Late Thrombo-Embolic

Complications after Complex

Trauma of Lower Extremities
Mihail Nagea, O. Lupescu, Gh. I. Popescu , C. Patru, N. Ciurea, M. Coltan ,
D. Sucoveschi , Al. Dimitriu, D. Lupescu

CLINICAL EMERGENCY HOSPITAL

BUCHAREST
 Different terms

CRUSHING
CRUSHING= SYNDROME=
mechanism systemic efects of
1.High values of energy/
traumatic
suphace unit
2. Higher values of rhabdomyolisis
absorbed energy
Local efects=
rhabdomyolisis
physiopathology
 Tisular
thromboplastine
Endothelial lesion
Stasis
Arterial contusion

Thrombotic Ischaemic risk

risk
Toxic risk
Acute Renal Failure Products of
muscular anaerobic
metabolism

Septic risk
Imune depression Necrotic muscles- ideal for
due to MSOF microorganisms
 Purpose
to draw attention upon the
considerably late thrombotic
potential of severe crushing injuries,
to raise a question about the duration

of thrombo-prophylaxis after these

injuries
 Virchow Triade

Tissular factors
 Crushing
injury

Necrotic
Thromboplastine
muscle
Thrombosis in microcirculation
and small vessels
 MATERIAL and METHOD
55 patients admitted between
01.01.2010-01.01.2012 with a
diagnosis including crushing, with
MESS under 7 points.
FASCIOTOMY+DEBRIDEMENT
Criteria:
1. Age and sex
2. Affected regions
3. Type of injuries
4. Dynamic of CK, LDH
5. Time trauma- debridement
6. Outcome of the patients-clinical and
CDU 1,2,6,12,24and 48 months after
injury 1. Age and sex
 MATERIAL and METHOD

Affected regions
Injuries produced by the crushing mechanism

The mechanism of CRUSHING can produce different

clinical entities
RESULTS- Arterial
Complications
11 cases- initial Acute Peripheral
Ischemia 3 arterial thrombosis:
1 recurrent API within the first
week
3 cases- late post-traumatic
arterial incomplete occlusion by
thrombotic material ( after 2
months- routine Doppler)
2 cases- late API ( more than 16 hours)
 VTE
3 cases- non fatal PE- ( 3,6,8 weeks)
2 cases- post-thrombotic syndrome
WITHOUT signs of DVT
6 cases- venous thrombosis
following crushing
1 case- femoral vein- 6 weeks

4 cases- tibial veins- 4 weeks

1 cases- peroneal veins- 6

weeks
2/6- post-thrombotic

syndrome following DVT

 Thigh and shank crushing with Segmentary arterectomy with
femoral fracture and knee arterioplasty ( saphenous graft)
dislocation

Thrombosis of the femoral artery

after crushing

Case 1- I.C. 33 yrs

CK and LDH after DEBRIDEMENT
Internal and external
fasciotomy

Cutaneous graft to cover the post-

fasciotomy defect
 Case 2-M.P. 42 yrs

Crushing with fracture of the tibial shaft-

osteosynthesis

Fasciotomy-debridement
Case 2- male, 28 yrs, crushed by a transporting
vehicle
RIGHT
THIGH
LEFT
THIGH
 Purpose
to draw attention upon the
considerably late thrombotic
potential of severe crushing injuries,
to raise a question about the duration

of thrombo-prophylaxis after these

injuries
 Thrombo-prophylaxisfor how
long?

As long as risk factors persist..

THANK YOU !