Is Thromboprophylaxis Warranted After Lower-Leg Fractures?

Is thromboprophylaxis warranted in patients with lower-leg fractures? To determine the incidence of symptomatic venous thromboembolism (VTE) in such patients, researchers in Ontario prospectively followed 1200 patients with nonoperatively treated fractures of the tibia, fibula, or ankle, and operatively or conservatively treated fractures of the patella or foot; 82% of patients had casts or splints (average duration, 42 days). Pharmacologic or mechanical thromboprophylaxis was not permitted during the study.

During 3 months of follow-up, the incidence of symptomatic VTE was only 0.6%: Five patients developed deep venous thrombosis (2 proximal, 3 calf-vein), and two patients developed pulmonary embolism (none fatal).