The preoperative prevalence of deep vein thrombosis in patients with femoral neck fractures and delayed operation

Out of 61 consecutive patients admitted for femoral neck fracture 21 patients had a delay to operation for more than 48 h from the time of injury. We studied these patients prospectively for the presence of deep-vein thrombosis (DVT). 13 (62%) had venographic evidence of thrombosis. All occurred in the broken limb. Five patients had bilateral thrombosis. The delay alone seems to be the major risk factor for thrombosis irrespective of age, fracture type, premorbid mobility and coexisting illness. The prevalence of preoperative DVT 48 h after injury approaches the reported postoperative incidence of DVT, which suggests that DVT will occur in a high proportion of patients regardless of treatment and prophylaxis. We recommend that those patients, in whom operation is delayed, should be routinely investigated for the presence of thrombosis preoperatively and a prophylactic vena cava filter should be considered when major deep vein thrombosis occurred.