The effect of calf muscular vein thrombosis on the prognosis within one year postoperatively of geriatric hip fracture patients: a propensity score-matched analysis

The effect of calf muscular vein thrombosis on the prognosis within one year postoperatively of geriatric hip fracture patients: a propensity score-matched analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of calf muscular vein thrombosis on the prognosis within one year postoperatively of geriatric hip fracture patients: a propensity score-matched analysis Jiabao Jiang, Fei Xing, Rong Luo, Zhao Chen, Hao Liu, Xin Duan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2931055/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Calf muscular vein thrombosis (CMVT) is a type of distal deep vein thrombosis, which is common in geriatric hip fracture patients. However, studies focusing on whether the orthopedic operation has an impact on the prognosis of geriatric hip fracture patients with CMVT are very limited. Therefore, the aim of this study was to explore whether geriatric hip fractures with CMVT affect the mortality of patients within one year postoperatively. The difficulty of the operation, postoperative complications, the status of thrombosis, and long-term function were also compared. Materials and Methods Geriatric hip fracture patients who underwent surgery between January 2019 and January 2021 were included. Patients were divided into groups with and without CMVT by preoperative color Doppler ultrasound examination. Propensity score-matching (PSM) was performed in a ratio of 1:1 between the patient with and without CMVT groups. Baseline characteristics, laboratory results, perioperative indicators and prognosis of patients were collected retrospectively. Intraoperative and long-term postoperative comparisons were conducted between patients with and without CMVT. Results Two hundred and sixty geriatric hip fracture patients were included. Eighty-nine patients in each group were matched after PSM. There was no significant difference in mortality between the two groups at one-month, three-month, six-month, and one-year postoperatively. However, patients with CMVT had longer hospital stays, a higher incidence of postoperative complications, and a higher incidence of thrombosis progression than patients without CMVT in long-term follow-up. Conclusion CMVT in Chinese geriatric hip fracture patients is not associated with mortality within one year postoperatively. In addition, when orthopedic surgeons treat geriatric hip fracture patients with CMVT, enhanced postoperative rehabilitation, meticulous nursing, and thrombosis management are recommended to achieve better clinical outcomes and long-term prognosis. Trial registration: Chinese Clinical Trial Registry (ChiCTR2300069411). Registered March 15, 2023, https://www.chictr.org.cn/showproj.html?proj=192079 Calf muscular vein thrombosis geriatric patients deep vein thrombosis hip fracture propensity score-matched analysis Figures Figure 1 Figure 2 Figure 3 1. Introduction Calf muscle venous thrombosis (CMVT) is a type of distal deep vein thrombosis (DVT) in which the thrombosis is original and confined to the venous plexus of the soleus and gastrocnemius muscles[ 1 ]. CMVT is a category of DVT with a high incidence. It has been shown that isolated CMVT accounts for approximately 25% of all lower limb DVT and up to 47%-79% of those containing CMVT[ 2 , 3 ]. However, because of the small extent of its formation, its effect on venous blood return and stimulation of the inflammatory response is less severe[ 4 ]. The clinical symptoms are not obvious and are often overlooked by clinicians. Hip fractures in the geriatric population are very common in clinical practice. The characteristics are high mortality and disability rates and expensive medical treatment. As the global population ages, it is predicted that the number of hip fractures worldwide will increase from 1.26 million in 1990 to 4.5 million in 2050, with approximately half of these likely to occur in Asia, particularly in China[ 5 ]. Geriatric patients with hip fractures are at high risk for DVT, and most have CMVT. However, there are many geriatric hip fracture patients with isolated CMVT. Most of them inevitably require surgical treatment. However, studies on whether conventional orthopedic surgery has an impact on the prognosis of such patients are very limited. Current opinions on this aspect are still controversial. It has been reported that CMVT may perpetuate and progress into the deep veins of the lower limbs, causing proximal DVT and inducing pulmonary embolism[ 1 ]. It has also been shown that the incidence of isolated CMVT developing into pulmonary embolism is only 0-6.2% and does not lead to the development of fatal pulmonary embolism[ 6 ]. Therefore, the primary outcome of this study was to explore whether geriatric hip fracture patients with CMVT would affect patient mortality within one year postoperatively. Secondary outcomes included surgical difficulty, postoperative complications, the status of thrombosis, and long-term function. 2. Material and methods 2.1 Patients The study was conducted in accordance with the ethical principles of the Helsinki declaration and was approved by the Ethical Review Committee of West China Hospital, Sichuan University. Informed consent procedures for this study have been waived due to the retrospective design. The clinical trial registration number is ChiCTR2300069411. Geriatric hip fracture patients who underwent surgery at the West China Hospital between January 2019 and January 2021 were included in this study. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines[ 7 ]. The inclusion criteria for our study included the following: (1) acute hip fractures including femoral neck and intertrochanteric fractures (≤ 7 days); (2) the fracture has been proven by X-ray or CT preoperatively; (3) treated by internal fixation such as cannulated cancellous screw, dynamic hip screw, femoral neck system, and proximal femoral nail anti-rotation or arthroplasty; (4) the patient agrees to participate in this study. The exclusion criteria of our study included the following: (1) age < 65 years; (2) multiple fractures; (3) open fractures; (4) pathological fracture; (5) fracture with vascular or nerve lesion; (6) history of arthroplasty or venous thromboembolism; (7) incomplete clinical data; (8) coexistence of DVT at other locations than CMVT. 2.2 Data collection Data on selected patients were retrospectively retrieved from our hospital medical database. Demographic characteristics included gender, age, body mass index (BMI), type of fracture, injury side, therapy method, American Society of Anesthesiologists (ASA) grade, time from injury to admission, routine blood indexes (including the concentrations of hemoglobin and platelet), blood biochemistry indexes (including the concentrations of serum albumin, potassium, and sodium), coagulation indexes (including prothrombin time (PT), activated partial prothrombin time (APTT), thrombin time (TT), and the concentrations of fibrinogen and D-dimer ), and Charlson comorbidity index (CCI) score. The CCI score was calculated to obtain an overall assessment of preoperative comorbid conditions. The CCI score consists of nineteen severe, chronic diseases, each assigned a weight from one to six corresponding to the relative risk of mortality from the disease[ 8 ]. One’s CCI score is calculated by summing all the weights. All patients routinely received a color Doppler ultrasound on admission. Color Doppler ultrasound is conducted by an experienced radiologist in the color ultrasound room. All ultrasound results were reviewed by a senior radiologist. Re-examination of the ultrasound was conducted when there were different opinions. According to guideline recommendations all geriatric hip fracture patients at our institution received DVT prophylaxis[ 9 ]. The prophylactic regimen consisted of low molecular heparin (4000 AxaIU/0.4 ml) or fondaparinux (2.5 mg) to be injected subcutaneously once daily. Routine ultrasound or any other imaging will not be performed on the patient postoperatively unless they have preoperative thrombosis or symptoms suggesting assessment. Signs and symptoms of DVT include changes in skin temperature and color, swelling, pain and tenderness in the thigh or calf.[ 10 ]. 2.3 Outcome measures The primary outcome measures were mortality within one year after undergoing hip fracture surgery. The one-month postoperative observation window is the most common follow-up period in the literature[ 11 , 12 ]. Considering the temporal correlation between the surgical delay and the development of complications, longer follow-up periods of three-month, six-month, and one-year were also analyzed. The secondary outcomes include intraoperative indicators (preoperative waiting time, hospital stays, surgical time, intraoperative blood loss), postoperative complications (incision infection, hematoma, hip or thigh pain, urinary tract infection, postoperative delirium, implant failure, pulmonary infection), Harris score[ 13 ], visual analogue scale (VAS) score, and Barthel Index. All pain and functional scores were documented at the one-year postoperative follow-up. 2.4 Statistical analysis Continuous variables are expressed as mean and standard deviation (SD) if normally distributed, and as median and interquartile range (IQR) otherwise, while categorical variables are presented as absolute numbers and percentages. Categorical variables were compared using χ2 analysis or Fisher's exact test; continuous variables were compared using t-test or Wilcoxon rank sum test for normally and nonnormally distributed data, respectively. The rationale and methodology of PSM for assessing causality have been well demonstrated in retrospective studies[ 14 , 15 ]. The R software (version × 64 3.5.1, http://www.r-project.org ) was used to conduct the propensity score-matched (PSM) analysis with 1:1matching method to reduce baseline confounding bias. Survival analysis was also performed using Kaplan-Meier survival curves, and differences between groups were estimated using the log-rank test. All statistical computations were performed using SPSS statistical software (version 25.0; IBM Corp, Armonk, NY, USA). P ≤ 0.05 was considered statistically significant; all tests were two-sided. 