The Journal of Bone and Joint Surgery, Vol 72, Issue 4 495-500, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Deep-vein thrombosis after fracture of the pelvis: assessment with serial duplex-ultrasound screening
RH White, JA Goulet, TJ Bray, MM Daschbach, JP McGahan and RP Hartling
Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento 95817.
Sixty patients who had had a major fracture of the pelvis and were in
stable condition on the orthopaedic ward three to five days after the
injury were tested serially with duplex ultrasound, beginning approximately
seven days after the injury, in order to determine the incidence of
deep-vein thrombosis. Contrast venography was performed to confirm all
positive non-invasive studies. Deep-vein thrombosis developed in eight
patients (approximately 15 per cent). The thrombosis was in the popliteal
or a more proximal vein in six of the eight patients, whereas in two it was
distal to the popliteal vein. In four patients, evidence of thrombosis
developed after one or more normal duplex-ultrasound studies. In one
patient, symptoms that were suggestive of deep-vein thrombosis developed
fifty-two days after the injury (four days after the fourth normal
duplex-ultrasound examination), and ascending venography was entirely
normal. Another patient had a pulmonary embolus fifteen days after the
injury, and on the same day a duplex-ultrasound study was positive for
thrombosis. During six weeks of follow-up after discharge from the
hospital, symptoms of deep-vein thrombosis or pulmonary embolism did not
develop in any patient in whom serial duplex-ultrasound studies had been
negative.
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