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Purpose: The purpose of this prospective study was to investigate the pre-operative incidence of and risk factors for deep venous thrombosis (DVT) in geriatric intertrochanteric fractures to help facilitate the peri-operative management of them., Materials and Methods: Data of 1515 geriatric intertrochanteric fracture patients were extracted from a prospective intertrochanteric fractures database according to the inclusion criteria and exclusion criteria. The demographics, fracture characteristics, and pre-operative laboratory indicators of patients were evaluated statistically., Results: The incidence of pre-operative DVT was 10.2% (155 in 1360 patients) in the present study. The rates of proximal DVT, distal DVT, and mixed DVT were 18.1% (28 patients), 56.8% (88 patients), and 25.2% (39 patients), respectively. The percentages of DVT developing in the affected limb, uninjured limb, and bilateral limbs were 74.2% (115 in 55 patients), 16.8% (26 in 155 patients), and 9% (14 in 155 patients), respectively. After the multivariable analysis, the time from injury to surgery (TIS) > 4 days [odds ratio (OR) = 1.870, p = 0.001], the number of comorbidities > 2 (OR = 2.124, p = 0.014), and albumin (ALB) < 35 g/L (OR = 1.516, p = 0.043), etc. were significantly associated with the development of preoperative DVT in geriatric intertrochanteric fracture patients., Conclusions: Although routine anticoagulant therapy was used to prevent the formation of DVT, the incidence of which was still high. Therefore, pre-operative ultrasound of both lower extremities was advised for pre-operatively, especially for patients with delayed surgery, hypoproteinemia, three or more comorbidities, and a D-dimer level > 1.59 mg/L., (© 2021. The Author(s), under exclusive licence to The Author(s) under exclusive licence to SICOT aisbl.)

There are no studies on epidemiologic characteristics of deep vein thrombosis (DVT), when specified at in patients with bilateral calcaneal fractures. This study aimed to address the preoperative DVT in bilateral calcaneal fractures. Between October 2014 and December 2018, adult patients presenting with bilateral calcaneal fractures and having preoperative Duplex ultrasound (DUS) of bilateral lower extremities for detection of DVT were included. Their medical data were collected, with regards to demographics, comorbidities, injury-related data and biomarkers. Baseline characteristics between patients with and without DVT were compared using bivariate tests. The further multivariate logistics regression analysis was conducted to identify independent factors associated with DVT. In total, 258 patients with bilateral calcaneal fractures were included, with 21 (8.1%) having preoperative DVT, diagnosed at 7.7 ± 4.2 days after injury. The prevalence rate of proximal DVT was 1.9% and of distal DVT was 6.2%. Thirty five thrombi were found, with 6 (17.1%) in proximal veins and 29 (82.9%) in distal veins. Nine patients had DVTs in multiple veins, and 2 patients had bilateral DVTs. The multivariate analyses showed history of allergy (odds ratio [OR] = 2.17), concurrent other fractures (OR = 4.53), prolonged time since injury (for each day, OR = 1.16), elevated plasma D-dimer level (≥1.73 vs <1.73 mg/L, OR = 3.74) and reduced albumin level (<34.2 g/L vs ≥34.2 g/L, OR = 2.92) were independent factors associated with DVT. Multiple factors were identified to be associated with DVT and greater consideration should be given to the use of pharmacologic prophylaxis in patients involving these factors, to reduce DVT occurrence., (Copyright © 2021 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

This study aimed to investigate the incidence of and risk factors for postoperative new-onset deep venous thrombosis (PNO-DVT) following intertrochanteric fracture surgery. Information on 1672 patients who underwent intertrochanteric fracture surgery at our hospital between January 2016 and December 2019 was extracted from a prospective hip fracture database. Demographic information, surgical data, and preoperative laboratory indices were analysed. Receiver operating characteristic curve analysis, univariate analyses and binary logistic regression analyses were performed. The incidences of postoperative deep venous thrombosis (DVT) and PNO-DVT in inpatients after intertrochanteric fracture surgery were 11.5% (202 of 1751 patients) and 7.4% (123 of 1672 patients), respectively. PNO-DVT accounted for 60.9% of postoperative DVT. Additionally, there were 20 cases of central thrombosis (16.3%), 82 cases of peripheral thrombosis (66.7%), and 21 cases of mixed thrombosis (17.1%). In addition, 82.1% of PNO-DVTs were diagnosed within 8 days after surgery. The multivariate analysis revealed that age > 70 years, duration of surgery (> 197 min), type of anaesthesia (general), and comorbidities (≥ 3) were independent risk factors for the development of PNO-DVT after intertrochanteric fracture surgery. This study demonstrated a high incidence of PNO-DVT in inpatients after intertrochanteric fracture surgery. Therefore, postoperative examination for DVT should be routinely conducted for patients., (© 2021. The Author(s).)