3. Results 3.1 Baseline characteristics of patients before and after PSM The baseline characteristics of the patients were shown in Table 1 . There were two hundred and sixty patients included in the study after screening, consisting of ninety-three patients with CMVT and one hundred and sixty-seven patients without CMVT. The difference of time from injury to admission, hemoglobin, blood platelet, serum albumin, and serum potassium in two groups have statistical significance. Eighty-nine patients were included in each group after PSM, and no significant differences in baseline characteristics were observed between patients with and without CMVT after matching. The sampling procedure of Chinese geriatric patients with hip fracture in our study is shown in Fig. 1 . The scatter plots before and after PSM for each group are shown in Fig. 2 . After PSM the bias was effectively reduced for confounding variables such as the time from injury to admission, hemoglobin, blood platelet, serum albumin, and serum potassium. Table 1 Baseline characteristics of patients before and after propensity score matching Variables Before Propensity Score-Matching After Propensity Score-Matching Without CMVT With CMVT P Value Without CMVT With CMVT P Value Patients (%) 167(64.23) 93(35.77) 89(50.00) 89(50.00) Age(years) 80.25 (7.70) 80.53 (7.71) 0.778 80.56 (7.98) 80.30 (7.77) 0.827 BMI 21.74 (3.66) 22.09 (3.48) 0.447 22.00 (3.60) 22.00 (3.53) 0.995 Time from injury to admission (days) 1.00(0.50-2.00) 1.00 (0.50-5.00) 0.029 1.00 (0.50–3.50) 1.00 (0.50-4.00) 0.560 CCI score 1.00 (0.00–2.00) 1.00 (0.00–2.00) 0.234 1.00 (0.00–2.00) 1.00 (0.00–2.00) 0.579 Hemoglobin (g/L) 113.16 (21.95) 107.38 (21.45) 0.041 108.53 (23.11) 108.63 (20.74) 0.976 Blood platelet (109/L) 155.05 (62.04) 173.49 (73.21) 0.032 165.71 (73.87) 172.21 (72.95) 0.555 Serum albumin (g/L) 37.56 (4.05) 36.37 (4.28) 0.026 36.98 (4.18) 36.54 (4.20) 0.487 Serum potassium (mmol/L) 3.89 (0.48) 4.03 (0.60) 0.043 4.02 (0.52) 4.01 (0.59) 0.838 Serum sodium (mmol/L) 139.24 (3.90) 139.32 (3.91) 0.875 139.03 (4.36) 139.33 (3.91) 0.626 PT (s) 11.55 (0.90) 11.66 (1.00) 0.356 11.55 (0.88) 11.62 (0.96) 0.632 APTT (s) 28.92 (3.17) 28.69 (3.75) 0.596 28.86 (3.30) 28.64 (3.62) 0.664 TT (s) 17.52 (1.62) 17.61 (5.15) 0.834 17.60 (1.77) 17.64 (5.26) 0.947 Fibrinogen (g/L) 3.94 (1.22) 4.09 (1.21) 0.338 3.98 (1.28) 4.07 (1.20) 0.641 D-dimer (µg/ml) 4.61 (2.16–14.85) 5.86 (3.01–15.78) 0.339 4.24 (2.33–15.13) 5.86 (3.01–15.78) 0.464 Gender (%) 0.311 1.000 Female 112 (67.10) 68 (73.10) 65 (73.00) 65 (73.00) Male 55 (32.90) 25 (26.90) 24 (27.00) 24 (27.00) Type of fracture (%) 0.912 0.881 Intertrochanteric fracture 85 (50.90) 48 (51.60) 44 (49.40) 45 (50.60) Femoral neck fracture 82 (49.10) 45 (48.40) 45 (50.60) 44 (49.40) Injury side (%) 0.940 0.764 Right 87 (52.10) 48 (51.60) 49 (55.10) 47 (52.80) Left 80 (47.90) 45 (48.40) 40 (44.90) 42 (47.20) Therapy method (%) 0.768 0.529 Arthroplasty 58 (34.70) 34 (36.60) 29 (32.60) 33 (37.10) Internal fixation 109 (65.30) 59 (63.40) 60 (67.40) 56 (62.90) ASA grade (%) 0.253 0.950 2 52 (31.10) 34 (36.60) 35 (39.30) 33 (37.10) 3 104 (62.30) 49 (52.70) 45 (50.60) 47 (52.80) 4 11 (6.60) 10 (10.80) 9 (10.10) 9 (10.10) CMVT = calf muscular vein thrombosis; BMI = body mass index; CCI = Charlson comorbidity index; PT = prothrombin time; APTT = activated partial prothrombin time; TT = thrombin time; ASA = American Society of Anesthesiologists. Data are expressed as mean (standard deviation) or median (interquartile range). 3.2 Survival outcomes of hip fracture patients with and without CMVT There was no significant difference in postoperative one-month mortality between the group of patients without CMVT and the group of patients with CMVT (1.1% vs 2.2%; Odds Ratio, 2.02; 95% Confidence Interval, 0.18–22.72, P = 1.000; Table 2 ). However, no significant differences were found in mortality between the groups at three-month, six-month, and one-year postoperatively. Kaplan-Meier analysis showed that one-year accumulated survival rate was higher in the group of patients without CMVT without reaching a significant level (Fig. 3 ). A total of nineteen deaths were documented within the first year after surgery (seven in the group of patients without CMVT and twelve in the group of patients with CMVT). One-, three-, six-month and one-year mortality of geriatric hip fracture patients without CMVT, and with CMVT were shown in Table 2 . Table 2 One-, three-, six-month, and one-year mortality of all geriatric hip fracture patients, geriatric hip fracture patients without CMVT, and with CMVT, respectively. Variables Fracture patients Patients without CMVT Patients with CMVT Odds Ratio (95% CI) P Value One-month mortality (%) 3 (1.70) 1(1.10) 2 (2.20) 2.02 (0.18–22.72) 1.000 Three-month mortality (%) 4 (2.20) 1(1.10) 3 (3.40) 3.07 (0.31–30.09) 0.613 Six-month mortality (%) 11 (6.20) 4 (4.50) 7 (7.90) 1.81 (0.51–6.43) 0.350 One-year mortality (%) 19 (10.70) 7 (7.90) 12 (13.50) 1.83 (0.68–4.88) 0.225 CMVT = calf muscular vein thrombosis; CI = Confidence Interval. 3.3 Operative outcomes of hip fracture patients without and with CMVT The length of hospital stays for hip fracture patients with CMVT was significantly longer than that of patients without CMVT ((10.90 ± 4.84 vs 8.89 ± 3.24 days, p = 0.001; Table 3 ). However, no significant differences were found in the preoperative waiting time, surgical time and intraoperative blood loss between the groups. The incidence of overall postoperative complications was significantly higher in the group of patients with CMVT than in the group of patients without CMVT (7.9% vs 29.2%, P < 0.001; Table 3 ). However, there was no significant difference between the groups in the incidence of other complications, such as pneumonia and urinary tract infections. (Table 3 ). Table 3 Operative outcomes of all geriatric hip fracture patients, geriatric hip fracture patients without CMVT, and with CMVT, respectively. Variables Fracture patients Patients without CMVT Patients with CMVT P Value Preoperative waiting time in hospital (day) 5.32(3.07) 4.91 (2.70) 5.73(3.36) 0.074 Hospital stays (day) 9.89(4.23) 8.89(3.24) 10.90 (4.84) 0.001 Surgical time (min) 79.63 (31.44) 76.89 (33.44) 82.37 (29.25) 0.246 Intraoperative blood loss (mL) 101.93 (73.14) 107.85 (81.84) 96.00 (63.18) 0.281 Complication (overall) (%) 33 (18.50) 7 (7.90) 26 (29.20) < 0.001 Incision infection 3 0 3 0.244 Hematoma 2 1 1 1.000 Hip or thigh pain 6 1 5 0.213 Urinary tract infection 3 0 3 0.244 Postoperative delirium 2 0 2 0.477 Implant failure 2 1 1 1.000 Pulmonary infection 15 4 11 0.059 CMVT = calf muscular vein thrombosis. Data are expressed as mean (standard deviation). 3.4 Long-term clinical outcomes of hip fracture patients without and with CMVT The group of patients without CMVT and the group of patients with CMVT were comparable in terms of Harris scores postoperatively (82.79 ± 13.13 vs 83.30 ± 11.22, P = 0.795; Table 4 ). There was no significant difference between the two groups in terms of VAS scores and Barthel Index. In terms of the state of thrombosis, the incidence of thrombosis progression was significantly higher in the group of patients with CMVT than in the group of patients without CMVT (14.6% vs 1.1%, P = 0.001; Table 4 ). The details of thrombosis progression in each group of patients are summarized in Table 5 . In the group of patients without CMVT, only one patient developed unilateral CMVT postoperatively, and no thrombosis was found in other patients. The majority of patients in the group with CMVT progressed from unilateral to bilateral CMVT postoperatively. Table 4 The outcomes of long-term function and state of thrombosis in all geriatric hip fracture patients, geriatric hip fracture patients without CMVT, and with CMVT, respectively. Variables Fracture patients Patients without CMVT Patients with CMVT P Value Harris score 83.04 (12.20) 82.79 (13.13) 83.30 (11.22) 0.795 VAS score 1.72 (1.02) 1.63(0.96) 1.81(1.08) 0.292 Barthel Index 83.49 (18.46) 82.74(19.88) 84.29(16.91) 0.600 State of thrombosis (%) 0.001 No progress 164 (92.10) 88 (98.90) 76 (85.40) Progression 14 (7.90) 1 (1.10) 13 (14.60) CMVT = calf muscular vein thrombosis; VAS = visual analogue scale. Data are expressed as mean (standard deviation). Table 5 Details of the thrombotic progression in geriatric hip fracture patients with and without CMVT Variables Patients without CMVT Patients with CMVT From no thrombosis to unilateral CMVT 1 0 From unilateral CMVT to bilateral CMVT 0 8 From unilateral CMVT to bilateral CMVT and left peroneal vein thrombosis 0 2 From unilateral CMVT to bilateral CMVT and left posterior tibial vein thrombosis 0 1 From bilateral CMVT to right common femoral vein and bilateral popliteal vein thrombosis 0 1 From bilateral CMVT to right external iliac vein thrombosis 0 1 CMVT = calf muscular vein thrombosis. 