{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T16:45:31Z","timestamp":1784911531769,"version":"3.55.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T00:00:00Z","timestamp":1666224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk\/benefit consideration. The goal of this study was to determine what patients are most at risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The M53Ortho Pearldiver database was used to identify patients with fractures isolated to the foot and ankle that were treated non-operatively or operatively. Patients with pilon, other appendicular fractures remote from the foot and ankle, and other traumatic injuries were excluded. The 90-day occurrence of VTE was identified based on codes for deep vein thrombosis or pulmonary embolism. Characteristics of those patients who did and did not have VTEs were compared using chi-square analyses. Multivariate logistical regression was then performed to determined factors independently associated with VTE. Finally, timing of VTE relative to fracture was analyzed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 298,886 patients with isolated foot or ankle fractures were identified, of which 1,661 (0.56%) had VTE in the 90 days following fracture. In terms of timing, 27.3% occurred in the first week, and 49.8% occurred in the first three weeks. Independent risk factors for VTE included (in decreasing order):prior VTE (odd ratio [OR] = 25.44), factor V Leiden (OR = 24.34), active cancer (OR = 1.84), specific fracture relative to metatarsal fracture (multiple fractures [OR: 1.51], ankle fracture [OR = 1.51], and calcaneus fracture [OR = 1.24]), surgical treatment (OR = 1.41), male sex (OR = 1.19), greater Elixhauser index (OR = 1.05), and increasing age (OR:1.05 per decade) (p&lt;0.05 for each).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The present study found that, although only 0.56% of isolated foot and ankle fractures had a VTE within ninety days. Defined risk factors, such as Factor V Leiden, prior VTE, surgical treatment, active cancer, specific fracture patterns, and surgical treatment significantly affected the odds of their occurrence.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0276548","type":"journal-article","created":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T18:37:32Z","timestamp":1666291052000},"page":"e0276548","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":22,"title":["Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture"],"prefix":"10.1371","volume":"17","author":[{"given":"Michael J.","family":"Gouzoulis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4370-0720","authenticated-orcid":true,"given":"Peter Y.","family":"Joo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3997-2803","authenticated-orcid":true,"given":"Alexander J.","family":"Kammien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6582-1868","authenticated-orcid":true,"given":"William M.","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2626-7278","authenticated-orcid":true,"given":"Jonathan N.","family":"Grauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,20]]},"reference":[{"issue":"2","key":"pone.0276548.ref001","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/BPB.0000000000000424","article-title":"Venous thromboembolism among pediatric orthopedic trauma patients: a database analysis","volume":"27","author":"D Guzman","year":"2018","journal-title":"J Pediatr Orthop B"},{"issue":"9","key":"pone.0276548.ref002","doi-asserted-by":"crossref","first-page":"416","DOI":"10.3390\/medicina56090416","article-title":"An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020.","volume":"56","author":"DC Santana","year":"2020","journal-title":"Medicina (Kaunas)."},{"key":"pone.0276548.ref003","article-title":"Venous thromboembolism in orthopaedic oncology","author":"JR Lex","year":"2020","journal-title":"Bone Joint J"},{"issue":"8","key":"pone.0276548.ref004","doi-asserted-by":"crossref","first-page":"265","DOI":"10.5435\/JAAOS-D-17-00763","article-title":"Venous Thromboembolism After Shoulder Arthoplasty and Arthroscopy.","volume":"27","author":"CM Rapp","year":"2019","journal-title":"J Am Acad Orthop Surg."},{"issue":"1","key":"pone.0276548.ref005","doi-asserted-by":"crossref","first-page":"22440","DOI":"10.1038\/s41598-020-79490-w","article-title":"Venous thromboembolism in patients hospitalized for knee joint replacement surgery","volume":"10","author":"K Keller","year":"2020","journal-title":"Sci Rep"},{"key":"pone.0276548.ref006","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jss.2019.09.012","article-title":"High Rate of Fibrinolytic Shutdown and Venous Thromboembolism in Patients With Severe Pelvic Fracture","volume":"246","author":"JT Nelson","year":"2020","journal-title":"J Surg Res"},{"issue":"3","key":"pone.0276548.ref007","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00402-020-03505-4","article-title":"Rate of venous thromboembolism after surgical treatment of proximal humerus fractures.","volume":"141","author":"JH Heyer","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"issue":"8","key":"pone.0276548.ref008","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/BOT.0000000000001790","article-title":"The Incidence of Venous Thromboembolism Following Pelvic and Lower Extremity Trauma Despite Adherence to Modern Prophylactic Protocols.","volume":"34","author":"JA Lowe","year":"2020","journal-title":"J Orthop Trauma."},{"issue":"3","key":"pone.0276548.ref009","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1002\/rth2.12323","article-title":"What\u2019s new in VTE risk and prevention in orthopedic surgery","volume":"4","author":"SR Kahn","year":"2020","journal-title":"Res Pract Thromb Haemost"},{"issue":"7110","key":"pone.0276548.ref010","first-page":"981","article-title":"Prevention of venous thrombosis and pulmonary embolism in injured patients. 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