The aim of this study was to identify factors independently associated with symptomatic venous thromboembolism (VTE) following acute Achilles tendon rupture (ATR), and to suggest a clinical VTE risk assessment tool for patients with ATR. From 2010–2018, 984 consecutive adults (median age 47yrs, 73% male) sustaining an ATR were retrospectively identified. There were 95% managed non-operatively (below-knee cast 52%, n=507/984; walking boot 44%, n=432/984), with 5% (n=45/984) undergoing primary operative repair (<6wks). VTE was diagnosed using medical records and national imaging archives, reviewed at a mean of 5yrs (1–10) post-injury. Regression was performed to identify factors independently associated with VTE. Incidence of VTE within 90 days of ATR was 3.6% (n=35/984; deep vein thrombosis 2.1% [n=21/984], pulmonary embolism 1.9% [n=19/984]). Age ≥50yrs (adjusted OR [aOR] 2.3, p=0.027), personal history of VTE/thrombophilia (aOR 6.1, p=0.009) and family history of VTE (aOR 20.9, p<0.001) were independently associated with VTE. These non-modifiable risk factors were incorporated into a VTE risk assessment tool. 23% of patients developing VTE (n=8/35) had a relevant personal or family history, but incorporating age into the tool identified 69% of patients with VTE (n=24/35). Non weight-bearing ≥2wks after ATR was also independently associated with VTE (aOR 3.2, p=0.026). Age ≥50 years, personal history of VTE/thrombophilia and a positive family history were independently associated with VTE following ATR. Incorporating age into our suggested VTE risk assessment tool enhanced sensitivity in identifying at-risk patients. Early weight-bearing in an appropriate orthosis may be beneficial in VTE risk reduction

Introduction. Venous thromboembolism (VTE) is a significant cause of patient morbidity and mortality, the risk of which increases in orthopaedic patients with lower limb immobilisation. This incidence should in theory reduce if the patients are ambulatory early in the treatment phase. The aim of this study was, therefore, to identify a difference in the incidence of symptomatic VTE by treating acute Achilles tendon rupture patients with conventional non-weight bearing plaster versus functional weight bearing mobilisation. Methodology. The notes of 91 consecutive patients with acute Achilles tendon rupture were retrospectively reviewed and prospectively followed. The patients' demographics, treatment modality (non-weight bearing plaster versus weight bearing boot), and the type of plaster immobilisation was compared to assess whether they affect the incidence of clinical VTE. The predisposing risk factors were also analysed between the treatment groups. Out of 91 patients, 50 patients with acute Achilles tendon rupture were treated conservatively in a conventional non-weight bearing immobilisation cast. From these 50 patients, 3 then underwent surgery and were therefore excluded from the results. On the other hand, 41 patients were treated with functional weight bearing mobilisation (Vacupad). Patients who did have a symptomatic thromboembolic event also had an ultrasound scan to confirm a deep vein thrombosis of the lower limb or a CT-scan to confirm pulmonary embolism. Results. Out of the 47 patients who were treated conservatively in a non-weight bearing plaster cast, 9 patients had a thromboembolic event (19.1%). On the other hand, out of the 41 patients who were treated with functional weight bearing mobilisation, only 2 patients had a symptomatic thromboembolic event (4.2%). This was statistically significant (p=0.012). This shows that patients who are treated in a non-weight bearing plaster have about five times increased risk of developing a sypmptomatic VTE compared to those treated by functional weight bearing mobilisation. There was however no difference in the predisposing factors in patients who developed VTE compared to those who did not. Conclusion. The incidence of symptomatic VTE after acute Achilles tendon rupture is high and under-recognised. Asymptomatic VTE after this injury is probably even higher. There is a significant decrease in the clinical incidence of thromboembolic events in patients treated conservatively with early mobilisation in the functional weight bearing boot compared to those treated in a non-weight bearing cast. There is a need for further research to define the possible benefit of thromboprophylaxis in patients treated by non-weight bearing plasters

Introduction. Venous thromboembolism (VTE) is an uncommon complication of foot and ankle surgery but has the potential for significant morbidity and mortality. The incidence, risk factors and prevention of VTE in foot and ankle surgery is not clear. Materials and methods. We conducted a systematic review of the literature using MEDLINE, EMBASE, CINAHL, the Cochrane library and reference lists of retrieved articles without language or date restriction upto 31st July 2010. The Coleman methodology score was used to evaluate the quality of studies. From 985 citations, 38 full text articles fulfilled the inclusion criteria. Conclusions were drawn on the incidence, risk factors and prevention of VTE in foot and ankle surgery. Results. The incidence of symptomatic VTE in foot and ankle surgery in general is low; higher incidence has been reported in tendoachilles surgery. There is some evidence that history of prior VTE, immobilisation, non-weight bearing, obesity, hormone replacement therapy and oral contraceptives predispose to VTE in foot and ankle surgery. The evidence on the efficacy of different thromboprophylaxis agents and the optimum duration of treatment is unclear. Conclusion. The current evidence on VTE prophylaxis in foot and ankle surgery is insufficient to draw any firm conclusions. Long term effects of VTE in foot and ankle surgery need to be investigated further. Further large scale, multicentre studies are needed to delineate the role of VTE prophylaxis in foot and ankle surgery

This paper reports the cost of outpatient venous thromboembolism (VTE) prophylaxis following 388 injuries of the lower limb requiring immobilisation in our institution, from a total of 7408 new patients presenting between May and November 2011. Prophylaxis was by either self-administered subcutaneous dalteparin (n = 128) or oral dabigatran (n = 260). The mean duration of prophylaxis per patient was 46 days (6 to 168). The total cost (pay and non-pay) for prophylaxis with dalteparin was £107.54 and with dabigatran was £143.99. However, five patients in the dalteparin group required nurse administration (£23 per home visit), increasing the cost of dalteparin to £1142.54 per patient. The annual cost of VTE prophylaxis in a busy trauma clinic treating 12 700 new patients (2010/11), would be £92 526.33 in the context of an income for trauma of £1.82 million, which represents 5.3% of the outpatient tariff.

Outpatient prophylaxis in a busy trauma clinic is achievable and affordable in the context of the clinical and financial risks involved.

Cite this article: Bone Joint J 2013;95-B:673–7.