGoogle Scholar
  16. 16.
    Kret MR, Liem TK, Mitchell EL et al (2013) Isolated calf musclar vein thrombosis is associated with pulmonary embolism and a high incidence of additional ipsilateral and contralateral deep venous thrombosis. J Vasc Surg 1(1):33–38PubMedGoogle Scholar
  17. 17.
    Su LY, Guo FJ, Xu G et al (2013) Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound. Chin Med J 126(23):4448–4452PubMedGoogle Scholar
  18. 18.
    Gillet JL, Perrin MR, Allaert FA (2007) Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis. J Vasc Surg 46(3):513–519CrossRefPubMedGoogle Scholar
  19. 19.
    Antignani PL, Aluigi L (2013) The calf vein thrombosis. Rev Vasc Med 1:1–4CrossRefGoogle Scholar
  20. 20.
    Petrauskiene V, Falk M, Waernbaum I et al (2005) The risk of venous thromboembolism is markedly elevated in patients with diabetes. Diabetologia 48(5):1017–1021CrossRefPubMedGoogle Scholar
  21. 21.
    Kurdee Z, King R, Ajjan RA (2014) The fibrin network in diabetes: its role in thrombosis risk. Pol Arch Med Wewn 124(11):617–627PubMedGoogle Scholar
  22. 22.
    Jones EW, Mitchell JR (1983) Venous thrombosis in diabetes mellitus. Diabetologia 25(6):502–525CrossRefPubMedGoogle Scholar
  23. 23.
    Abelseth G, Buckley RE, Pineo GE et al (1996) Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip. J Orthop Trauma 10(4):230–235CrossRefPubMedGoogle Scholar

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

Personalised recommendations