Backgrounds: Deep vein thrombosis (DVT) occurring during the preoperative waiting period may affect the prognosis of traumatic patients, but there still lack of relevant data. This study aimed to address the preoperative DVT in isolated calcaneal fractures., Methods: Patients who presented with isolated calcaneal fracture and received preoperative Duplex ultrasound scanning of bilateral lower extremities for detection of DVT between October and December 2018 were eligible for inclusion. Relevant data were prospectively collected, including demographics, comorbidities, lifestyles, injury, and laboratory biomarkers at admission. Univariate analyses were used to compare the difference of each variable between patients with and without DVT. Multivariate logistics regression analysis was used to identify the independent risk factors for DVT., Results: Totally, 770 patients met the criteria and were included, and 24 (3.1%) had preoperative DVT diagnosed at mean of 5.3 days after injury, all of which were asymptomatic. Among patients with DVTs, 36 thrombi were found and 29 (80.6%) were in distal veins. Eight patients had DVTs in multiple veins, but no patients had bilateral DVTs. The multivariate analyses showed older age (≥58 vs <58 years, OR = 3.84), delay from injury to DUS (in each day, OR = 1.23) and elevated plasma D-dimer level (≥1.79 vs <1.79 mg/L, OR = 2.53) were independent risk factors associated with DVT., Conclusions: Due to low prevalence of DVT in isolated fracture, routine throboprophylaxis is not recommended. However, emphasis should be given in older patients with delay to admission and elevated plasma D-dimer level for targeted detection of DVT and rapid therapeutic intervention., (Copyright © 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background and Purpose: New-onset deep vein thrombosis (DVT) reportedly affects prognosis and surgical outcomes of elderly patients. However, its effect on distal femur fractures (DFFs) remains unclear. We aimed to address the epidemiological characteristics and the associated predictors for post-operative DVT in patients with closed DFFs over age 60 years old., Patients and Methods: We designed a prospective cohort trial at our hospital between October 2018 and June 2020 and recruited consecutive 140 patients over age 60 years diagnosed with closed DFFs. We examined location and prognosis of postoperative DVT and then conducted a three month follow-up. We used Duplex ultrasonography (DUS) to diagnose DVT in all patients and then classified the subjects into DVT and non-DVT groups. We further classified DVTs into proximal, distal, and mixed thromboses and then performed Whitney U test or t test, receiver operating characteristic (ROC) curve analysis, Chi-square test, and multiple logistic regression analysis to confirm the adjusted factors of post-operative DVT., Results: We found a 35% (n = 49) overall incidence of post-operative DVTs, which occurred 5.7 days following open reduction internal fixation (ORIF). Among patients with post-operative DVTs, 53.1% (n = 26) and 10.2% (n = 5) were distal and proximal thromboses, respectively. Additionally, peroneal veins were the most common DVT sites (71.4%, n = 35). Multivariate analysis revealed that venous thrombosis at admission (odds ratio [OR], 4.619; 95% confidence interval [CI]: 2.072-10.299; P = 0.000), operation duration over 195 minutes (OR, 3.289; 95% CI, 1.155-9.370; P = 0.026), intra-operative blood loss over 325 mL (OR, 2.538; 95% CI, 1.047-6.155; P = 0.039) were the three independent risk factors of post-operative DVT. Unified antithrombotic agents after diagnosis showed that 16.3% (n = 8) of DVTs were completely recanalized, 12.6 days after first diagnosis., Conclusion: Our findings indicate a strong association between venous thrombosis at admission, the longer operation duration, and considerable intra-operative blood loss with high risk of post-operative DVTs in patients over age 60 years with closed DFFs. Preventive approaches for postoperative DVTs should seek to shorten operation duration and reduce intra-operative blood loss.

