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The incidence of deep vein thrombosis and pulmonary embolism following cast immobilisation and early functional bracing of Tendo Achilles rupture without thromboprophylaxis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

An Erratum to this article was published on 26 July 2014

Abstract

Purpose

The routine use of thromboprophylaxis during cast immobilisation for lower leg trauma is controversial. The concern involves the perceived increased risk of deep vein thrombosis (DVT) and its sequelae following leg immobilisation. However, immobilisation is used for a spectrum of trauma and for varying duration. This heterogenicity in management is reflected in the current evidence and coupled with the risks of thromboprophylaxis; no clear consensus has been made.

Methods

In this retrospective study, we report the incidence of DVT and pulmonary embolism (PE) observed following cast immobilisation and early functional management of patients with Tendo Achilles rupture. Over 12 years, 945 consecutive patients (949 tendons) were treated without additional thromboprophylaxis.

Results

The incidence of DVT was 1.05 % and PE was 0.32 %. Females were significantly more likely to develop a DVT but not a PE. When compared to the incidence of DVT and PE observed in the general population, DVT rate was statistically significantly higher than that observed in the general population. There was no significant difference in PE rates. The number needed to treat to reduce the DVT incidence is 106. The number needed to treat to reduce the PE incidence is 475.

Conclusions

Although we can conclude that conservative treatment for Tendo Achilles does increase the incidence of symptomatic DVT from the general population, we feel that large randomised control trials are required to evaluate the efficacy, compliance and cost effectiveness of routine DVT thromboprophylaxis in the outpatient setting.

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Conflict of interest

Gavin Heyes, Adam Tucker, Richard GH Wallace and Anthony LR Michael declare that they have no conflict of interest.

Compliance with ethics guidelines

Gavin Heyes, Adam Tucker, Richard GH Wallace and Anthony LR Michael confirm that there was no experimental treatment of patients, and that treatment was in accordance with the ethical standards expected by the hospital and in accordance with the Helsinki Declaration of 1975, as revised in 2008. Gavin Heyes, Adam Tucker, Richard GH Wallace and Anthony LR Michael confirm that informed consent was taken from all patients included in the study at time of clinical review. No identifying patient information was used in the study.

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Authors and Affiliations

  1. Apartment 1001, 70 Chichester Street, Belfast, Co. Antrim, BT1 4JQ, Northern Ireland, UK

    G. J. Heyes

  2. 400, Sandygate Road, Sheffield, South Yorkshire, S10 5UE, UK

    A. Tucker & A. L. R. Michael

  3. Northern General Hospital, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK

    A. Tucker & A. L. R. Michael

  4. 8, My Lady’s Mile, Holywood, Northern Ireland, Co. Down, BT18 9EW, UK

    R. G. H. Wallace

  5. Department of Trauma and Orthopaedics, Ulster Hospital Dundonald, Upper Newtownards Road, Dundonald, Belfast, BT16 1RH, UK

    A. Tucker & R. G. H. Wallace

Authors
  1. G. J. Heyes
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  2. A. Tucker
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  3. A. L. R. Michael
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  4. R. G. H. Wallace
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Corresponding author

Correspondence to G. J. Heyes.

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Heyes, G.J., Tucker, A., Michael, A.L.R. et al. The incidence of deep vein thrombosis and pulmonary embolism following cast immobilisation and early functional bracing of Tendo Achilles rupture without thromboprophylaxis. Eur J Trauma Emerg Surg 41, 273–276 (2015). https://doi.org/10.1007/s00068-014-0408-5

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  • DOI: https://doi.org/10.1007/s00068-014-0408-5

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