4. Discussion Currently, there are no long-term follow-up studies of clinical differences between geriatric hip fracture patients with and without CMVT. The clinical relevance of CMVT to the prognosis of geriatric hip fracture patients undergoing surgical treatment remains controversial[ 16 , 17 ]. DVT or PE is one of the most serious complications that can occur in hip fracture patients, significantly increasing perioperative mortality[ 18 ]. Current guidelines recommend that hip fracture patients should be operated on within forty-eight hours of admission for a positive prognosis[ 19 , 20 ]. However, a point of controversy is whether patients with CMVT should undergo a rigorous cycle of anticoagulation before surgery, or whether surgery should be performed following routine anticoagulation with perfect preoperative preparation. As no literature is available, the primary aim of this study was to compare the effects of CMVT on long-term clinical outcomes in geriatric hip fracture patients. There is a high incidence of CMVT in geriatric hip fracture patients. However, due to its insidious symptoms, large-scale multicenter randomized controlled studies are still lacking. In this study, there were still some confounding factors at baseline for unmatched patients that could directly affect the veracity of the comparison between the control and experimental groups. In recent years, PSM has been widely used in retrospective studies with small sample sizes and multiple baseline confounders[ 21 ]. PSM has certain advantages over traditional regression methods in controlling confounding[ 22 ]. In our study, PSM attempted to simulate randomization by creating groups of patients with and without CMVT that were comparable on all observed covariates. As many variables as possible were included in our propensity score model to maximize the propensity to inform the dependent variable. the PSM model included nineteen independent variables that were proven to influence or potentially influence mortality. The variables described in previous studies that were associated with postoperative mortality were also included in the study, such as gender, age, CCI score, and level of D-dimer[ 15 , 23 ]. Previous studies have reported that the longer the time from injury to admission, the higher the risk of DVT and the increase in perioperative mortality[ 24 ]. All baseline variables were comparable between the two groups after PSM. In our study, PSM effectively reduced confounding bias and made the results as close as possible to a randomized controlled study. In our study, there was no significant difference in mortality between the two groups at one-month, three-month, six-month, and one-year postoperatively. The formation of CMVT does not increase the risk of death within one year postoperatively in hip fracture patients on the same anticoagulation regimen. Previous studies have also found no significant association between CMVT and mortality[ 25 , 26 ]. It has also been reported that CMVT in geriatric hip fracture patients is associated with increased mortality at thirty days postoperatively, but disappeared at ninety days follow-up[ 12 ]. We believe that the difference in mortality at one month postoperatively may be related to the perioperative management and quality of care in different hospitals, and the underlying conditions of the patients included. The one-year mortality rate in hip fracture patients can reach up to 30%[ 27 ]. However, there are fewer studies focusing on mortality in geriatric hip fracture patients with CMVT. The one-year postoperative mortality of patients with CMVT in our study was 13.5%, which could be attributed to the standardized anticoagulation protocol and advances in enhanced recovery after surgery. In terms of operative outcomes, no significant differences were found in the preoperative waiting time, surgical time and intraoperative blood loss between the groups. It demonstrates that the formation of CMVT does not make the procedure more difficult for the surgeon with the same anticoagulation regimen. However, our study found that hip fracture patients with CMVT had longer hospital stays and a higher incidence of postoperative complications compared with patients without CMVT. We believe that longer hospital stays may be associated with a longer postoperative period of clinical observation. The operation may cause the patient's existing CMVT to dislodge, or progress proximally[ 28 ]. These patients usually require dynamic monitoring of the thrombosis and further examination or treatment postoperatively[ 29 ]. And the higher incidence of postoperative complications is associated with a longer time in bed postoperatively for patients with CMVT. In order to avoid dislodgement of the thrombosis by movement of the calf muscles, most clinicians recommend braking of the affected limb or early functional exercises based on ankle pump[ 30 ]. The longer time in bed can lead to a series of postoperative complications, such as urinary tract infections and pulmonary infections[ 31 ]. However, in our study, no significant differences were observed in these outcomes between the groups, which may be attributed to standard clinical nursing practice or a lack of statistical validity due to small sample sizes. Currently, it is still controversial whether such patients can get out of bed early for functional exercise after surgery[ 32 ]. Some studies have shown that early ambulation is effective in reducing the progression of DVT and improving limb pain without increasing the incidence of complications compared to bed rest[ 33 , 34 ]. However, there are no clear recommendations in this respect in the relevant guidelines and further research is needed in the future[ 35 ]. The calf muscular venous plexus is located in the dorsal and ventral muscles of the calf and includes the soleus plexus and the gastrocnemius plexus, both of which eventually converge into the popliteal vein[ 36 ]. It is characterized by slender ducts with many branches and few venous valves that interweave into a network of veins, resulting in slow blood flow, and is prone to the formation of thrombosis[ 37 ]. In addition, vascular endothelial damage and the release of inflammatory factors during fracture initiate endogenous and exogenous coagulation, resulting in increased risk of thrombosis[ 18 ]. Although CMVT is less harmful to patients than proximal DVT, there is also a risk of upward spread[ 38 ]. Furthermore, the formation of preoperative CMVT may have an impact on the quality of life of geriatric hip fracture patients. In our study, there was no significant difference in Harris score, VAS score, or Barthel Index between the two groups of patients. It was demonstrated that the formation of CMVT did not affect the long-term hip function or quality of daily life of geriatric hip fracture patients. However, the group of patients with CMVT had a higher incidence of progression of thrombosis postoperatively than the group of patients without CMVT. Only two patients progressed from CMVT to proximal DVT, the remaining patients remained with distal DVT and no fatal pulmonary embolism occurred. Currently, the natural history of CMVT can be divided into dissolution recanalization, spreading, and embolization[ 39 ]. On the basis of anticoagulation therapy, the CMVT will gradually dissolve in most patients, increasing the probability of revascularization. Similar outcomes have been observed in patients underwent knee arthroscopy and total knee replacement[ 40 , 41 ]. The patient's CMVT will progress due to the repeated intraoperative pulling of the leg muscles and the interaction between the thrombosis, but whether it can lead to pulmonary embolism is still controversial[ 38 , 42 ]. Therefore, multidisciplinary treatment, enhanced thrombosis management and monitoring, and meticulous care are recommended in the postoperative period for geriatric hip fracture patients with CMVT. There are several limitations in our study. First, although we performed PSM to minimize the effect of baseline confounding factors, the relatively small sample size of this study may affect the authenticity of the results. Second, although our study reported indicators of postoperative mortality, operative outcomes, long-term function, and state of thrombosis, recall bias is inevitable because of restrictions of retrospective studies. Third, our institution did not routinely perform color Doppler ultrasound in all patients postoperatively and only in patients with relevant symptoms, which may miss some asymptomatic DVT. 5. Conclusion We conducted a retrospective study with the PSM design and found no association between the formation of CMVT and mortality within one year postoperatively in Chinese geriatric hip fracture patients. However, patients with CMVT had longer hospital stays, a higher incidence of postoperative complications, and a higher incidence of thrombosis progression compared to patients without CMVT in long-term follow-up. PSM can effectively reduce the impact of baseline confounders and improve the credibility of our findings. Therefore, we recommend that orthopedic surgeons must pay more attention to postoperative rehabilitation, care, and enhanced management of thrombosis when treating geriatric hip fracture patients with CMVT for better clinical outcomes and long-term prognosis. However, large-scale, multicenter, randomized controlled studies are still needed in the future to confirm our findings. Abbreviations CMVT Calf muscular vein thrombosis PSM Propensity score-matching ChiCTR Chinese Clinical Trial Registry DVT Distal deep vein thrombosis STROBE Strengthening the Reporting of Observational Studies in Epidemiology BMI Body mass index ASA American Society of Anesthesiologists PT Prothrombin time APTT Activated partial prothrombin time TT Thrombin time CCI Charlson comorbidity index VAS Visual analogue scale SD Standard deviation IQR Interquartile range CI Confidence interval. Declarations Disclosure of interest: The authors declare that they have no competing interests. Authors' contributions: Jiabao Jiang and Fei Xing contributed equally to this work. Jiabao Jiang wrote the manuscript. Fei Xing, Rong Luo, Zhao Chen, and Hao Liu collected the data and assisted in the data analysis. Xin Duan and Zhou Xiang designed and supervised this project. Funding: This work was supported by the National Natural Science Foundation of China (82202705), the Sino-German Center for Research Promotion (GZ1219), the Project of the Science and Technology Department of Sichuan Province (No. 2022YFS0099, No. 2023NSFSC1738) and Clinical Research Incubation project of West China Hospital of Sichuan University (2019HXFH041). References J.C. Henry, B. Satiani, Calf muscle venous thrombosis: a review of the clinical implications and therapy, Vascular and endovascular surgery 48(5-6) (2014) 396-401. J.P. Galanaud, M.A. Sevestre, C. Genty, J.P. Laroche, V. Zizka, I. Quéré, J.L. Bosson, Comparison of the clinical history of symptomatic isolated muscular calf vein thrombosis versus deep calf vein thrombosis, Journal of vascular surgery 52(4) (2010) 932-8, 938.e1-2. S.R. Kahn, I. Shrier, C. Kearon, Physical activity in patients with deep venous thrombosis: a systematic review, Thrombosis research 122(6) (2008) 763-73. W. Kuczmik, W.E. Wysokinski, G.K. 