Thromboembolic events in pelvic and acetabulum fractures: a systematic review of the current literature on incidence, screening, and thromboprophylaxis

• Published in: International orthopaedics 2022-08, Vol.46 (8), p.1707-1720
• Main Authors: Mahmoud, Samer SS, Esser, Max, Jain, Arvind
• Format: Article
• Language: English
• Subjects: Acetabulum - injuries; Acetabulum - surgery; Anticoagulants - therapeutic use; Humans; Incidence; Medicine; Medicine & Public Health; Original Paper; Orthopedics; Pulmonary Embolism - etiology; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; Venous Thrombosis - epidemiology; Venous Thrombosis - prevention & control
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-022-05431-z

Purpose Rates of venous thromboembolic events (VTEs) as high as 41% deep vein thrombosis (DVT) were reported in association with pelvic and acetabular fractures (PAFs). There is no clear consensus on VTE prophylaxis for PAFs. Extracting evidence-based guidelines is key to overcome this challenging complication. The aims of this review are (A) to highlight the incidence of VTEs in PAFs, (B) to examine the screening and prophylaxis methods available in the current literature, and (C) direct future creation of a best practice protocol to reduce the risk of VTE in PAFs. Methods We performed a systematic search of Medline, EMBASE databases, and the Cochrane library. MESH terms were used to identify studies pertinent to VTE in PAFs, including incidence, prophylaxis, and screening. Results In total, 28 studies were identified and grouped into four categories including incidence, screening, prophylaxis, and the use of inferior vena cava filters (IVCFs). Incidence of VTE ranged from 0.21 to 41% for DVT and 0 to 21.7% for PE. Nine studies screened 1360 patients using different imaging modalities. Ten articles, 2836 patients, examined different thromboprophylaxis protocols. Two out of three studies investigating the use of IVCF showed significant reduction of the rates of PE. Conclusion Incidence of VTE in PAF varies significantly with different protocols. The current literature shows that screening is still controversial. The combination of chemical and mechanical prophylaxis starting at 24 hours from the injury would provide the best protection. Guidelines were extracted; however, higher level multicenter studies are still required to guide future protocols.