Prophylactic vena cava filter insertion in selected high-risk orthopaedic trauma patients

Objectives: (a) To determine the incidence and risk factors for the development of pulmonary embolism in orthopaedic trauma patients and (b) to determine whether prophylactic vena cava filters are efficacious against pulmonary edema in high-risk patients. Designs: Before and after trial on the incidence of pulmonary embolism in the orthopaedic trauma population before and after the introduction of prophylactic vena cava filters. Setting: Tertiary care level I trauma center. Patients: Thirty-five patients received prophylactic vena cava filters. These patients had a long bone and pelvic, multiple long bone fractures, or a complex (Kane's III or IV) pelvic fracture with at least one additional risk factor at an age of >55 years and an Injury Severity Score of >16 or requiring prolonged (>6 weeks) immobilization. Intervention: Thirty-five patients had vena cava filters placed (32 titanium Greenfield filters, Medi-tech/Boston Scientific, Watertown, MA; and three Bird's Nest filters, Cook, Bloomington, IN). Most filters (n = 33) were placed percutaneously in radiology. Main Outcome Measures: (n) Morbidity related to filter insertion, (b) incidence of pulmonary embolism in orthopaedic trauma population compared with historical controls who did not receive filters, and (c) patency of filters. Results and Conclusions: Minimal morbidity was related to prophylactic vena cava filter insertion. There was a significant (p < 0.04); (Fisher's exact) decrease in the incidence of pulmonary embolism in the orthopaedic trauma population as a whole after the use of prophylactic vena cava filters. Followup ultrasound showed a 1 and 2-year inferior vena cava patency rate of 93.6% +/- 6.2% by life table analysis. We conclude that selected use of prophylactic vena cava filters in orthopaedic trauma is safe and decreases the incidence of pulmonary embolism.