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Xiang, Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening, BMC Musculoskelet Disord 19(1) (2018) 444. S.K. Nayar, M. Marrache, J.A. Bressner, M. Raad, B. Shafiq, U. Srikumaran, Temporal Trends in Hip Fractures: How Has Time-to-Surgery Changed?, The archives of bone and joint surgery 9(2) (2021) 224-229. D. Pincus, B. Ravi, D. Wasserstein, A. Huang, J.M. Paterson, A.B. Nathens, H.J. Kreder, R.J. Jenkinson, W.P. Wodchis, Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery, Jama 318(20) (2017) 1994-2003. O. Kuss, M. Blettner, J. Börgermann, Propensity Score: an Alternative Method of Analyzing Treatment Effects, Deutsches Arzteblatt international 113(35-36) (2016) 597-603. U. Benedetto, S.J. Head, G.D. Angelini, E.H. 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Takabayashi, H. Shiomi, T. Kato, T. Makiyama, K. Ono, M. Inoko, T. Kimura, Impact of no, distal, and proximal deep vein thrombosis on clinical outcomes in patients with acute pulmonary embolism: From the COMMAND VTE registry, Journal of cardiology 77(4) (2021) 395-403. S.M. Stevens, S.C. Woller, L.B. Kreuziger, H. Bounameaux, K. Doerschug, G.J. Geersing, M.V. Huisman, C. Kearon, C.S. King, A.J. Knighton, E. Lake, S. Murin, J.R.E. Vintch, P.S. Wells, L.K. Moores, Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report, Chest 160(6) (2021) e545-e608. M.J. Parker, J.K. Anand, What is the true mortality of hip fractures?, Public health 105(6) (1991) 443-6. T. Yamaguchi, M. Hasegawa, R. Niimi, A. Sudo, Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty, Thrombosis research 126(4) (2010) e323-6. J.M. Januel, G. Chen, C. Ruffieux, H. Quan, J.D. Douketis, M.A. Crowther, C. Colin, W.A. Ghali, B. Burnand, Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review, Jama 307(3) (2012) 294-303. H. Rahemi, J. Chung, V. Hinko, S. Hoeglinger, W.A. Martinek, M. Montero-Baker, J.L. Mills, B. Najafi, Pilot study evaluating the efficacy of exergaming for the prevention of deep venous thrombosis, Journal of vascular surgery. Venous and lymphatic disorders 6(2) (2018) 146-153. J. Li, X. Wu, Z. Li, X. Zhou, J. Cao, Z. Jia, X. Wan, J. Jiao, G. Liu, Y. Liu, F. Li, B. Song, J. Jin, Y. Liu, X. Wen, S. Cheng, Nursing resources and major immobility complications among bedridden patients: A multicenter descriptive study in China, Journal of nursing management 27(5) (2019) 930-938. J. Cao, S. Li, Y. Ma, Z. Li, G. Liu, Y. Liu, J. Jiao, C. Zhu, B. Song, J. Jin, Y. Liu, X. Wen, S. Cheng, X. Wan, X. Wu, Risk factors associated with deep venous thrombosis in patients with different bed-rest durations: A multi-institutional case-control study, International journal of nursing studies 114 (2021) 103825. Z. Liu, X. Tao, Y. Chen, Z. Fan, Y. Li, Bed rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis: a meta-analysis, PloS one 10(4) (2015) e0121388. J. Trujillo-Santos, E. Perea-Milla, A. Jiménez-Puente, E. Sánchez-Cantalejo, J. del Toro, E. Grau, M. Monreal, Bed rest or ambulation in the initial treatment of patients with acute deep vein thrombosis or pulmonary embolism: findings from the RIETE registry, Chest 127(5) (2005) 1631-6. J.D. Douketis, A.C. Spyropoulos, M.H. Murad, J.I. Arcelus, W.E. Dager, A.S. Dunn, R.A. Fargo, J.H. Levy, C.M. Samama, S.H. Shah, M.W. Sherwood, A.J. Tafur, L.V. Tang, L.K. Moores, Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline, Chest 162(5) (2022) e207-e243. J.M. Bright, K.B. Fields, R. Draper, Ultrasound Diagnosis of Calf Injuries, Sports health 9(4) (2017) 352-355. G.H. Utter, T.S. Dhillon, E.S. Salcedo, D.J. Shouldice, C.L. Reynolds, M.D. Humphries, R.H. White, Therapeutic Anticoagulation for Isolated Calf Deep Vein Thrombosis, JAMA surgery 151(9) (2016) e161770. J. Garry, A. Duke, N. Labropoulos, Systematic review of the complications following isolated calf deep vein thrombosis, The British journal of surgery 103(7) (2016) 789-96. C.J. Carter, The natural history and epidemiology of venous thrombosis, Progress in cardiovascular diseases 36(6) (1994) 423-38. Chun, Kit, Lai, Qunn, Jid, Lee, Yiu, Chung, Wong, Yuk, Incidence of Deep Vein Thrombosis and Its Natural History Following Unilateral Primary Total Knee Replacement in Local Chinese Patients—A Prospective Study, Journal of Orthopaedics Trauma & Rehabilitation 21(1) (2016) 35-38. K.T. Delis, N. Hunt, R.K. Strachan, A.N. Nicolaides, Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy, Thrombosis and haemostasis 86(3) (2001) 817-21. P.S. Macdonald, S.R. Kahn, N. Miller, D. Obrand, Short-term natural history of isolated gastrocnemius and soleal vein thrombosis, Journal of vascular surgery 37(3) (2003) 523-7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2931055","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":200801283,"identity":"12d922d6-1ee7-44a4-a0a5-3184bb9e996a","order_by":0,"name":"Jiabao Jiang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jiabao","middleName":"","lastName":"Jiang","suffix":""},{"id":200801284,"identity":"47737bdb-b574-47d5-b307-05a4791acf56","order_by":1,"name":"Fei Xing","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Fei","middleName":"","lastName":"Xing","suffix":""},{"id":200801285,"identity":"da373dc5-7718-4bed-a757-ef4c13db6144","order_by":2,"name":"Rong Luo","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Luo","suffix":""},{"id":200801286,"identity":"15ecd3ee-a402-4c80-9033-2642c3d50b22","order_by":3,"name":"Zhao Chen","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Zhao","middleName":"","lastName":"Chen","suffix":""},{"id":200801287,"identity":"20060d87-295f-403b-b363-b5cc7fd29b6e","order_by":4,"name":"Hao Liu","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Liu","suffix":""},{"id":200801288,"identity":"ed63426d-ddfd-487d-9fe6-6475a6a60a4d","order_by":5,"name":"Xin Duan","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Duan","suffix":""},{"id":200801289,"identity":"9c1065ae-382c-422f-8b08-1a4ef9e883da","order_by":6,"name":"Zhou Xiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDACZjB5gIGB//zDxxAR5gYitTDzMBszMBgAGYwEtDAgtLBJg7UwENBicJz52cMvf+7IGRzmPVZdUPEnmr8dqOVHxTacWiSb2cyNZXieGRsc5ku7PeOMQe6Mw4wNjD1nbuPUws/MYCYtIXE4ccNhBrPbvG0GuQ1ALcyMbbi1sDGzf5OWMIBoKQZpmU9ICz8zj5nkhwSQFh4zZpCWDYS0SDbzlEkzHDhsLHmYLVma54xx7kagloP4/GJw/vg2yR9/DsvxnT988DNPhVzuPCDjwY8K3FpAgJkHXeQAXvVAwPiDkIpRMApGwSgY2QAAyIJWiTLohFwAAAAASUVORK5CYII=","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Zhou","middleName":"","lastName":"Xiang","suffix":""}],"badges":[],"createdAt":"2023-05-13 12:59:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2931055/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2931055/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":37193441,"identity":"f6c1a795-b054-44d5-8857-b25a47397393","added_by":"auto","created_at":"2023-05-18 13:20:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":512272,"visible":true,"origin":"","legend":"\u003cp\u003eThe sampling procedure used for all geriatric patients with hip fracture in this study. CMVT, Calf muscular vein thrombosis.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2931055/v1/f858f9e32ace581b21aad202.jpg"},{"id":37191927,"identity":"18508641-1cb8-4327-a86d-28dec4c6eaa8","added_by":"auto","created_at":"2023-05-18 13:12:36","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":355750,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot of baseline characteristics of all geriatric hip fracture patients before and after propensity score matching. CMVT, Calf muscular vein thrombosis.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2931055/v1/07014619dae38b80bbbc3b57.jpg"},{"id":37191928,"identity":"28ff37aa-5cf7-4112-a9c7-416a6352db98","added_by":"auto","created_at":"2023-05-18 13:12:37","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":239940,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curve of geriatric hip fracture patients with and without CMVT. CMVT, Calf muscular vein thrombosis.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2931055/v1/6c5891e9963a6dd5905a925a.jpg"},{"id":41860281,"identity":"dfb7d99b-dea5-44fa-a994-fbd79dacf8e5","added_by":"auto","created_at":"2023-08-21 10:22:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":646105,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2931055/v1/d3fc2ce2-9ec4-4a1b-9539-79f971c64eab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of calf muscular vein thrombosis on the prognosis within one year postoperatively of geriatric hip fracture patients: a propensity score-matched analysis","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCalf muscle venous thrombosis (CMVT) is a type of distal deep vein thrombosis (DVT) in which the thrombosis is original and confined to the venous plexus of the soleus and gastrocnemius muscles[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. CMVT is a category of DVT with a high incidence. It has been shown that isolated CMVT accounts for approximately 25% of all lower limb DVT and up to 47%-79% of those containing CMVT[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, because of the small extent of its formation, its effect on venous blood return and stimulation of the inflammatory response is less severe[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The clinical symptoms are not obvious and are often overlooked by clinicians.\u003c/p\u003e \u003cp\u003eHip fractures in the geriatric population are very common in clinical practice. The characteristics are high mortality and disability rates and expensive medical treatment. As the global population ages, it is predicted that the number of hip fractures worldwide will increase from 1.26\u0026nbsp;million in 1990 to 4.5\u0026nbsp;million in 2050, with approximately half of these likely to occur in Asia, particularly in China[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Geriatric patients with hip fractures are at high risk for DVT, and most have CMVT.\u003c/p\u003e \u003cp\u003eHowever, there are many geriatric hip fracture patients with isolated CMVT. Most of them inevitably require surgical treatment. However, studies on whether conventional orthopedic surgery has an impact on the prognosis of such patients are very limited. Current opinions on this aspect are still controversial. It has been reported that CMVT may perpetuate and progress into the deep veins of the lower limbs, causing proximal DVT and inducing pulmonary embolism[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It has also been shown that the incidence of isolated CMVT developing into pulmonary embolism is only 0-6.2% and does not lead to the development of fatal pulmonary embolism[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, the primary outcome of this study was to explore whether geriatric hip fracture patients with CMVT would affect patient mortality within one year postoperatively. Secondary outcomes included surgical difficulty, postoperative complications, the status of thrombosis, and long-term function.