OUTCOMES OF PROLONGED ANTICOAGULANT PREVENTION OF THROMBOSIS OF DEEP VEINS OF THE CRUS IN CLOSED COMMINUTED FRACTURES OF TIBIAL BONES

Tsukanov Yu.T., Noskov V.K., Dzyuba G.G., Epanchintsev P.M.
The Chair of Surgical Diseases, Omsk State Medical Academy,
Omsk, Russia

Analysed herein are the outcomes of treating a total of 96 patients with closed comminuted fractures of crural bones. By the duration of antithrombotic prevention, the patients were subdivided into two groups: the Comparison Group comprising 45 patients with a brief course of anticoagulant treatment (mean 5.8±1.3 days) and the Study Group consisting of 51 patients receiving anticoagulant treatment till achieving full restoration of the supporting function of the limb (averagely 21.2±2.1 days). In the Comparison Group, thrombosis of the deep veins localizing exclusively on the crus was registered by the results of duplex scanning in 13 patients (28.9%). In two thirds of the cases (10 cases, 76.9%) thrombosis occurred predominantly on days 6 – 14, while in 3 cases (7.7%) it occurred on days 15-21 after the injury. In the Study Group patients with protracted anticoagulation prevention, thrombosis of the deep veins was revealed in 9.8% of cases (5 patients). Of the five Study Group patients with thromboses of tibial veins four were subjected to prolonged prevention with indirect anticoagulants and only one – with fraxiparine. It was found that the development of venous thrombi in fractures significantly (p<0.05) makes the terms of consolidation 1.6-fold longer. A conclusion was made that because a high risk of the development of thrombosis of the deep veins preserves during the whole period of restoration of the supporting function of the extremity in fractures of the crural bones, the patients concerned should, based on early (within the first 3-7 days) stable osteosynthesis making it possible to activate the patient and to restore the function of the limb, be subjected to a prolonged course of anticoagulant preventive treatment till the final changeover of the patient to the full load on the affected extremity.

KEY WORDS: thrombosis of tibial bones, fractures of the bones of the crus, anticoagulant prevention, fraxiparine.

P. 79-82

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