OTS2 Use of interior vena caval filters in high risk pelvic and acetabular fracture. (Orthopaedic & Trauma Surgery).

OTS2 USE OF INTERIOR VENA CAVAL FILTERS IN HIGH RISK PELVIC AND ACETABULAR FRACTURE

PATIENTS: A RETROSPECTIVE EXPERIENCE. Mahesh Bagwe, MD. University of Illinois, Chicago.

The purpose of the study was to evaluate the efficacy of using the inferior vena caval filters to prevent pulmonary embolism in high-risk and acetabular fractures. A retrospective chart review identified 121 patients treated for pelvic and acetabular fractures over a 2-year period. Fifty-two of these patients had multiple risk factors for DVT and had prophylactic vena caval filter placement. They comprised the study group and their charts were reviewed. The average ISS was 12.9. The average number of lower extremity fractures, including the pelvic injury was 2.09. The average number of anesthetics was 2.58. The average ICU stay was 2.79 days. Thirty-six of these 52 patients had operative fracture treatment in the pelvic girdle. Seven patients had negative ultrasounds for DVT due to lower extremity swelling. One patient was readmitted from extended care with a symptomatic DVT. Two patients had pulmonary emboli before filter placement. We found no patient had a pulmonary embolus after filter placement. No patie nt had complications from filter placement such as hematoma, infection, vascular injury, filter malposition, or lower extremity swelling. Pelvic and acetabular fracture patients are at high risk for the development of deep vein thromboses. Risk factors for DVT in these patients include prolonged periods of bed rest leading to venous stasis, either as treatment for the fractures or as a result of extraskeletal injuries such as pulmonary contusion, spinal cord injuries, and abdominal trauma. The incidence of DVT has been reported as high as 60% with a 30% proximal DVT rate. Pulmonary embolus incidence ranges from 2% to 12% with fatal PE ranging from 0.5% to 10%. In conclusion, inferior vena caval filter placement has been a reliable and safe method of prophylaxis against pulmonary embolus in a busy urban trauma center experience.