Early Diagnosis and Prevention of Acute Deep Vein Thrombosis of the Calf in Patients with Closed Comminuted Fractures of the Tibia

The dissertation is dedicated to the development of approaches for early diagnosis and prevention of acute deep vein thrombosis of the calf in patients with closed comminuted fractures of the tibia. The research substantiates the leading role of lower extremity trauma as an etiological factor in the development of acute venous thrombosis and demonstrates the effectiveness of electromagnetic resonance impedancemetry for early detection and prediction of thrombosis course. A method of prolonged medication anticoagulant prophylaxis has been developed, allowing a significant reduction in the incidence of venous thrombosis in this patient category.

Venous thrombosis of the lower extremities occupies a leading place among post-traumatic and post-surgical complications [23, 36, 117, 226] and is one of the most serious dangers that any physician of any specialty must face in practice. Despite the constant improvement of surgical care for the population, this problem continues to be relevant [95,146, 154,246].

The annual incidence of deep vein thrombosis of the lower extremities is 84 cases per 100,000 population [151, 254]. However, one can assume that the total number of such patients and the significance of the pathology are considerably greater if one takes into account "silent" flowing and undiagnosed cases of thrombosis [217, 97]. These complications are sufficiently frequent in patients with damage to the musculoskeletal system, including during surgical interventions on the lower extremities, which is due to forced immobilization of the extremity that creates favorable conditions for the occurrence of deep vein thrombosis of the lower extremities [104]. According to Berguist D. (1993), who conducted diagnostic studies using labeled fibrinogen, the incidence of deep vein thrombosis in traumatology reaches 56% [118].

Venous thromboses can be caused by various reasons [65, 90] and often occur during traumatic fractures of the bones of the extremity. At the same time, observations indicate the possibility of various pathways of thrombosis development in such patients, due to the combination of external and internal factors [227].

"Silent" forms of deep vein thrombosis of the lower extremities are often accompanied by the development of pronounced violations of venous blood flow. Over three years after the onset of venous thrombosis, the post-thrombotic syndrome is detected in 35-69% of patients, and over 5-10 years in 49-100% of cases [137]. After several years, the majority of such patients, due to pronounced post-thrombotic disorders of hemodynamics in the extremity, develop calf edema, trophic ulcers leading to patient disability [217,257].

It is important to search for the possibility of more early detection of post-traumatic thrombosis of the veins of the calf in patients with damage to the musculoskeletal system. Traditionally used diagnostic methods are either technically complex and require special equipment (radioisotope studies with labeled fibrinogen, angiographic methods, etc.) or are technically not feasible during treatment of closed comminuted fractures of the tibia using the Ilizarov method (duplex ultrasonography with Doppler mapping).

The system of thrombosis prophylaxis in patients with trauma to the bones of the lower extremities, and first of all in closed comminuted fractures of the bones of the leg - the most threatening in terms of the occurrence of venous thromboses due to complexities of anatomical structure [2, 7, 57] - requires further development.

Goal of the research:

Development of criteria for early diagnosis and a method for prevention of deep vein thrombosis of the calf in patients with closed comminuted fractures of the tibia through the use of electromagnetic resonance impedancemetry and prolonged anticoagulant therapy.

Tasks:

1. To determine the incidence of deep vein thrombosis of the calf in patients with closed comminuted fractures of the tibia.

2. To determine the incidence of venous thrombosis of various locations depending on the level of tibial fracture.

3. To identify the effect of developed post-traumatic deep vein thrombosis of the calf on the consolidation time of tibial fractures during treatment using the Ilizarov method.

4. To develop a methodology and evaluate the results of applying electromagnetic resonance impedancemetry in the diagnosis and prediction of the course of deep vein thrombosis of the calf in patients with closed comminuted fractures of the tibia.

5. To develop a method for prevention of deep vein thrombosis in patients with traumatic fractures of the tibia.

Scientific novelty

Based on a comprehensive approach, the incidence of deep vein thrombosis of the calf in patients with closed comminuted fractures of the tibia has been identified.

The dependence of the incidence of deep vein thrombosis of the calf of various locations on the type and level of traumatic fracture has been established.

A methodology (RF patent for invention No. 2258459 dated 20.08.2005 "Method of early diagnosis of post-traumatic thrombosis of veins of the lower extremities") has been developed, allowing differentiation of traumatic edema phenomena from deep vein thrombosis of the calf in patients with closed comminuted fractures of the bones of the leg.

A patent for invention No. 2005105239 dated 20.06.2007 "Method of predicting the course of acute thrombosis of veins of the lower extremities" has been obtained.

A method for prevention of deep vein thrombosis of the calf in traumatic fractures of the tibia has been developed, allowing a significant reduction in their incidence.

Scientific and practical significance

The obtained data expand the available information on the occurrence and clinical manifestations of deep vein thrombosis of the lower extremities in traumatic fractures.

The method of electromagnetic resonance impedancemetry can be widely applied in orthopedic-traumatological departments of hospitals, as well as in outpatient clinic settings for early diagnosis and prediction of the course of deep vein thrombosis in comminuted fractures of the bones of the leg.

The developed method for prevention of venous thrombosis of the calf in closed fractures of the bones of the leg can be recommended for wide application both in the hospital and outpatient stages of treatment of this type of injury.

Validation of the work

The main provisions of the dissertation were reported at the X All-Russian Congress of Cardiovascular Surgeons (Moscow, 2004), at the scientific-practical conference "Actual Questions of Surgery and Clinical Anatomy" (Yaroslavl, 2005), at the scientific-practical conference "New Technologies in Medicine (Morphological, Experimental, Clinical and Social Aspects)" (Volgograd, 2005), at the international scientific-practical conference "New Technologies in Diagnosis and Treatment in Traumatology and Orthopedics" (Karaganda, 2005), at a conference dedicated to the 50th anniversary of MUZ MCS No. 4 (Omsk, 2006), at the conference "Modern Methods of Treatment of Patients with Injuries and Their Complications" (Kurgan, 2006), as well as at meetings of the scientific medical society of traumatologist-orthopedists of the city of Omsk and the Omsk Region (2006-2007).

Main provisions to be defended:

1. An injury of the lower extremity leading to a closed comminuted fracture of the tibia is the leading etiological factor in the development of acute deep vein thrombosis of the calf.

2. The method of electromagnetic resonance impedancemetry allows performing early diagnosis and prediction of the course of deep vein thrombosis of the calf in patients with closed comminuted fractures of the tibia.

3. The method of prolonged medication prophylaxis allows reducing the incidence of deep vein thrombosis of the calf by 3.6 times in patients with closed comminuted fractures of the bones of the leg.