Frequency of deep venous thrombosis in patients with fractures of the proximal femur. Main reasons of its occurrence in Ukrainian emergency care

Relevance: Deep vein thrombosis (DVT) is a dangerous complication that occurs in patients with fractures of large tubular bones. The issue is particularly acute in Ukraine, when due to insufficient material and technical support and an insufficient level of insurance coverage, the patient lies for more than 3 days, waiting for urgent-delayed intervention concerning a proximal femoral fracture (PFF).

Purpose: analysis and correction of thromboprophylaxis in patients with PFF, taking into account the most important factor - time to surgical intervention.

Materials and methods. The results of 155 patients treatment (95 women, 60 men) with PFF for the year 2023 aged from 23 to 94 years (on average 69.77=15.91 years) were analyzed.

The results. Surgical treatment of PFF was occurred in 77 out of 155 patients, of which: 41 (53.2%) cases - hip joint replacement, 33 (42.9%) - metal osteosynthesis, 3 (3.9%) cases - VAC therapy after secondary surgical treatment. The average time from the injury to hospitalization at Kyiv Hospital No. 8 was 5.9 days. The time from hospitalization to surgery was 9 days, which is the main factor, together with the time of hospitalization, in the frequency of occurrence of preoperative thrombosis. Ultrasound of the lower extremities was performed in all patients with PFF, in which the time from the moment of injury to surgical intervention was more than three days. DVT before the operation developed in 19/155 (12.2%), after the operation in the postoperative/interoperative period (staged treatment using VAC, External fixation device (EFD) due to contaminated wounds) was occurred in 3/155 (1.9%).

Conclusions. In 2023, the frequency of DVT in patients with PFF in the Kyiv Hospital No. 8 was 14.2%. The main factor is the inability to perform surgical intervention on patients with PFF in the first 24 hours, which significantly increases the risk of DVT and worsens the prognosis of six-months survival in patients with PFF.

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