Abstract
Introduction
Ankle fractures are one of the commonest orthopaedic injuries. A substantial proportion of these are treated non-operatively at outpatient clinics with cast immobilization. Recent literature and NICE guidelines suggest risk assessment and provision of appropriate thromboembolism in patients with lower limb casts. We conducted this survey to assess the current practice in UK regarding thromboembolism prophylaxis in these patients.
Materials/Methods
A telephonic survey was carried out on junior doctors within orthopaedic departments of 56 hospitals across the UK. A questionnaire was completed regarding venous thromboembolism risk assessment, prophylaxis and hospital guidelines etc.
Results
Eighty-four percent (n=47) hospitals didn't routinely use any prophylaxis for these patients while 7% (n=4) hospitals used chemo-prophylaxis. Only 5.3% (n=3) hospitals had DVT prophylaxis guidelines regarding these patients while other 9% (n=5) hospitals were in process of developing such guidelines. In 64% (n=36) hospitals, no formal DVT risk assessment was carried out. Fifty percent (n=28) of the responders expressed that a DVT prophylaxis was not required in these patients, thirty-four percent (n=19) had opinion that prophylaxis should be prescribed, seven percent (n=4) said that prophylaxis was only required in the presence of additional DVT risk.
Conclusion
A large variation exists across NHS hospitals and a poor risk assessment is being carried out in these patients. Development of local guidelines and extension of national guidelines to include high risk outpatients may improve the situation.
