Preoperative prevalence and risk factors for thromboembolic events following tibial plateau fractures: a retrospective analysis of an underestimated risk.
Herold J, Lorenz E, et al. • European journal of trauma and emergency surgery : official publication of the European Trauma Society • 2026
Surgically treated tibial plateau fractures carry a substantial burden of preoperative VTE, and routine duplex ultrasound reveals a high proportion of clinically silent thrombosis that would otherwise remain undetected, with duration of external fixation, pre-existing therapeutic anticoagulation and severe closed soft-tissue injury identifying patients at increased risk.
Key Findings
Results
When duplex ultrasound was performed only on clinical suspicion, the detected prevalence of preoperative VTE in surgically treated tibial plateau fractures was low (3.7%).
Cohort A comprised 246 fractures with DUS restricted to clinical suspicion (until August 2020).
Detected preoperative VTE prevalence was 3.7% (95% CI 1.9-6.8).
Detected DVT prevalence was 2.4% (95% CI 1.1-5.2).
Study population overall: 547 patients, 554 fractures (AO 41B/C), January 2015 to August 2025, single level 1 trauma centre.
Results
Under routine preoperative DUS screening, the detected prevalence of preoperative VTE was 20.0% and of DVT 17.1%, with most DVT being distal.
Cohort B comprised 205 screened fractures.
VTE prevalence was 20.0% (95% CI 15.1-26.0); DVT prevalence was 17.1% (95% CI 12.5-22.8).
82.9% of DVT were distal.
The authors state the difference reflects the higher diagnostic yield of screening rather than a true increase in VTE, since two different diagnostic strategies were compared.
Results
Most VTE detected under routine screening were clinically silent.
In cohort B, 28 of 41 VTE (68.3%) were clinically silent.
24 of 35 DVT (68.6%) were clinically silent.
Without screening, such thrombosis would otherwise remain undetected.
Results
Two patients had in-hospital cardiac arrest from pulmonary embolism, one before and one after screening was introduced.
One patient died from a DVT that was undetected before screening was introduced.
The other patient had an asymptomatic DVT identified by screening.
Results
Pre-existing therapeutic anticoagulation and longer duration of external fixation were independently associated with preoperative VTE.
Pre-existing therapeutic anticoagulation: adjusted OR 2.96 (95% CI 1.10-7.98).
Duration of external fixation: adjusted OR 1.11 per day (95% CI 1.02-1.20).
Regression analyses were performed at fracture level, except for the patient-related model.
Results
High-grade closed soft-tissue injury, polytrauma and initial external fixation were associated with VTE, but these associations did not remain significant after accounting for fixation duration.
High-grade closed soft-tissue injury: adjusted OR 2.41 (1.07-5.45), then 1.42 (0.52-3.89) after accounting for fixation duration.
Polytrauma: adjusted OR 2.24 (1.07-4.68), then 1.96 (0.76-5.05) after accounting for fixation duration.
Initial external fixation: univariable OR 3.60 (1.76-7.35), then 0.62 (0.12-3.27) after accounting for fixation duration.
The authors interpret this as risk driven by time in the fixator rather than by external fixation as such.
Conclusions
The study design cannot establish whether screening improves outcomes or reduces PE.
Two diagnostic strategies, not two treatment strategies, were compared.
Retrospective single-centre design.
The authors call for prospective evaluation of structured screening and risk-adapted thromboprophylaxis.
What This Means
This study looked at blood clots in the legs and lungs in people who needed surgery for a broken tibial plateau (the top of the shinbone at the knee). Researchers at one major trauma centre reviewed 547 patients treated over about ten years. Before August 2020, ultrasound was used only when doctors suspected a clot; afterward, ultrasound screening before surgery became routine.
When only symptomatic patients were tested, clots were found in about 4 in 100 fractures. With routine screening, they were found in about 20 in 100, mostly in the lower leg veins, and roughly two-thirds were causing no symptoms. The authors say this mainly reflects better detection rather than a real rise in clots. Two patients had cardiac arrest from a lung clot, one of whom died from a leg clot that had gone undetected before screening was introduced.
Clots were more likely in patients already on blood thinners and in those who spent more days in an external fixator (a temporary frame holding the bone). Severe soft-tissue injury and polytrauma were also linked to clots, but this appeared to be explained by time in the fixator. This research suggests that clots may be common and often silent after these fractures, but because the study was retrospective and compared testing strategies rather than treatments, it cannot show whether screening improves outcomes. The authors call for prospective studies of screening and risk-tailored clot prevention.
Herold J, Lorenz E, Eymann H, Lohse F, Kamin K, Walther E, et al.. (2026). Preoperative prevalence and risk factors for thromboembolic events following tibial plateau fractures: a retrospective analysis of an underestimated risk.. European journal of trauma and emergency surgery : official publication of the European Trauma Society. https://doi.org/10.1007/s00068-026-03371-6