Fatal Risk Thrombosis? A Prospective Study for the Incidence of Deep Vein Thrombosis in Pelvic Fractures

Aim: The aim of the study was to determine the incidence of deep vein thrombosis (DVT) after pelvic trauma and surgical stabilisation of pelvic and acetabular fractures under medicamentous prophylaxis. Patients and Method: Within 20 months we prospectively included 50 patients. 25 had an isolated pelvic trauma, 25 patients had multiple injuries. 21 of them were polytrauma patients (average ISS: 31.4 min. 26 pts., max. 50 pts.), four patients had additional highly unstable spine fractures or fractures of the lower extremities. Low molecular-weight heparin (Enoxaparin 40 g/d) was administered on average within 24 hours of injury in 44 cases, one patient received low-dose heparin (Liquemin 15000 to 22500 I.E./d), five patients received both. 31 patients were treated operatively and 19 conservatively. Colour-flow duplex ultrasonography was performed within 72 hours of injury and stabilisation of the pelvic and acetabular fracture, or weekly. By means of ultrasound, 97 to 100% of the deep and superficial leg veins could be examinated safely, as well as 88 to 89% of the external iliac veins and 64 to 66% of the common iliac veins. Only in 36 to 40% of the patients the internal iliac veins were visible by ultrasound. Results: Proximal DVTs were detected postoperatively in two patients (4%), one patient (2%) died after a fatal RE. before the scheduled duplex scan. Conclusion: Early medicamentous prophylaxis can prevent deep vein thrombosis after pelvic trauma. Delayed applications due to pelvic operations are risk factors. In such cases duplex scanning should be performed routinely and postoperative medicamentous prophylaxis should be increased.