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A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts
CATEGORY: Diabetes INTRODUCTION/PURPOSE: Venous Thrombo-Embolism (VTE) is a recognized complication of lower limb immobilization. In the neuropathic patient total contact casting (TCC) is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers. To our knowledge,...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697303/ http://dx.doi.org/10.1177/2473011419S00418 |
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author | Tonge, Xenia Widnall, James Jackson, Gillian Platt, Simon |
author_facet | Tonge, Xenia Widnall, James Jackson, Gillian Platt, Simon |
author_sort | Tonge, Xenia |
collection | PubMed |
description | CATEGORY: Diabetes INTRODUCTION/PURPOSE: Venous Thrombo-Embolism (VTE) is a recognized complication of lower limb immobilization. In the neuropathic patient total contact casting (TCC) is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers. To our knowledge, there is currently no literature stating the prevalence of VTE in patients, despite the possibility of prolonged lower limb immobilization. There are also no recommendations regarding VTE prophylaxis in the setting of TCCs. We report a retrospective case series assessing the frequency of symptomatic VTE in the patients treated with TCCs. Given that diabetic foot disease manifests as one of many co-morbidities in this medically complex group of patients we hypothesize that the rate of occurrence of VTE should be higher than that of the general population. METHODS: Patients undergoing TCC between 2006 and 2018 were identified using plaster room records. These patients subsequently had electronic clinical letters and radiological reports assessed for details around the TCC episode, past medical history and any VTE events. RESULTS: There were 143 TCC episodes in 105 patients. Average age at cast application was 55 years. The mean time in a cast was 45 days (range from 5 days to 8 months). 3 out of 4 patients had neuropathy as a consequence of diabetes. One TCC related VTE (0.7% of casting episodes) was documented. This was a proximal DVT confirmed on USS 9 days following cast removal. Only 3 patients received VTE prophylaxis while in TCC. CONCLUSION: Despite these complex patients having a multitude of co-morbidities the frequency of VTE in the TCC setting remains similar to that of the general population. This may be due to the fact that TCCs permit weight bearing or that Charcot arthropathy leads to a high outflow state, potentially turning Virchow’s triad in the patient’s favour. This case series suggests that, while all patients should be individually VTE risk assessed as for any lower limb immobilization, chemical thromboprophylaxis is not routinely indicated in the context of TCCs. |
format | Online Article Text |
id | pubmed-8697303 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-86973032022-01-28 A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts Tonge, Xenia Widnall, James Jackson, Gillian Platt, Simon Foot Ankle Orthop Article CATEGORY: Diabetes INTRODUCTION/PURPOSE: Venous Thrombo-Embolism (VTE) is a recognized complication of lower limb immobilization. In the neuropathic patient total contact casting (TCC) is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers. To our knowledge, there is currently no literature stating the prevalence of VTE in patients, despite the possibility of prolonged lower limb immobilization. There are also no recommendations regarding VTE prophylaxis in the setting of TCCs. We report a retrospective case series assessing the frequency of symptomatic VTE in the patients treated with TCCs. Given that diabetic foot disease manifests as one of many co-morbidities in this medically complex group of patients we hypothesize that the rate of occurrence of VTE should be higher than that of the general population. METHODS: Patients undergoing TCC between 2006 and 2018 were identified using plaster room records. These patients subsequently had electronic clinical letters and radiological reports assessed for details around the TCC episode, past medical history and any VTE events. RESULTS: There were 143 TCC episodes in 105 patients. Average age at cast application was 55 years. The mean time in a cast was 45 days (range from 5 days to 8 months). 3 out of 4 patients had neuropathy as a consequence of diabetes. One TCC related VTE (0.7% of casting episodes) was documented. This was a proximal DVT confirmed on USS 9 days following cast removal. Only 3 patients received VTE prophylaxis while in TCC. CONCLUSION: Despite these complex patients having a multitude of co-morbidities the frequency of VTE in the TCC setting remains similar to that of the general population. This may be due to the fact that TCCs permit weight bearing or that Charcot arthropathy leads to a high outflow state, potentially turning Virchow’s triad in the patient’s favour. This case series suggests that, while all patients should be individually VTE risk assessed as for any lower limb immobilization, chemical thromboprophylaxis is not routinely indicated in the context of TCCs. SAGE Publications 2019-10-28 /pmc/articles/PMC8697303/ http://dx.doi.org/10.1177/2473011419S00418 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Tonge, Xenia Widnall, James Jackson, Gillian Platt, Simon A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts |
title | A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts |
title_full | A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts |
title_fullStr | A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts |
title_full_unstemmed | A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts |
title_short | A 10-year Retrospective Case-Series of Venous Thrombo-Embolism frequency in Patients Treated with Total Contact Casts |
title_sort | 10-year retrospective case-series of venous thrombo-embolism frequency in patients treated with total contact casts |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697303/ http://dx.doi.org/10.1177/2473011419S00418 |
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