Prevalence of Venous Thrombo-Embolism in Patients with Total Contact Cast

Mr J Widnall, Dr X Tonge, Mr S Platt, Miss G Jackson

Background: Venous Thrombo-Embolism is a recognized complication of lower limb immobilization. In the neuropathic patient, limb immobilization, in the form of total contact casting (TCC), is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers. There is currently no literature stating the prevalence of VTE in patients undergoing TCC. There are also no recommendations regarding VTE prophylaxis in the setting of TCCs. We aim to perform a retrospective case series assessing the prevalence of VTE in the patients being treated with TCCs. Given the multitude of co-morbidities that exist within this heterogeneous group of patients we hypothesize the rate of VTE is higher than that of the general population.

Methods: Patients undergoing TCC between 2006 and 2018 were identified using plaster room records. These patients subsequently had clinical letters and radiological reports assessed for details around the TCC episode, past medical history and any VTE events.

Results: There were 143 TCC episodes in 104 patients. Average age at cast application was 55 years. Time in cast averaged 45 days (range from 5 days to 8 months). 3 out of 4 patients had neuropathy as a consequence of diabetes. One TCC related VTE (0.7% of casting episodes) was documented. This was a proximal DVT confirmed on USS 9 days following cast removal. No patient received VTE prophylaxis while in TCC

Conclusion: Despite these complex patients having a multitude of co-morbidities the prevalence of VTE in the TCC setting remains similar to that of the general population. This may be due to the fact that TCCs permit weight bearing. This case series suggests that, while all patients should be individually VTE risk assessed as for any lower limb immobilization, chemical thromboprophylaxis is not routinely indicated in the context of TCCs.