Venous thromboembolism following prolonged cast immobilisation for injury to the tendo Achillis

Abstract

We report an audit of 208 patients with a mean age of 39 years (16 to 65) attending the Orthopaedic Assessment Unit at the Wellington Hospital between January 2006 and December 2007 with an injury of the tendo Achillis requiring immobilisation in a cast. Information on assessment of venous thromboembolism (VTE) risk, prophylactic measures and VTE events for all patients was obtained from the medical records. A VTE risk factor was documented in the records of three (1%) patients. One of the 208 patients received aspirin prophylaxis; none received low molecular weight heparin. In all, 13 patients (6.3%, 95% confidence interval 3.4 to 10.5) developed symptomatic VTE during immobilisation in a cast, including six with a distal deep-vein thrombosis (DVT), four with a proximal DVT, and three with a confirmed pulmonary embolus. This incidence of symptomatic VTE is similar to that reported following elective hip replacement. We propose that consideration is given to VTE prophylaxis during prolonged immobilisation of the lower limbs in a cast, to ensure that the same level of protection is provided as for patients undergoing elective hip replacement.

Incidence of Deep Vein Thrombosis and Pulmonary Embolism after Achilles Tendon Rupture

“…Nilsson-Helander et al [19] reported a 34% rate of DVT after routine scans using color duplex sonography. Patients with Achilles tendon ruptures treated with cast immobilization had a 6% rate of symptomatic DVT and/or PE [6]. Our reported incidence of symptomatic DVT is lower than incidences reported in other studies.…”

“…This study was performed at Kaiser Permanente, South Bay. rate of symptomatic DVT and 1.4% rate of PE [6]. A study regarding routine screening for DVT using color duplex sonography after Achilles tendon ruptures reported a rate of 34% [19].…”

Thrombembolic complications after total ankle replacement

“…Finally, postoperative non-weight-bearing was associated with an increased incidence of symptomatic deep vein thrombosis resulting in the odds ratio 4.53 (95 % confidence interval 1.86 to 11.00). In another clinical study of patients with Achilles tendon injury, prolonged immobilization in a cast without weight-bearing was also associated with increased incidence of thrombembolic complications [78]. Conversely, early mobilization after total knee replacement resulted in a 30-fold reduction in the risk of deep vein thrombosis [79].…”

Venous Thromboembolism Prophylaxis in Outpatient Lower Limb Fractures and Injuries

“…The relationship between immobility and venous thromboembolism (VTE) is well documented [4,5,6]. In 2006, up to 62% of British Orthopaedic departments did not routinely use VTE prophylaxis and only 11% performed risk stratification in ambulatory lower limb trauma patients with rigid immobilisation [8].…”

“…The incidence of Deep Venous Throm bosis (DVT) in patients with temporary lower limb immobilisation is considerable and varies from 5-39% depending on the type of immobilisation and patient factors [4][5][6]. Given the obvious risks of lower limb cast immobilisation it appears that the same emphasis is not placed on VTE assessment in outpatients that are treated for lower limb trauma with cast im mobilisation.…”