Venous thromboembolism in pelvic ring and acetabular fractures - A prospective cohort study

Venous thromboembolism (VTE) is a major complication in pelvic ring and acetabular fractures (PAF). Evidence on incidence and optimal prophylaxis strategies remains limited. This study aimed to investigate the incidence of VTE in PAF patients under a standardized prophylaxis regimen.

A prospective cohort study was conducted at a German Level I trauma center between January and December 2024. 81 patients with PAF (Pelvic ring fracture (PF) n = 47, Acetabular fracture (AF) n = 28, Combined fracture (CF) n = 6) were included. All patients received enoxaparin 4000 IU twice daily, initiated within 12 h of admission. Primary outcome was radiologically confirmed VTE during index hospitalization. Secondary outcomes included VTE timing, association with fracture type and treatment, and bleeding complications.

The overall incidence of VTE was 7.4% (6/81), including deep vein thrombosis (DVT) 6.2% (5/81), pulmonary embolism (PE) 2.5% (2/81), and one combined event. VTE occurred more often in AF (10.7% (3/28)) and CF (33.3% (2/6)) compared with PF (2.1% (1/47); p = 0.016). Three of five DVTs (60%) were asymptomatic. No associations were found with age, sex, ASA, trauma mechanism, or associated injuries. In the operatively treated group, one patient (1.9%; 1/53) required revision for postoperative hematoma; no further bleeding complications occurred.

A prophylactic regimen with enoxaparin 4000 IU twice daily was associated with a low incidence of VTE in PAF patients without an increased risk of bleeding. Routine duplex ultrasound screening enabled early VTE detection, including asymptomatic cases, and may improve outcomes in this high-risk population.