Hidden Dangers Associated with Leg Fractures | Dr. Joseph A. Caprini

This lecture presents a comprehensive examination of the relationship between lower extremity fractures and the development of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). Delivered at the Ukrainian Vascular Society Annual Congress in Lviv in 2026, the presentation synthesizes decades of clinical research, mechanistic understanding, and risk assessment science to clarify why patients with leg fractures represent one of the highest-risk populations for thrombotic complications. The lecture reviews the pathophysiology of thrombosis through Virchow's triad — venous stasis, endothelial injury, and hypercoagulability — and how leg fractures uniquely activate all three components. A central focus is quantitative risk stratification, emphasizing individualized assessment using validated scoring systems. Special attention is given to how fracture location, operative versus nonoperative management, duration of surgery, patient age, obesity, prior VTE history, and thrombophilia interact to create escalating levels of risk. The presentation also addresses the concept of threshold risk — not every fracture patient requires identical prophylaxis. Mechanical methods, early mobilization, pharmacologic anticoagulation, and extended-duration prophylaxis are reviewed in light of contemporary data. The core message remains clear: understanding mechanism, measuring risk accurately, and tailoring prophylaxis appropriately are the critical principles that save lives. 00:00 Introduction 02:10 Virchow's Triad in Trauma 08:45 Fracture Location & Risk Gradient 15:20 Operative Duration & VTE Incidence 22:10 Risk Stratification Principles 29:40 Precision Prophylaxis Strategy 34:00 Key Takeaways 🔗 Website: https://www.capriniriskscore.org 📘 Facebook: Joe Caprini 🐦 Twitter: @caprinijoseph 📷 Instagram: venous resource center Selected References: Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Lobastov K et al. Ann Surg. 2023. Cassidy MR et al. J Am Coll Surg. Borow M et al. (1981, 1983 studies on operative duration and DVT).