ABSTRACT
The exact incidence of DVT and pulmonary embolism (PE) associated with fractures of
the pelvis and acetabulum is unknown. The incidence varies from 5% to as high as 61%
(2-10). Equally as variable is the use of screening methods and prophylaxis in patients
with these injuries. Letournel, in his series of 569 acetabular fractures treated operatively
within 21 days of injury, had a 6% incidence of DVT or PE (2). Seven incidents occurred
prior to any prophylaxis; however, 22 occurred after using routine prophylaxis. When no
prophylaxis is used in trauma patients, a documented 58% incidence of DVT was
detected by impedance plethysmography and venography in a prospective study (6).
Further, a documented 61% incidence of DVT was identified following patients with
pelvic fractures in the same population who had received no prophylaxis (6). Surpris-
ingly, only 1.5% of the patients in this study with DVT had clinical characteristics sug-
gestive of thrombosis prior to the diagnosis on venography (6). In patients using some
form of prophylaxis for DVT, the incidence is reported as low as 2% to as high as 33%
(11,12). The goal of DVT prophylaxis is to prevent long-term morbidity associated with
DVT and ultimately the potential mortality associated with PE. By prevention of DVT,
the hope is to decrease the incidence of PE. DVT of the lower extremities is believed to
be the source of emboli in 75% to 95% of the cases (13,14). However, PE is often
reported in patients without a documented lower extremity DVT. The source of the
emboli may be from the veins in the pelvis (11). With trauma to the pelvis or acetabulum,
such emboli in the veins of the pelvis are more likely, but identification is difficult. Con-
ventional screening methods cannot reliably identify thrombi proximal to the inguinal
ligament. Ultrasonography, arguably the current, most commonly used screening test for
DVT, has been shown to have a poor positive predictive value for screening, especially
more proximally, and is operator dependent (15,16). The current “gold standard,” ascend-
ing venography, does not visualize the internal iliac or deep femoral venous system ade-
quately (12,17-19). To visualize the veins proximal to the inguinal ligament, cannulation
of the femoral system can be done, but requires an additional invasive procedure, and is
not suited for routine screening (17,20). More recently, in patients with pelvic and acetab-
ular fractures, magnetic resonance venography (MRV) and contrast-enhanced computed
tomography have been studied with variable results (12,20,21). At this point, neither
technique has received nationwide acceptance for routine screening.
