Tromboembolismo venoso in chirurgia ortopedica. Aspetti clinici e medico-legali

The incidence of venous thromboembolism in orthopaedic patients is high and can lead to pulmonary thrombo-embolism (PTE). Deaths caused by PTE are often of forensic interest, due to the suddeness of death, and possible professional responsibility. Early diagnosis of vein thromboembolism is often difficult, therefore prevention and clinical management deserves special attention: a lack of prophylaxis, inadequate prophylaxis, lack of monitoring of coagulative parameters, insufficient duration of prophylaxis, lack of diagnostic testing can frequently lead to legal suits. In order to avoid blame on the profession to choose suitable and correct treatment is essential. The availability and the adoption of pharmacological methods has revealed a costant and continuous reduction of events during which orthopaedic and trauma patients were affected by TEP. Guidelines recommend pharmacological prophylaxis with low molecular heparin or fondaparinux in patients with total hip and knee arthroplasty and with proximal femur fractures. We report two cases: the first one illustrates an example of lack of adequate prophylactic measures, the second one describes the clinical risk correlated to underdosage. These cases are the premise for a brief pharmacological and clinical description of deep venous thrombosis prophylaxis and for some considerations regarding professional responsibility