Background: There is still lack of data on deep vein thrombosis (DVT) following bone trauma. This study aimed to determine the epidemiologic characteristics of deep venous thrombosis (DVT) of lower extremities following tibial plateau fractures., Methods: Retrospective analysis of prospectively collected data on patients presenting with tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on demographics, comorbidities, injury-related data, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT., Results: A total of 1179 patients were included, among whom 192 (16.3%) had a preoperative DVT, with incidence rate of 1.0% for proximal and 15.3% for distal DVT. The average interval between fracture occurrence and diagnosis of DVT was 3.5 days (median, 2 days), ranging from 0 to 19 days. DVT involved the injured extremity in 166 (86.4%) patients, both the injured and uninjured extremities in 14 patients (7.3%) and only the uninjured extremity in 12 patients (6.3%). Six risk factors were identified to be associated with DVT, including gender (male vs female), hypertension, open fracture, alkaline phosphatase > 100 u/L, sodium concentration < 135 mmol/L, and D-dimer > 0.5 mg/L., Conclusion: These epidemiologic data are conducive to the individualized assessment, risk stratification, and development of targeted prevention programs.

Objective: To investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures., Methods: Retrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT., Results: Among 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43-6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12-3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21-4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01-1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34-4.83; p = 0.004)., Conclusion: These epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.

Background: In this study, we investigated the epidemiological characteristics and predictors of preoperative new-onset deep vein thrombosis (DVT) in adult patients with closed distal femur fractures (DFFs)., Methods: The study was designed as a prospective cohort trial at the Third Hospital of Hebei Medical University. From October 2018 to June 2020, a total of 160 patients with closed DFFs were enrolled to assess the location and prognosis of preoperative DVT. The patients were followed up for 2 months. Duplex ultrasonography (DUS) was used to diagnose patients with DVT. The patients were divided into two groups (DVT group and non-DVT group). The DVT was then classified into proximal, distal, and mixed thromboses. The Mann-Whitney U test or t test, receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to analyze the adjusted predictors of DVT., Results: The overall incidence of preoperative DVTs was 52.5% (n = 84), which was diagnosed at a mean period of 3.1 days after injury. Among patients diagnosed with DVTs, 50.0% (n = 42) had distal thrombosis while 47.6% (n = 40) had mixed thrombosis. The calf muscle veins were the most common sites of DVTs (90.5%, n = 76). Of note, 45.2% (n = 38) of diagnosed DVTs were completely recanalized at a mean period of 12.0 days after the initial (first) diagnosis. Multivariate analysis revealed that age of ≥ 65 years of age (odds ratio [OR], 4.390; 95% confidence interval [CI] 1.727-11.155; p = 0.002), C-reactive protein (CRP) levels exceeding 11 mg/L (OR 4.158; 95% CI 1.808-11.289; p = 0.001), platelet (PLT) levels over 217 × 109/L (OR, 2.55; 95% CI 1.07-6.07; p = 0.035), D-dimer levels over 1.0 mg/L (OR 3.496; 95% CI 1.483-8.237; p = 0.004), and an American Society of Anesthesiologists (ASA) score of III-V (OR 2.753; 95% CI 1.216-6.729; p = 0.026) were the independent risk factors of preoperative DVT., Conclusions: High levels of CRP, PLT, D-dimer, ASA, and ≥ 65 years of age increase the risk of preoperative DVTs in adult patients with closed DFFs. Thus, the prediction of preoperative DVTs can significantly be improved by identifying older patients over the age of 65, and establishing the biochemical cut-off values of CRP, PLT, ASA, and D-dimer., Trial Registration: No. 2018-026-1, 24 October 2018, prospectively registered. This trial was registered prospectively on 24 October 2018 before the first participant was enrolled. This study protocol conformed to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the study on the factors of prognosis for patients with fractures. Data used in this study were obtained from the patients who underwent orthopedic surgery between October 2018 and June 2020.

