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The Journal of Bone and Joint Surgery (American) 83:1047-1051 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Mechanical Prophylaxis Against Deep-Vein Thrombosis After Pelvic and Acetabular Fractures

James P. Stannard, MD, Reneé S. Riley, MD, Michelle D. McClenney, RN, Robert R. Lopez-Ben, MD, David A. Volgas, MD and Jorge E. Alonso, MD

Investigation performed at the University of Alabama Hospital, Birmingham, Alabama
James P. Stannard, MD
Reneé S. Riley, MD
Michelle D. McClenney, RN
Robert R. Lopez-Ben, MD
David A. Volgas, MD
Jorge E. Alonso, MD
Division of Orthopaedic Surgery, University of Alabama Hospital, 509 Medical Education Building, 1813 6th Avenue South, Birmingham, AL 35294-3295. E-mail address for J.P. Stannard: james.stannard{at}ortho.uab.edu

Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received, but are directed solely to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was NuTech, Kinetic Concepts, Incorporated.

Background: Deep-vein thrombosis is a common complication following pelvic and acetabular fractures. The hypothesis of this study was that pulsatile mechanical compression is superior to standard sequential mechanical compression for decreasing the prevalence of deep-vein thrombosis in patients with pelvic or acetabular fracture.

Methods: A prospective, randomized, blinded study of two methods of mechanical prophylaxis against deep-vein thrombosis was conducted. One hundred and seven patients were randomized into either Group A (fifty-four patients), in which a thigh-calf low-pressure sequential-compression device was used, or Group B (fifty-three patients), in which a calf-foot high-pressure pulsatile-compression pump was used. All patients underwent duplex ultrasonography and magnetic resonance venography. The two groups were comparable with regard to demographics, fracture type, fracture treatment, time from the injury to the prophylaxis, and patient compliance.

Results: Deep-vein thrombosis developed in ten patients (19%) in Group A, with seven (13%) having a large or occlusive clot and one (2%) having a documented pulmonary embolism. Deep-vein thrombosis developed in five patients (9%) in Group B, with two (4%) having a large or occlusive clot and none having a documented pulmonary embolism. Nine of the nineteen detected thromboses were in the deep pelvic veins. The difference in the prevalence of large or occlusive clots between the two groups demonstrated a trend but, with the numbers available, was not significant (p = 0.16). Increased patient age and the time elapsed from the injury to the surgery were found to be associated with higher rates of thrombosis.

Conclusions: Pulsatile compression was associated with fewer deep-vein thromboses than was standard compression, with the difference representing a trend but not reaching significance with the number of patients studied.


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