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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 2, 209-212.
doi: 10.1302/0301-620X.87B2.14447  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Thromboprophylaxis in pelvic and acetabular trauma surgery

THE ROLE OF EARLY TREATMENT WITH LOW-MOLECULAR-WEIGHT HEPARIN

N. Steele, BSc, FRCS(Ed), Specialist Registrar; R. M. Dodenhoff, FRCS (Orth), Consultant Orthopaedic Surgeon; A. J. Ward, FRCS, Consultant Orthopaedic Surgeon; and M. H. Morse, MRCP, FRCR, FDSRCPS, Consultant Radiologist

Epsom General Hospital, Dorking Road, Epsom, Surrey KT18 7EG, UK.
Princess Royal Hospital, Telford, Shropshire TF1 6TF, UK.
Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK.

Correspondence should be sent to Mr A. J. Ward; e-mail: anthonyjward{at}blueyonder.co.uk

We prospectively studied the outcome of a protocol of prophylaxis for deep vein thrombosis (DVT) in 103 consecutive patients undergoing surgical stabilisation of pelvic and acetabular fractures. Low-molecular-weight heparin (LMWH) was administered within 24 hours of injury or on achieving haemodynamic stability. Patients were screened for proximal DVT by duplex ultrasonography performed ten to 14 days after surgery.

The incidence of proximal DVT was 10% and of pulmonary embolus 5%. Proximal DVT developed in two of 64 patients (3%) who had received LMWH within 24 hours of injury, but in eight of 36 patients (22%) who received LMWH more than 24 hours after the injury (p < 0.01). We conclude that LMWH, when begun without delay, is a safe and effective method of thromboprophylaxis in high-risk patients with major pelvic or acetabular fractures.






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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General