DEEP VENOUS THROMBOSIS IN BELOW KNEE FRACTURES IN A MIDDLE EASTERN POPULATION: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: The incidence of thromboembolism and the need for thromboprophylaxis for below knee fractures treated by immobilization are not well established. Several risk factors affect the incidence of deep venous thrombosis including genetic and ethnic factors. The primary aim of this study was to investigate the rate of deep venous thrombosis in a Middle Eastern population undergoing immobilization for below knee fractures. The secondary aim was to identify possible risk factors and differences in the symptoms between patients with and without deep venous thrombosis and highlight subgroups that require further investigation and possible thromboprophylaxis. Methods: During a period of one-year, patients presenting to our university based medical center with below knee fractures requiring immobilization, whether requiring surgical or non-surgical treatment, were enrolled in the study. Patients were followed up with a compression duplex ultrasonography at 6 weeks and asked to fill a questionnaire to assess their symptoms. Results: Out of 101 patients included, 4 (3.96%) had positive venous duplex scan after immobilization for below knee fractures. All 4 patients with positive venous duplex scan had been treated non-surgically for their fractures which included base of fifth metatarsal fractures (n=3) and a nondisplaced lateral malleolar fracture (n=1). There were no statistically significant differences in the baseline characteristics or the type and rate of symptoms between the duplex positive and duplex negative patients. There was however, a statistically significant difference in the time of the day when patients felt the symptoms most (P =0.005). Duplex negative patients reported most symptoms upon walking and at the end of the day, while patients with positive duplex had pain during the night and in the morning. Conclusion: A 4% rate of deep venous thrombosis was found in our Middle Eastern cohort of patients with below knee fractures. Larger multicenter studies are needed to combine clinical symptoms of patients with deep venous thrombosis after immobilization for below knee fractures and compare them with physiologic symptoms, to build a scoring system and assess the need for screening duplex and thromboprophylaxis in this population that might be at a higher risk due to genetic and ethnic predispositions. © 2022, American University of Beirut. All rights reserved.