Objective: To determine the relationship between inflammation/immune-based indexes and deep venous thrombosis (DVT) incidence rate following tibial plateau fractures METHODS: Retrospective analysis of a prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was performed. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on biomarkers (neutrophil, lymphocyte, monocyte, and platelet counts) at admission were collected, based on which neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte/lymphocyte (MLR), and systemic immune-inflammation index (SII, neutrophil* platelet/lymphocyte) were calculated. Receiver operating characteristic (ROC) was used to determine the optimal cutoff value for each variable. Multivariate logistic regression analysis was used to evaluate the independent relationship of each biomarker or index with DVT, after adjustment for demographics, co-morbidities, and injury-related variables., Results: Among 1179 patients included, 16.3% (192/1179) of them had a preoperative DVT. Four factors were identified to be significantly associated with DVT, including open fracture, increased D-dimer level. Among the biomarkers and indexes, only platelet and neutrophil were identified to be independently associated with DVT, and the significance remained after exclusion of open fracture. The other independent variables were elevated D-dimer level (> 0.55 mg/L), male gender, and hypertension in the sensitivity analysis with open fractures excluded., Conclusion: These identified factors are conducive to the initial screening for patients at risk of DVT, individualized risk assessment, risk stratification, and accordingly, development of targeted prevention programs.

The present study aims to introduce a technique combining double reverse traction repositor (DRTR) with minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of pilon fractures and to observe the efficiency of this approach during a short-term follow-up period. From January to December 2018, patients with pilon fractures who were treated by MIPO with DRTR were reviewed. The demographic and fracture characteristics, surgical data, and prognostic data of 24 patients were extracted. In all 24 patients, closed reduction was achieved with the MIPO technique, and excellent functional and radiological outcomes were observed. The average duration of surgery and intraoperative blood loss were 95.0 ± 14.2 min and 152.1 ± 52.1 ml, respectively. A mean of 16.0 ± 1.9 intraoperative fluoroscopies were conducted. At the 12-month follow-up evaluation, the average AOFAS score was 85.2 ± 5.1. Anatomic or good reduction was observed in 23 (95.8%) patients. The mean ranges of motion of dorsiflexion and plantarflexion were 11.0 ± 2.7 and 32.7 ± 11.1, respectively. Two patients with deep venous thrombosis and one patient with wound non-purulent exudate were noted. Additionally, the wounds healed after routine dressing change. No other complications, including skin necrosis or delayed, non-union or malunion, were observed. The new strategy combining DRTR with MIPO in the treatment of pilon fractures allowed excellent radiological and clinical outcomes and a low postoperative complication rate to be achieved in a short-term follow-up period. Further large sample and comparative studies should be conducted to validate our results. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether closed suction drainage (CSD) is related to accelerated rehabilitation of patients after open reduction and internal fixation (ORIF) for closed distal femur fractures. Methods: This study was a prospective, randomized controlled clinical trial. Between October 2018 and June 2020, 160 closed distal femur fracture patients who were prepared for ORIF were prospectively randomized into two groups: a CSD group with the mean age of 57.91 ± 14.38 years (32 [40%] men and 48 [60%] women) and a non‐CSD group with the mean age of 59.73 ± 17.55 years (27 [34%] men and 54 [66%] women). Wound visual analogue scale (VAS) pain scores, peri‐wound skin temperature, hematocrit (Hct), hemoglobin (Hb) concentrations, hidden blood loss (HBL), dressing change, period of wound oozing, postoperative blood transfusion, and length of postoperative hospital stay were recorded. Postoperative wound complications, namely wound infections, wound haematoma, wound dehiscence, erythema of wound, and lower limb deep vein thrombosis (DVT) were collected. All the patients were administrated by a single surgical team and followed up for 1 month after the ORIF. Results: The patients without CSD were identified with lower peri‐wound skin temperature and wound VAS pain scores during the first three postoperative days (36.69 ± 0.33 vs 36.86 ± 0.38 °C, P = 0.002; 1.88 ± 0.82 vs 3.15 ± 1.15, P = 0.000). However, both the peri‐wound skin temperature and wound VAS pain scores did not differ significantly between the two groups on the fifth postoperative day. In addition, patients with CSD had a longer length of postoperative hospitalization time (11.45 ± 5.95 vs 9.78 ± 4.64 days, P = 0.049). There was no statistically significant difference between CSD and non‐CSD groups within 1 month after the ORIF regarding blood loss, period of wound oozing, and postoperative complications, such as incidence of wound infection, haematoma, erythema, dehiscence, and lower limb DVT. Conclusion: Prophylactic CSD after primary ORIF for closed distal femur fractures not only had no significant advantage to minimize blood loss and wound complications, but increased local inflammation and postoperative hospital stay, and thus we suggest that prophylactic CSD after primary ORIF for closed distal femur fractures is not recommended for optimized clinical pathways and accelerated recovery. [ABSTRACT FROM AUTHOR]