\u003c/p\u003e"},{"header":"2. Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patients\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the ethical principles of the Helsinki declaration and was approved by the Ethical Review Committee of West China Hospital, Sichuan University. Informed consent procedures for this study have been waived due to the retrospective design. The clinical trial registration number is ChiCTR2300069411. Geriatric hip fracture patients who underwent surgery at the West China Hospital between January 2019 and January 2021 were included in this study. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe inclusion criteria for our study included the following: (1) acute hip fractures including femoral neck and intertrochanteric fractures (\u0026le;\u0026thinsp;7 days); (2) the fracture has been proven by X-ray or CT preoperatively; (3) treated by internal fixation such as cannulated cancellous screw, dynamic hip screw, femoral neck system, and proximal femoral nail anti-rotation or arthroplasty; (4) the patient agrees to participate in this study. The exclusion criteria of our study included the following: (1) age\u0026thinsp;\u0026lt;\u0026thinsp;65 years; (2) multiple fractures; (3) open fractures; (4) pathological fracture; (5) fracture with vascular or nerve lesion; (6) history of arthroplasty or venous thromboembolism; (7) incomplete clinical data; (8) coexistence of DVT at other locations than CMVT.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003eData on selected patients were retrospectively retrieved from our hospital medical database. Demographic characteristics included gender, age, body mass index (BMI), type of fracture, injury side, therapy method, American Society of Anesthesiologists (ASA) grade, time from injury to admission, routine blood indexes (including the concentrations of hemoglobin and platelet), blood biochemistry indexes (including the concentrations of serum albumin, potassium, and sodium), coagulation indexes (including prothrombin time (PT), activated partial prothrombin time (APTT), thrombin time (TT), and the concentrations of fibrinogen and D-dimer ), and Charlson comorbidity index (CCI) score. The CCI score was calculated to obtain an overall assessment of preoperative comorbid conditions. The CCI score consists of nineteen severe, chronic diseases, each assigned a weight from one to six corresponding to the relative risk of mortality from the disease[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. One\u0026rsquo;s CCI score is calculated by summing all the weights.\u003c/p\u003e \u003cp\u003eAll patients routinely received a color Doppler ultrasound on admission. Color Doppler ultrasound is conducted by an experienced radiologist in the color ultrasound room. All ultrasound results were reviewed by a senior radiologist. Re-examination of the ultrasound was conducted when there were different opinions. According to guideline recommendations all geriatric hip fracture patients at our institution received DVT prophylaxis[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The prophylactic regimen consisted of low molecular heparin (4000 AxaIU/0.4 ml) or fondaparinux (2.5 mg) to be injected subcutaneously once daily. Routine ultrasound or any other imaging will not be performed on the patient postoperatively unless they have preoperative thrombosis or symptoms suggesting assessment. Signs and symptoms of DVT include changes in skin temperature and color, swelling, pain and tenderness in the thigh or calf.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcome measures\u003c/h2\u003e \u003cp\u003eThe primary outcome measures were mortality within one year after undergoing hip fracture surgery. The one-month postoperative observation window is the most common follow-up period in the literature[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Considering the temporal correlation between the surgical delay and the development of complications, longer follow-up periods of three-month, six-month, and one-year were also analyzed. The secondary outcomes include intraoperative indicators (preoperative waiting time, hospital stays, surgical time, intraoperative blood loss), postoperative complications (incision infection, hematoma, hip or thigh pain, urinary tract infection, postoperative delirium, implant failure, pulmonary infection), Harris score[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], visual analogue scale (VAS) score, and Barthel Index. All pain and functional scores were documented at the one-year postoperative follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are expressed as mean and standard deviation (SD) if normally distributed, and as median and interquartile range (IQR) otherwise, while categorical variables are presented as absolute numbers and percentages. Categorical variables were compared using χ2 analysis or Fisher's exact test; continuous variables were compared using t-test or Wilcoxon rank sum test for normally and nonnormally distributed data, respectively. The rationale and methodology of PSM for assessing causality have been well demonstrated in retrospective studies[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The R software (version \u0026times; 64 3.5.1, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.r-project.org\u003c/span\u003e\u003cspan address=\"http://www.r-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used to conduct the propensity score-matched (PSM) analysis with 1:1matching method to reduce baseline confounding bias. Survival analysis was also performed using Kaplan-Meier survival curves, and differences between groups were estimated using the log-rank test. All statistical computations were performed using SPSS statistical software (version 25.0; IBM Corp, Armonk, NY, USA). P\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant; all tests were two-sided.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline characteristics of patients before and after PSM\u003c/h2\u003e \u003cp\u003eThe baseline characteristics of the patients were shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were two hundred and sixty patients included in the study after screening, consisting of ninety-three patients with CMVT and one hundred and sixty-seven patients without CMVT. The difference of time from injury to admission, hemoglobin, blood platelet, serum albumin, and serum potassium in two groups have statistical significance. Eighty-nine patients were included in each group after PSM, and no significant differences in baseline characteristics were observed between patients with and without CMVT after matching. The sampling procedure of Chinese geriatric patients with hip fracture in our study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The scatter plots before and after PSM for each group are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. After PSM the bias was effectively reduced for confounding variables such as the time from injury to admission, hemoglobin, blood platelet, serum albumin, and serum potassium.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients before and after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore Propensity Score-Matching\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter Propensity Score-Matching\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithout CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWithout CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWith CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e167(64.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93(35.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e89(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e89(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80.25 (7.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.53 (7.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80.56 (7.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e80.30 (7.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.74 (3.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.09 (3.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.00 (3.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.00 (3.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from injury to admission (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00(0.50-2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00 (0.50-5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00 (0.50\u0026ndash;3.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00 (0.50-4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.00\u0026ndash;2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00 (0.00\u0026ndash;2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00 (0.00\u0026ndash;2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00 (0.00\u0026ndash;2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113.16 (21.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107.38 (21.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e108.53 (23.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e108.63 (20.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood platelet (109/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155.05 (62.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173.49 (73.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e165.71 (73.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e172.21 (72.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum albumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37.56 (4.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.37 (4.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.98 (4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36.54 (4.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum potassium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.89 (0.