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Edema in the Lower Limb of Patients Operated on for Proximal Femoral Fractures

Kazmi, S Sajid H. MD; Stranden, Einar PhD; Kroese, Andries J. MD, PhD; Slagsvold, Carl-Erik MD, PhD; Diep, Lien M. MSc; Stromsoe, Knut MD, PhD; Jorgensen, Jorgen J. MD, PhD

The Journal of Trauma: Injury, Infection, and Critical Care: March 2007 - Volume 62 - Issue 3 - p 701-707
doi: 10.1097/01.ta.0000196968.45151.7f
Original Articles
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Background: Patients with proximal femoral fracture (PFF) often develop postoperative edema in the operated limb. This may lead to reduced mobilization, increasing the length of hospitalization. It is therefore relevant to gain information about the extent and pathogenesis of this edema formation.

Methods: Forty-one patients with PFF (30 women and 11 men) were studied pre- and postoperatively. Patients were grouped into pertrochanteric fractures and femoral cervical fractures, according to the AO/ASIF classification of PFF. Thigh and calf volumes were calculated in both fractured and contralateral limbs preoperatively and on postoperative days 3, 5, 7, and 30.

Results: All patients with PFF developed edema in the operated limb. The greatest volume increase occurred on postoperative day 7 (p < 0.0005). The magnitude of edema in the thigh and the leg of patients with pertrochanteric fractures as compared with the nonoperative side was approximately twice as great as in those with femoral cervical fractures (p < 0.0001). There was a statistically significant daily increase in the volume of the operative limb as compared with the nonoperative side. Age and sex were not correlated with the extent of edema formation. Functionally significant deep venous thrombosis and local infection could be excluded as causative factors.

Conclusions: Postoperative edema in the thigh and leg of the operated limb was considerable. The magnitude of edema formation was related to the severity of primary trauma and the type of osteosynthesis. Therefore, the operation performed for PFF should be minimally traumatic.

© 2007 Lippincott Williams & Wilkins, Inc.