Venous thromboembolism in patients with surgically treated ankle fractures

Objectives: In patients with rotational ankle fracture, we compare the rate of venous thromboembolism development between patients who received chemoprophylaxis vs those patients that received none.

Design: Retrospective cohort study.

Setting: Level I trauma center.

Patients/participants: Between 2014 and 2018, we identified 483 patients with rotational ankle fracture that had no VTE risk factors, were under 70 years of age, and had an isolated injury.

Intervention: Chemoprophylaxis vs no chemoprophylaxis after open reduction internal fixation of a rotational ankle fracture.

Main outcome measurements: Development of VTE was the primary outcome. Secondary outcomes included wound problems, infection, hematoma, or non-union.

Results: There were 313 patients that received no prophylaxis and 170 patients that received chemoprophylaxis after operative fixation of an isolated ankle fracture. Demographics including age, gender, body mass index, and ASA class were similar between groups. The rate of DVT/PE was 3.5% in those without DVT prophylaxis, and 4.1% in those on DVT prophylaxis with no significant differences found (p = 0.8). There was no significant difference in wound complication (no VTE prophylaxis-3.7% vs VTE prophylaxis-2.5%, p = 0.7) or infection rates (no VTE prophylaxis-3.8% vs VTE prophylaxis 4.1%, p = 1.0) between groups.

Conclusions: No difference was detected in the rate of symptomatic DVT or PE in patients based on chemoprophylaxis. Our results support the conclusion that the use of chemoprophylaxis may remain surgeon preference and based on patient risk factors for VTE development.

Level of evidence: Level III-retrospective cohort study.