Elsevier

Injury

Volume 33, Issue 1, January 2002, Pages 33-39
Injury

Altered venous function and deep venous thrombosis following proximal femoral fracture

https://doi.org/10.1016/S0020-1383(01)00137-1Get rights and content

Abstract

The effect of surgery for femoral neck fracture on lower limb venous blood flow and its relationship to deep vein thrombosis was investigated in 179 patients. Blood flow was measured using strain gauge plethysmography before surgery, in the 1st week after surgery, and at 6 week review. There was a significant reduction in both venous outflow and venous capacitance, affecting both fractured and non-fractured legs but significantly greater in the fractured leg. Venous function remained significantly impaired in both lower limbs 6 weeks after surgery.

There was a significant correlation between the reduction in venous function and the development of deep vein thrombosis.

Introduction

Proximal femoral fracture is common in the elderly population [1]. This large group of patients is at high risk for the development of deep venous thrombosis (DVT) [2] with incidences of up to 91% having been recorded [3]. The prevalence of fatal pulmonary embolism following hip fracture has been reported up to 7.5% [4] compared with less than 1% following elective hip arthroplasty [5]. In contrast to the elective hip arthroplasty patient, the hip fracture patient is a decade older, undergoes the double assault of traumatic fracture and surgical intervention, and endures a longer immobilisation in the pre- and early postoperative period. Hip fracture patients following surgery have a recorded in-patient mortality of 12% [6] and 1 year mortality of 22% [7].

All of Virchow's triad of factors (altered coagulation, venous stasis and vessel wall damage) have been implicated in the aetiology of DVT after hip surgery [4]. This study was designed to determine the effect of surgery for proximal femoral fracture on the venous haemodynamics of both legs by using the Belfast strain gauge plethysmograph [8], [9], [10], [11], [12], [13], [19] to record venous indices in the 1st week after surgery and again at review at 6 weeks postoperation. The association of altered venous function and the development of venographically identified deep venous thrombosis was also investigated.

Section snippets

Patients and methods

All patients admitted to a single Belfast fracture unit during a 12-month period were assessed for inclusion in this investigation. Exclusion criteria involved a previous history of deep venous thrombosis or pulmonary embolus, known active malignancy, coexistent lower limb or pelvic injury at the time of hip fracture, gross obesity, presence of a clinically large thigh haematoma, evidence of ascites or clinically apparent abdominal distension. Informed consent from the patient and immediate

Results

Two hundred and sixty-two patients were assessed for inclusion. Twenty were excluded due to history of thromboembolic disease, 12 because of known malignancy, eight because of gross obesity, three because of associated pelvic or ipsilateral femoral shaft fracture, two because of bilateral proximal femoral fractures, and 38 because of failure to gain consent to be included. These exclusions resulted in 179 patients being entered to the study.

The mean age of the patients was 82 years and the male

Discussion

This demonstration of maximal depression of venous function in the first 3–5 days postoperatively is supported by several authors [14], [15], [16], [17] who also found the effect to be maximal in the 1st postoperative week. A number of factors may contribute to the impaired venous function in the 1st week following hip surgery, including pain [18], [19], relative immobility [6], lower limb swelling [20], wound haematoma or oedema, and altered coagulation as a consequence of injury and surgery

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