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.03 (0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.02 (0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.01 (0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum sodium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139.24 (3.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139.32 (3.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e139.03 (4.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e139.33 (3.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.55 (0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.66 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.55 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.62 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPTT (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.92 (3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.69 (3.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.86 (3.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28.64 (3.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.52 (1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.61 (5.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.60 (1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17.64 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrinogen (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.94 (1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.09 (1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.98 (1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.07 (1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer (\u0026micro;g/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.61 (2.16\u0026ndash;14.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.86 (3.01\u0026ndash;15.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.24 (2.33\u0026ndash;15.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.86 (3.01\u0026ndash;15.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (67.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (73.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65 (73.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e65 (73.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (32.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (26.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24 (27.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24 (27.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of fracture (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntertrochanteric fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85 (50.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (51.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44 (49.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45 (50.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral neck fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (49.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (48.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45 (50.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44 (49.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInjury side (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (52.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (51.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49 (55.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e47 (52.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80 (47.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (48.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40 (44.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42 (47.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTherapy method (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArthroplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (34.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (36.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29 (32.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33 (37.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109 (65.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (63.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60 (67.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56 (62.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA grade (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (31.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (36.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35 (39.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33 (37.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104 (62.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (52.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45 (50.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e47 (52.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (6.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (10.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (10.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9 (10.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eCMVT\u0026thinsp;=\u0026thinsp;calf muscular vein thrombosis; BMI\u0026thinsp;=\u0026thinsp;body mass index; CCI\u0026thinsp;=\u0026thinsp;Charlson comorbidity index; PT\u0026thinsp;=\u0026thinsp;prothrombin time; APTT\u0026thinsp;=\u0026thinsp;activated partial prothrombin time; TT\u0026thinsp;=\u0026thinsp;thrombin time; ASA\u0026thinsp;=\u0026thinsp;American Society of Anesthesiologists. Data are expressed as mean (standard deviation) or median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Survival outcomes of hip fracture patients with and without CMVT\u003c/h2\u003e \u003cp\u003eThere was no significant difference in postoperative one-month mortality between the group of patients without CMVT and the group of patients with CMVT (1.1% vs 2.2%; Odds Ratio, 2.02; 95% Confidence Interval, 0.18\u0026ndash;22.72, P\u0026thinsp;=\u0026thinsp;1.000; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, no significant differences were found in mortality between the groups at three-month, six-month, and one-year postoperatively. Kaplan-Meier analysis showed that one-year accumulated survival rate was higher in the group of patients without CMVT without reaching a significant level (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A total of nineteen deaths were documented within the first year after surgery (seven in the group of patients without CMVT and twelve in the group of patients with CMVT). One-, three-, six-month and one-year mortality of geriatric hip fracture patients without CMVT, and with CMVT were shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOne-, three-, six-month, and one-year mortality of all geriatric hip fracture patients, geriatric hip fracture patients without CMVT, and with CMVT, respectively.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients without CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients with CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne-month mortality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.02 (0.18\u0026ndash;22.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree-month mortality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (3.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.07 (0.31\u0026ndash;30.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSix-month mortality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (6.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.81 (0.51\u0026ndash;6.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne-year mortality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (10.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (13.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.83 (0.68\u0026ndash;4.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCMVT\u0026thinsp;=\u0026thinsp;calf muscular vein thrombosis; CI\u0026thinsp;=\u0026thinsp;Confidence Interval.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Operative outcomes of hip fracture patients without and with CMVT\u003c/h2\u003e \u003cp\u003eThe length of hospital stays for hip fracture patients with CMVT was significantly longer than that of patients without CMVT ((10.90\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84 vs 8.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24 days, p\u0026thinsp;=\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, no significant differences were found in the preoperative waiting time, surgical time and intraoperative blood loss between the groups. The incidence of overall postoperative complications was significantly higher in the group of patients with CMVT than in the group of patients without CMVT (7.9% vs 29.2%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, there was no significant difference between the groups in the incidence of other complications, such as pneumonia and urinary tract infections. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOperative outcomes of all geriatric hip fracture patients, geriatric hip fracture patients without CMVT, and with CMVT, respectively.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients without CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients with CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative waiting time in hospital (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.32(3.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.91 (2.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.73(3.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stays (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.89(4.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.89(3.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.90 (4.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.63 (31.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.89 (33.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.37 (29.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101.93 (73.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107.85 (81.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.00 (63.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication (overall) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (18.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (29.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncision infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip or thigh pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative delirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplant failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCMVT\u0026thinsp;=\u0026thinsp;calf muscular vein thrombosis. Data are expressed as mean (standard deviation).