A prospective study to determine the prevalence of deep vein thrombosis in patients with pelvic, femoral and tibia/fibular fractures at the University Teaching Hospital in Lusaka

Abstract

Deep vein thrombosis (DVT) is a known occurrence in patients who have suffered trauma, especially severe trauma. The complication of DVT that makes it a great concern in trauma and orthopaedics is the fact that it occurs in an occult manner only to manifest as a fatal complication in the form of pulmonary embolism (PE). The PE may occur in a seemingly stable injured patient who suddenly changes condition with the prominent sign being difficulty in breathing. This can easily be misdiagnosed as pneumonia and the patient may die shortly after being symptomatic with the PE. This study set out to find out the prevalence of DVT in patients admitted with pelvic and lower limb fractures at the University Teaching Hospital. The study furthur sought to find out if there was an association between the occurrence of DVT and the severity of the injury as well as an association between the risks identified and the occurrence of DVT. 2. Materials and Methods Patients with pelvic and lower limb fractures had a doppler ultrasound on both their lower limbs was done in the between the 3rd and 13th day and then repeated about the 29th day on average. When a patient was found to have DVT, they were managed using Enoxaparin injection (Clexane). Patient data was collected on a standardised data collecting sheet and the fracture was classified using the Association for the Study of Internal Fixation. The risk factors were identified and noted and the doppler results were recorded. 3. Results DVT was found at a prevalence of 10.8% (8 subjects) were sample size was 74. Using Fisher’s exact test, no association was made between the severity of injury and the occurrence of DVT (2=2.133; df=4; p=0.701). The Fisher exact test also showed that no association was made between the risk factors identified and the occurrence of DVT (2=1.877; df=2; p=0.559). The risk factors identified in this study were orthopaedic trauma, bed rest, old age, obesity and tumour. 4. Conclusion The prevalence of DVT was found to be 10.8% where the sample size was 74. The study also ascertained that there was no relationship between the development of DVT and the severity of the trauma suffered. The identified risk factors for developing DVT did not show any relationship to the development of DVT in this group. 5. Recommendation The study recommended that each ward where trauma patients are being managed should be fitted with a portable doppler ultrasound machine for easy patient monitoring of DVT development. The second recommendation was to make available the drugs needed for DVT treatment as they are not readily available in the hospital.