Abstract
There are concerns regarding the rates and significance of DVT and PE following ankle fracture with published rates of VTEs varying widely. This study aimed to identify the incidence of VTEs in patients with ankle fractures and to compare this to the background risk of VTEs in these patients and the population.
1,283 consecutive patients with ankle fractures presenting to our trauma centre over a twenty-month period were studied prospectively. Patients with conservatively-managed ankle fractures were encouraged to mobilise weight-bearing but not provided with chemical thromboprophylaxis, whilst operatively-managed fractures were only prescribed chemical thromboprophylaxis during their inpatient stay. Both hospital and national episode data were searched to identify VTEs between 1981 and 2014.
Over this 33-year period there were 17 PEs and 5 DVTs. Of these, 50percnt; occurred prior to the ankle fracture, 23percnt; greater than one year after the fracture and only 27percnt; in the 90 days following injury, with no fatal PEs in this cohort. The incidence of VTEs among conservatively-managed ankle fractures within 30 and 90 days was 1.1 and 3.3 per thousand patients respectively. Operatively-managed fractures were at greater risk, with 5.2 per thousand patients at 30 days and 7.8 at 90 days.
We have found that the incidence of VTEs is very low after ankle fracture: approximately five times lower than after major joint arthroplasty. The efficacy of chemical thromboprophylaxis remains controversial, and given that the rate of major haemorrhagic complications is 2percnt;, it remains to be determined whether this is appropriate after ankle fracture.