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Long-term clinical outcomes of hip fracture patients without and with CMVT\u003c/h2\u003e \u003cp\u003eThe group of patients without CMVT and the group of patients with CMVT were comparable in terms of Harris scores postoperatively (82.79\u0026thinsp;\u0026plusmn;\u0026thinsp;13.13 vs 83.30\u0026thinsp;\u0026plusmn;\u0026thinsp;11.22, P\u0026thinsp;=\u0026thinsp;0.795; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). There was no significant difference between the two groups in terms of VAS scores and Barthel Index. In terms of the state of thrombosis, the incidence of thrombosis progression was significantly higher in the group of patients with CMVT than in the group of patients without CMVT (14.6% vs 1.1%, P\u0026thinsp;=\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The details of thrombosis progression in each group of patients are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. In the group of patients without CMVT, only one patient developed unilateral CMVT postoperatively, and no thrombosis was found in other patients. The majority of patients in the group with CMVT progressed from unilateral to bilateral CMVT postoperatively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe outcomes of long-term function and state of thrombosis in all geriatric hip fracture patients, geriatric hip fracture patients without CMVT, and with CMVT, respectively.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients without CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients with CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarris score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.04 (12.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.79 (13.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.30 (11.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.72 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.63(0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.81(1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.49 (18.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.74(19.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.29(16.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState of thrombosis (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo progress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164 (92.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (98.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76 (85.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (14.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCMVT\u0026thinsp;=\u0026thinsp;calf muscular vein thrombosis; VAS\u0026thinsp;=\u0026thinsp;visual analogue scale. Data are expressed as mean (standard deviation).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetails of the thrombotic progression in geriatric hip fracture patients with and without CMVT\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients without CMVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients with CMVT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom no thrombosis to unilateral CMVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom unilateral CMVT to bilateral CMVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom unilateral CMVT to bilateral CMVT and left peroneal vein thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom unilateral CMVT to bilateral CMVT and left posterior tibial vein thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom bilateral CMVT to right common femoral vein and bilateral popliteal vein thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom bilateral CMVT to right external iliac vein thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eCMVT\u0026thinsp;=\u0026thinsp;calf muscular vein thrombosis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eCurrently, there are no long-term follow-up studies of clinical differences between geriatric hip fracture patients with and without CMVT. The clinical relevance of CMVT to the prognosis of geriatric hip fracture patients undergoing surgical treatment remains controversial[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. DVT or PE is one of the most serious complications that can occur in hip fracture patients, significantly increasing perioperative mortality[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Current guidelines recommend that hip fracture patients should be operated on within forty-eight hours of admission for a positive prognosis[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, a point of controversy is whether patients with CMVT should undergo a rigorous cycle of anticoagulation before surgery, or whether surgery should be performed following routine anticoagulation with perfect preoperative preparation. As no literature is available, the primary aim of this study was to compare the effects of CMVT on long-term clinical outcomes in geriatric hip fracture patients.\u003c/p\u003e \u003cp\u003eThere is a high incidence of CMVT in geriatric hip fracture patients. However, due to its insidious symptoms, large-scale multicenter randomized controlled studies are still lacking. In this study, there were still some confounding factors at baseline for unmatched patients that could directly affect the veracity of the comparison between the control and experimental groups. In recent years, PSM has been widely used in retrospective studies with small sample sizes and multiple baseline confounders[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. PSM has certain advantages over traditional regression methods in controlling confounding[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In our study, PSM attempted to simulate randomization by creating groups of patients with and without CMVT that were comparable on all observed covariates. As many variables as possible were included in our propensity score model to maximize the propensity to inform the dependent variable. the PSM model included nineteen independent variables that were proven to influence or potentially influence mortality. The variables described in previous studies that were associated with postoperative mortality were also included in the study, such as gender, age, CCI score, and level of D-dimer[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Previous studies have reported that the longer the time from injury to admission, the higher the risk of DVT and the increase in perioperative mortality[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. All baseline variables were comparable between the two groups after PSM. In our study, PSM effectively reduced confounding bias and made the results as close as possible to a randomized controlled study.\u003c/p\u003e \u003cp\u003eIn our study, there was no significant difference in mortality between the two groups at one-month, three-month, six-month, and one-year postoperatively. The formation of CMVT does not increase the risk of death within one year postoperatively in hip fracture patients on the same anticoagulation regimen. Previous studies have also found no significant association between CMVT and mortality[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. It has also been reported that CMVT in geriatric hip fracture patients is associated with increased mortality at thirty days postoperatively, but disappeared at ninety days follow-up[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. We believe that the difference in mortality at one month postoperatively may be related to the perioperative management and quality of care in different hospitals, and the underlying conditions of the patients included. The one-year mortality rate in hip fracture patients can reach up to 30%[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, there are fewer studies focusing on mortality in geriatric hip fracture patients with CMVT. The one-year postoperative mortality of patients with CMVT in our study was 13.5%, which could be attributed to the standardized anticoagulation protocol and advances in enhanced recovery after surgery.\u003c/p\u003e \u003cp\u003eIn terms of operative outcomes, no significant differences were found in the preoperative waiting time, surgical time and intraoperative blood loss between the groups. It demonstrates that the formation of CMVT does not make the procedure more difficult for the surgeon with the same anticoagulation regimen. However, our study found that hip fracture patients with CMVT had longer hospital stays and a higher incidence of postoperative complications compared with patients without CMVT. We believe that longer hospital stays may be associated with a longer postoperative period of clinical observation. The operation may cause the patient's existing CMVT to dislodge, or progress proximally[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These patients usually require dynamic monitoring of the thrombosis and further examination or treatment postoperatively[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. And the higher incidence of postoperative complications is associated with a longer time in bed postoperatively for patients with CMVT. In order to avoid dislodgement of the thrombosis by movement of the calf muscles, most clinicians recommend braking of the affected limb or early functional exercises based on ankle pump[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The longer time in bed can lead to a series of postoperative complications, such as urinary tract infections and pulmonary infections[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, in our study, no significant differences were observed in these outcomes between the groups, which may be attributed to standard clinical nursing practice or a lack of statistical validity due to small sample sizes. Currently, it is still controversial whether such patients can get out of bed early for functional exercise after surgery[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Some studies have shown that early ambulation is effective in reducing the progression of DVT and improving limb pain without increasing