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Early development of deep-vein thrombosis following hip fracture surgery: the role of venous wall thickening detected by B-mode ultrasonography

Department of Vascular Medicine, CHU Grenoble, Grenoble, Department of Pharmacology Laboratory, PCEBM, Faculté de Médecine de Grenoble, La Tronche, France

Jean-Luc Bosson

Department of Vascular Medicine, CHU Grenoble, Grenoble, Department of Vascular Medicine, CHU Grenoble, Grenoble

Fatsah Baloul

Department of Vascular Medicine, CHU Grenoble, Grenoble

Cyrille Moirant

Department of Vascular Medicine, CHU Grenoble, Grenoble

Mark Hunt

Department of Pharmacology Laboratory, PCEBM, Faculté de Médecine de Grenoble, La Tronche, France

Philippe Merloz

Department of Orthopedic Surgery, CHU Grenoble, Grenoble

Patrick Carpentier

Department of Vascular Medicine, CHU Grenoble, Grenoble

Alain Franco

Department of Vascular Medicine, CHU Grenoble, Grenoble

Deep-vein thrombosis (DVT) remains the most frequent complication following hip surgery. This study was designed in order to evaluate the development of DVT after hip fracture surgery, and to determine if venous wall thickening detected before surgery predisposes patients to postoperative DVT.

Systematic ultrasound examinations were performed on 100 consecutive patients undergoing hip fracture surgery on the day preceding the operation, and then postoperatively on days 2, 5 and 10. A total of 12 proximal, 28 distal deep-vein and four saphenous vein thromboses were detected. Of the DVT, 19 (43%) were detected at day 2. Five out of eight patients with venous wall thickening had a previous history of DVT. Venous wall thickening was positively correlated with proximal DVT development (62.5% versus 8% incidence in the group of patients with and without venous wall thickening respectively; p, 0.001, relative risk = 7.8). This study highlights the high frequency of early major thromboembolic events following hip fracture surgery. It is considered that patients with a previous history of venous thromboembolic disease should undergo B-mode ultrasonographic examination before hip fracture surgery. Patients in whom venous wall thickening is detected should have repeated postoperative ultrasonographic examinations enabling early detection of DVT.

Key Words: deep venous thrombosis • hip fracture surgery • thromboembolism • ultrasonography • venous wall thickening

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