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Venous Thromboembolism in Upper Extremity Fractures
Suresh K Nayar1, Anne M Kuwabara1, José M Flores2
1* Department of Orthopaedic Surgery, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
The Journal of Hand Surgery Asian-Pacific Volume
|October 5, 2018
Summary
Venous thromboembolism (VTE) is a risk following upper extremity fractures, particularly proximal humerus or clavicle injuries. Radius/ulna fractures rarely lead to VTE, but a rise in pulmonary embolism incidence warrants further study.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Trauma Surgery
Background:
- Venous thromboembolism (VTE) is a known complication of lower extremity fractures, but its association with upper extremity (UE) fractures is less understood.
- VTE is a serious complication that can negatively impact patient outcomes following fractures.
Purpose of the Study:
- To investigate the incidence and risk factors of VTE in patients with upper extremity fractures.
- To identify specific UE fracture locations associated with a higher risk of VTE.
- To analyze trends in VTE incidence, including pulmonary embolism (PE), over time.
Main Methods:
- Retrospective analysis of inpatient data from a level-I trauma center and the National Surgical Quality Improvement Program database (2007-2014).
- Inclusion criteria: patients aged ≥18 years with UE fractures (clavicle, humerus, radius/ulna) and VTE during the same hospitalization.
- Data collected included demographics, fracture type, VTE location and onset, polytrauma, management (operative/nonoperative), comorbidities, and mortality.
Main Results:
- Overall VTE rate of 1.3% in the institutional cohort (1984 patients) and 0.36% in the national database (11570 patients).
- VTE incidence was highest for proximal humerus (3.0%) and clavicle (2.0%) fractures, and lowest for radius/ulna (0.95%) and distal humerus/elbow (0.36%) fractures (p = 0.0035).
- Predictors of VTE included chronic steroid use (OR=6.22), inpatient status (OR=4.09), and totally disabled functional status (OR=3.31). A rise in PE incidence was observed since 2011.
Conclusions:
- Proximal humerus and clavicle fractures are associated with the highest incidence of VTE among upper extremity fractures.
- Radius/ulna fractures are rarely associated with VTE.
- The potential increase in PE incidence since 2007 requires further investigation.
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