Abstract
Introduction
The use of intramedullary lengthening devices is becoming increasingly popular. There are no published data regarding the incidence of venous thromboembolism following intramedullary lengthening and no reports or guidance for current practices on use of thromboprophylaxis. Following a case of post-operative deep vein thrombosis in our institution, we felt that it is important to assess best practice. We conducted this survey to collect data that would describe current practice and help guide consensus for treatment.
Materials and Methods
We have identified surgeons across the UK that perform intramedullary lengthening through the British Limb Reconstruction Society membership and a Precise Users database. Surgeons were contacted and asked to respond to an online survey (SurveyMonkey - SVMK Inc.). Responses to thromboprophylaxis regimes employed in their practice and cases of venous thromboembolism were collated.
Results
24 out of 54 surgeons identified responded with a total of 454 cases of intramedullary lengthening (352 femoral and 102 tibial nails) performed over the last 5 years. Only one case of DVT following femoral lengthening was reported. There is wide variability in practice both in terms of thromboprophylaxis risk assessment, choice of medications (20% no pharmacological treatment, 75% Low molecular Weight Heparin, 5% Aspirin) and duration of treatment (0–42 days). The vast majority of surgeons (85%) felt that there was insufficient evidence available to guide their practice.
Conclusions
Intramedullary lengthening is a relatively recent and novel surgical treatment. As a result there is limited data available to guide decision making regarding aspects of treatment such as thromboprophylaxis. This is reflected in the wide variation in practice reported in this study. There is both a need and a desire to gather data that will allow us to come to a consensus and to guide safe practice.
