Upper extremity deep vein thrombosis in orthopaedic and trauma surgery: a systematic review

Thromboembolism prophylaxis in orthopaedic surgery and trauma

Thromboembolism prophylaxis is well-established in major orthopaedic surgery (hip and knee arthroplasty and hip fracture surgery), with low-molecular-weight heparins the most often chosen agent. In recent years, however, direct-acting anticoagulants have been gaining ground and can be used in this scenario (except for hip fracture surgery). In the US, even aspirin could be indicated for low-risk patients who undergo hip or knee arthroplasty. For other orthopaedic procedures (leg surgery below the knee, ankle and foot; knee arthroscopy; arm surgery; and spine surgery), thromboembolism prophylaxis requires individualisation based on the patient's risk factors and the surgery's characteristics, given that the risk of venous thromboembolic disease is minor. In this patient group, the agent of choice is low-molecular-weight heparin, given that direct-acting anticoagulants are not approved for these types of surgery.

Upper Extremity Deep Venous Thrombosis Prophylaxis After Elective Upper Extremity Surgery

Historically, upper extremity deep venous thromboses (DVTs) have been rare; however, their incidence has increased as awareness has increased. Patients who develop upper extremity DVTs often have multiple comorbidities. However, in the past decade, studies have found a small risk of upper extremity DVTs associated with orthopedic procedures involving the upper extremity. The risk of complications following a DVT, including postthrombotic syndrome and pulmonary embolism, is substantially higher with a DVT of the upper extremity compared with a DVT of the lower extremity. Furthermore, there is no consensus regarding the role and efficacy of prophylactic measures in preventing upper extremity DVT after upper extremity surgery. This article discusses the use of prophylactic agents after elective upper extremity surgery, with an emphasis on the efficacy of commonly used interventions. [Orthopedics. 2018; 41(1):21-27.].

Venous thromboembolism following elbow, wrist and hand surgery: a review of the literature and prophylaxis guidelines

This review summarizes the literature regarding venous thromboembolism and examines the prophylaxis guidelines with relation to hand, wrist and elbow surgery. We performed an extensive literature search identifying any relevant case reports or outcome studies. Of 680 potential articles, only four contained data relevant to thrombosis after elbow, wrist and hand surgery. No isolated deep vein thromboses and only nine pulmonary embolisms were identified suggesting that the rate of venous thromboembolism is extremely low following this subset of upper limb surgery. We identified nine guidelines, of which only two (the British Society for Surgery of the Hand and the National Institute of Health and Clinical Excellence) addressed the upper limb. We present a set of recommendations based on the results of this review.

Clavicular fracture and upper-extremity deep venous thrombosis

Upper-extremity deep venous thrombosis (DVT) is considered an uncommon clinical event with considerable potential for morbidity. This article presents a case of upper-extremity DVT following a clavicular fracture. A 25-year-old man presented with pain and distortion of the left midclavicular area after falling on his left shoulder during martial arts practice. Following physical examination and radiography, he was diagnosed with a simple displaced clavicle fracture at the middle third. The patient had no previous surgery or medical problem, and did not smoke. No family history of blood clotting disorders were present and neurovascular examination appeared normal on the symmetric contralateral side. A figure-of-8 bandage was applied to support the arm and the patient was discharged. One week later, he returned with swelling and severe pain in his left arm. On examination, a DVT was suspected and the figure-of-8 brace was removed. A Doppler ultrasonography was performed and the presence of a thrombus extending from the brachial axillary veins to the distal subclavian vein with no flow in that segment was revealed. The patient was placed in a sling instead of a figure-of-8 bandage to immobilize the arm, while anticoagulation therapy with enoxaparin was started (1 mg/kg every 12 hours, 80 mg subcutaneous daily for 3 months). The swelling was reduced after 5 days. At 2-week follow-up, the patient had no pain and the swelling had completely disappeared.