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VENOUS THROMBOSIS IN PATIENTS WITH FRACTURE OF THE UPPER END OF THE FEMUR

A Phlebographic Study of the Effect of Prophylactic Anticoagulation

H. W. Hamilton 1; J. S. Crawford 2; J. H. Gardiner 3; ; and A. M. Wiley 4

1 Toronto Western, Hospital and the University of Toronto; Toronto, Ontario, Canada; Department of Orthopaedic Surgery
2 Toronto Western, Hospital and the University of Toronto; Toronto, Ontario, Canada; Department of Medicine
3 Toronto Western, Hospital and the University of Toronto; Toronto, Ontario, Canada; Department of Radiology
4 Toronto Western, Hospital and the University of Toronto; Toronto, Ontario, Canada

1. Seventy-six patients with fracture of the upper end of the femur were examined phlebographically for evidence of thrombosis. The patients were randomly divided into two groups : one was given phenindione post-operatively ; the other acted as a control.

2. Analysis of the select series showed that the incidence of venous thrombosis in the anticoagulation group (19 per cent) was significantly less than that in the control group (48 per cent).

3. However, analysis of the complete series failed to show that the incidence of venous thrombosis in the anticoagulation group was significantly less than in the control group.

4. The number of bleeding complications in the anticoagulation group (47 per cent) exceeded those in the control group (16 per cent). The only life-endangering haemorrhage occurred in a patient who had not received an anticoagulant for five months.

5. We were unable to show that the fracture significantly influenced the site or the incidence of venous thrombosis.

6. No correlation was found between the clinical and phlebographic diagnosis of venous thrombosis.

7. It is concluded that the early use of a prophylactic anticoagulant is an effective means of reducing the incidence of venous thrombosis in patients with a fracture about the hip.
(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General