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Incidence and risk factors of preoperative deep venous thrombosis in closed tibial shaft fracture: a prospective cohort study

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

To investigate the preoperative morbidity of deep venous thrombosis (DVT) and predictive risk factors associated with DVT after closed tibial shaft fracture.

Methods

Ultrasonography and blood analyses were performed preoperatively in patients who sustained tibial shaft fracture between October 2014 and December 2018. Univariate analyses were used in the data of demographics, comorbidities, mechanism of injury, concomitant fractures and laboratory biomarkers. Multivariate logistic regression analyses were conducted to determine the independent risk factors associated with DVT.

Results

In total, 918 patients with an operatively treated tibial shaft fracture were included, among whom 122 patients had preoperative DVTs, indicating a crude morbidity of 13.3%. Ninety-two of 758 (12.1%) patients with isolated tibial shaft fracture developed DVT, while 30 of 160 (18.8%) patients with concurrent fracture presented with DVT. The average interval between fracture and initial diagnosis of DVT was 3.1 days (median, 2 days), ranging from 0 to 33 days. Among DVT-positive patients, 16 (13.1%) patients presented with proximal DVT and 106 (86.9%) patients had distal DVT. Multivariate logistic regression analysis showed four independent risk factors were significantly correlated to the development of DVT, including increased age (OR = 1.17, p = 0.003), diabetes (OR = 1.99, p = 0.009), serum hydroxybutyrate dehydrogenase > 182 U/L (OR = 1.83, p = 0.008), and delay to DUS (in each day) (OR = 1.13, p < 0.001).

Conclusion

In the present cohort study, the incidence of DVT was 12.1% in patients with isolated tibial shaft fracture. We suggest individualized risk stratification and early anticoagulation for patients with high risk factors including pre-existing diabetes, HBDH > 182 U/L, delay to DUS and older age.

Level of evidence

Level III, a prospective cohort study.

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Acknowledgements

We acknowledge all the patients who participated in the study and all the staff in the trauma center.

Funding

None.

Author information

Author notes

  1. Jiangtao Ma and Jin Qin contributed equally to this work.

Authors and Affiliations

  1. Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Jiangtao Ma, Jin Qin, Meishuang Shang & Yali Zhou

  2. Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Jiangtao Ma, Jin Qin, Meishuang Shang, Yali Zhou, Yingze Zhang & Yanbin Zhu

  3. Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Jiangtao Ma, Jin Qin, Meishuang Shang, Yali Zhou, Yingze Zhang & Yanbin Zhu

  4. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Yingze Zhang & Yanbin Zhu

  5. Chinese Academy of Engineering, Beijing, 100088, People’s Republic of China

    Yingze Zhang

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  1. Jiangtao Ma
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Contributions

YiZ and YaZ conceived the idea for the study; JM and JQ designed the study. MS, YZ and JM collected the relevant data and followed up the patients. YZ and JM prepared the tables. JQ performed the statistical analyses. All the authors interpreted the data and contributed to preparation of the manuscript. JM, YZ and JQ contributed equally to this manuscript.

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Correspondence to Yingze Zhang or Yanbin Zhu.

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Ma, J., Qin, J., Shang, M. et al. Incidence and risk factors of preoperative deep venous thrombosis in closed tibial shaft fracture: a prospective cohort study. Arch Orthop Trauma Surg 142, 247–253 (2022). https://doi.org/10.1007/s00402-020-03685-z

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  • DOI: https://doi.org/10.1007/s00402-020-03685-z

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