Hip Pelvis.  2017 Sep;29(3):159-167. 10.5371/hp.2017.29.3.159.

Recent Updates of the Diagnosis and Prevention of Venous Thromboembolism in Patients with a Hip Fracture

• Shin WC
• Lee SM
• Suh KT

• KMID: 2389521
• DOI: http://doi.org/10.5371/hp.2017.29.3.159

Abstract

Venous thromboembolism (VTE) is a potentially fatal complication that is relatively common after hip surgery. Since patients with a hip fracture have a higher risk of preoperative VTE due to an inability to ambulate after injury and aggravation of underlying age-related conditions, it may be difficult to effectively prevent VTE using only conventional approaches. Very few studies have been published reporting on the prevalence and prevention of VTE in patients with a hip fracture compared to those with hip arthroplasty. For this reason, we aimed to share recent updates on the diagnosis and prevention of VTE in patients with a hip fracture. Preoperative screening tests to diagnose VTE need to be performed more actively following hip fracture and indirect multidetector computed tomography venography is considered the most effective test for this purpose. As the risk of VTE appears to increase with time following a hip fracture, preventive measures should be taken as soon as possible in patients with a hip fracture. A wide variety of mechanical and pharmacological options are available for prophylaxis. When considering patient compliance and preventive impact, intermittent pneumatic compression devices and foot pumps are recommended as mechanical modalities. Of the available preventive medications for patients with a hip fracture, low molecular weight heparin seems to be the most appropriate option because of its short half-life and fast onset of action. Surgery should be performed as soon as possible in patients with hip fractures, and we recommend mechanical and pharmacological methods as active interventions immediately after injury to prevent VTE.

Keyword

Hip fractures; Venous thromboembolism; Diagnosis; Prevention

MeSH Terms

Arthroplasty
Diagnosis*
Foot
Half-Life
Heparin, Low-Molecular-Weight
Hip Fractures
Hip*
Humans
Intermittent Pneumatic Compression Devices
Mass Screening
Multidetector Computed Tomography
Patient Compliance
Phlebography
Prevalence
Venous Thromboembolism*
Heparin, Low-Molecular-Weight

Figure

• 

  Fig. 1 The ultrasonography showed deep vein thrombosis at a popliteal vein (arrow) in a patient with intertrochanteric femoral fracture.

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  Fig. 2 (A) This plain radiograph showed an intertrochateric femoral fracture in a 77-year-old women. (B) The venography was performed due to suspicion of deep vein thrombosis. The narrowing of deep femoral vein was observed because of deep vein thrombosis (arrow).

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  Fig. 3 Both pulmonary embolism and deep vein thrombosis were observed on indirect multidetector computed tomographic venography preoperatively in an 89-year-old female patient with intertrochanteric femoral fracture

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  Fig. 4 (A) This plain radiograph showed an intertrochateric femoral fracture in an 81-year-old man. (B) Deep vein thrombosis (arrow) of femoral vein was observed on preoperative indirect multidetector computed tomographic venography. (C) Inferior vena cava filter was inserted preoperatively.

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