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Thromboprophylaxis for acetabular injuries in the UK What prophylaxis is used?
J M Geoghegan1, K Hassan, D Calthorpe
1Department of Trauma and Orthopaedics, Derbyshire Royal Infirmary, Derby DE1 2QY, United Kingdom. john.geoghegan@ntlworld.com <john.geoghegan@ntlworld.com>
Insights
UK acetabular trauma care lacks national coordination, leading to delayed surgeries and inconsistent thromboprophylaxis. Current practices show varied approaches to preventing blood clots, highlighting a need for standardized guidelines in managing pelvic and acetabular injuries.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Vascular Surgery
Background:
- Chronic underfunding and lack of a coordinated national strategy impact acetabular trauma patient care in the UK.
- Prolonged recumbancy is a significant issue for patients with acetabular injuries due to management gaps.
Purpose of the Study:
- To investigate current clinical practices in UK specialist pelvic and acetabular units.
- To assess the time to surgery, thromboprophylaxis, and surveillance methods for acetabular trauma patients.
Main Methods:
- A postal questionnaire was distributed to specialist pelvic and acetabular units across the UK.
- Data collected from 21 units and 37 surgeons regarding management protocols.
Main Results:
- The mean time to surgery for acetabular trauma in the UK is 8.5 days.
- Chemical thromboprophylaxis (LDH or LMWH) is universal, while mechanical prophylaxis is used in 67% of units.
- Clinical surveillance for thromboembolism is common (90%), but routine radiological surveillance (ultrasound Doppler) is rare (10%).
Conclusions:
- There is a lack of consensus on thromboprophylaxis and surveillance for acetabular trauma in the UK.
- The absence of a dedicated surgeon directory and standardized protocols hinders optimal patient care.
- A coordinated national approach is needed to improve outcomes for acetabular trauma patients.
Abstract:
Due to chronic underfunding and the absence of a comprehensive and coordinated national approach to the management of acetabular trauma throughout the UK, patients can incur prolonged recumbancy. We have performed a postal questionnaire to establish the current clinical practice in the specialist pelvic and acetabular units throughout the UK, with respect to time to surgery from injury, thromboprophylaxis, and surveillance. We have identified 21 units, and 37 surgeons in the NHS who deal with acetabular trauma. The mean time to surgery from injury in the UK is 8.5 days (range 2-19 days). Mechanical thromboprophylaxis was used in 67% (14) of the units. No unit routinely uses prophylactic IVC filters. Chemical thromboprophylaxis is routinely used in 100% (21) of the units. Ninety-five percent (20) used prophylactic doses of LDH or LMWH. Clinical surveillance alone for thromboembolism is employed in 90% (19) of the units. Only 2 (10%) units routinely perform radiological surveillance with ultrasound Doppler, pre-operatively. Currently there is no published directory of dedicated pelvic and acetabular surgeons in the UK. There is no general consensus on the approach to thromboprophylaxis and surveillance in acetabular trauma in the UK. There is no consensus approach to thromboprophylaxis and surveillance in the literature.
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