the incidence of complications compared to bed rest[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, there are no clear recommendations in this respect in the relevant guidelines and further research is needed in the future[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe calf muscular venous plexus is located in the dorsal and ventral muscles of the calf and includes the soleus plexus and the gastrocnemius plexus, both of which eventually converge into the popliteal vein[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. It is characterized by slender ducts with many branches and few venous valves that interweave into a network of veins, resulting in slow blood flow, and is prone to the formation of thrombosis[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In addition, vascular endothelial damage and the release of inflammatory factors during fracture initiate endogenous and exogenous coagulation, resulting in increased risk of thrombosis[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Although CMVT is less harmful to patients than proximal DVT, there is also a risk of upward spread[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Furthermore, the formation of preoperative CMVT may have an impact on the quality of life of geriatric hip fracture patients. In our study, there was no significant difference in Harris score, VAS score, or Barthel Index between the two groups of patients. It was demonstrated that the formation of CMVT did not affect the long-term hip function or quality of daily life of geriatric hip fracture patients. However, the group of patients with CMVT had a higher incidence of progression of thrombosis postoperatively than the group of patients without CMVT. Only two patients progressed from CMVT to proximal DVT, the remaining patients remained with distal DVT and no fatal pulmonary embolism occurred. Currently, the natural history of CMVT can be divided into dissolution recanalization, spreading, and embolization[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. On the basis of anticoagulation therapy, the CMVT will gradually dissolve in most patients, increasing the probability of revascularization. Similar outcomes have been observed in patients underwent knee arthroscopy and total knee replacement[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The patient's CMVT will progress due to the repeated intraoperative pulling of the leg muscles and the interaction between the thrombosis, but whether it can lead to pulmonary embolism is still controversial[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Therefore, multidisciplinary treatment, enhanced thrombosis management and monitoring, and meticulous care are recommended in the postoperative period for geriatric hip fracture patients with CMVT.\u003c/p\u003e \u003cp\u003eThere are several limitations in our study. First, although we performed PSM to minimize the effect of baseline confounding factors, the relatively small sample size of this study may affect the authenticity of the results. Second, although our study reported indicators of postoperative mortality, operative outcomes, long-term function, and state of thrombosis, recall bias is inevitable because of restrictions of retrospective studies. Third, our institution did not routinely perform color Doppler ultrasound in all patients postoperatively and only in patients with relevant symptoms, which may miss some asymptomatic DVT.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eWe conducted a retrospective study with the PSM design and found no association between the formation of CMVT and mortality within one year postoperatively in Chinese geriatric hip fracture patients. However, patients with CMVT had longer hospital stays, a higher incidence of postoperative complications, and a higher incidence of thrombosis progression compared to patients without CMVT in long-term follow-up. PSM can effectively reduce the impact of baseline confounders and improve the credibility of our findings. Therefore, we recommend that orthopedic surgeons must pay more attention to postoperative rehabilitation, care, and enhanced management of thrombosis when treating geriatric hip fracture patients with CMVT for better clinical outcomes and long-term prognosis. However, large-scale, multicenter, randomized controlled studies are still needed in the future to confirm our findings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCMVT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCalf muscular vein thrombosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePropensity score-matching\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eChiCTR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChinese Clinical Trial Registry\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDVT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDistal deep vein thrombosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTROBE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStrengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProthrombin time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPTT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eActivated partial prothrombin time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThrombin time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCharlson comorbidity index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual analogue scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJiabao Jiang and Fei Xing contributed equally to this work. Jiabao Jiang wrote the manuscript. Fei Xing, Rong Luo, Zhao Chen, and Hao Liu collected the data and assisted in the data analysis. Xin Duan and Zhou Xiang designed and supervised this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (82202705), the Sino-German Center for Research Promotion (GZ1219), the Project of the Science and Technology Department of Sichuan Province (No. 2022YFS0099, No. 2023NSFSC1738) and Clinical Research Incubation project of West China Hospital of Sichuan University (2019HXFH041).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJ.C. Henry, B. Satiani, Calf muscle venous thrombosis: a review of the clinical implications and therapy, Vascular and endovascular surgery 48(5-6) (2014) 396-401.\u003c/li\u003e\n\u003cli\u003eJ.P. Galanaud, M.A. Sevestre, C. Genty, J.P. Laroche, V. Zizka, I. 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Xiang, Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening, BMC Musculoskelet Disord 19(1) (2018) 444.\u003c/li\u003e\n\u003cli\u003eS.K. Nayar, M. Marrache, J.A. Bressner, M. Raad, B. Shafiq, U. Srikumaran, Temporal Trends in Hip Fractures: How Has Time-to-Surgery Changed?, The archives of bone and joint surgery 9(2) (2021) 224-229.\u003c/li\u003e\n\u003cli\u003eD. Pincus, B. Ravi, D. Wasserstein, A. Huang, J.M. Paterson, A.B. Nathens, H.J. Kreder, R.J. Jenkinson, W.P. Wodchis, Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery, Jama 318(20) (2017) 1994-2003.\u003c/li\u003e\n\u003cli\u003eO. Kuss, M. Blettner, J. B\u0026ouml;rgermann, Propensity Score: an Alternative Method of Analyzing Treatment Effects, Deutsches Arzteblatt international 113(35-36) (2016) 597-603.\u003c/li\u003e\n\u003cli\u003eU. Benedetto, S.J. Head, G.D. Angelini, E.H. Blackstone, Statistical primer: propensity score matching and its alternatives, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 53(6) (2018) 1112-1117.\u003c/li\u003e\n\u003cli\u003eE.L. Yong, G. Ganesan, M.S. Kramer, T.S. Howe, J.S.B. Koh, W.P. Thu, S. Logan, J.A. Cauley, K.B. Tan, Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore, JAMA network open 3(2) (2020) e1919706.\u003c/li\u003e\n\u003cli\u003eF.G. Hefley, Jr., C.L. Nelson, C.L. Puskarich-May, Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip, The Journal of bone and joint surgery. American volume 78(4) (1996) 581-3.\u003c/li\u003e\n\u003cli\u003eS. Nishiwaki, Y. Morita, Y. Yamashita, T. Morimoto, H. Amano, T. Takase, S. Hiramori, K. Kim, M. Oi, M. Akao, Y. Kobayashi, M. Toyofuku, T. Izumi, T. Tada, P.M. Chen, K. Murata, Y. Tsuyuki, S. Saga, T. Sasa, J. Sakamoto, M. Kinoshita, K. Togi, H. Mabuchi, K. Takabayashi, H. Shiomi, T. Kato, T. Makiyama, K. Ono, M. Inoko, T. Kimura, Impact of no, distal, and proximal deep vein thrombosis on clinical outcomes in patients with acute pulmonary embolism: From the COMMAND VTE registry, Journal of cardiology 77(4) (2021) 395-403.\u003c/li\u003e\n\u003cli\u003eS.M. Stevens, S.C. Woller, L.B. Kreuziger, H. Bounameaux, K. Doerschug, G.J. Geersing, M.V. Huisman, C. Kearon, C.S. King, A.J. Knighton, E. Lake, S. Murin, J.R.E. Vintch, P.S. Wells, L.K. Moores, Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report, Chest 160(6) (2021) e545-e608.\u003c/li\u003e\n\u003cli\u003eM.J. Parker, J.K. Anand, What is the true mortality of hip fractures?, Public health 105(6) (1991) 443-6.\u003c/li\u003e\n\u003cli\u003eT. Yamaguchi, M. Hasegawa, R. Niimi, A. Sudo, Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty, Thrombosis research 126(4) (2010) e323-6.\u003c/li\u003e\n\u003cli\u003eJ.M. Januel, G. Chen, C. Ruffieux, H. Quan, J.D. Douketis, M.A. Crowther, C. Colin, W.A. Ghali, B. Burnand, Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review, Jama 307(3) (2012) 294-303.\u003c/li\u003e\n\u003cli\u003eH. Rahemi, J. Chung, V. Hinko, S. Hoeglinger, W.A. Martinek, M. Montero-Baker, J.L. Mills, B. Najafi, Pilot study evaluating the efficacy of exergaming for the prevention of deep venous thrombosis, Journal of vascular surgery. Venous and lymphatic disorders 6(2) (2018) 146-153.\u003c/li\u003e\n\u003cli\u003eJ. Li, X. Wu, Z. Li, X. Zhou, J. Cao, Z. Jia, X. Wan, J. Jiao, G. Liu, Y. Liu, F. Li, B. Song, J. Jin, Y. Liu, X. Wen, S. Cheng, Nursing resources and major immobility complications among bedridden patients: A multicenter descriptive study in China, Journal of nursing management 27(5) (2019) 930-938.\u003c/li\u003e\n\u003cli\u003eJ. Cao, S. Li, Y. Ma, Z. Li, G. Liu, Y. Liu, J. Jiao, C. Zhu, B. Song, J. Jin, Y. Liu, X. Wen, S. Cheng, X. Wan, X. Wu, Risk factors associated with deep venous thrombosis in patients with different bed-rest durations: A multi-institutional case-control study, International journal of nursing studies 114 (2021) 103825.\u003c/li\u003e\n\u003cli\u003eZ. Liu, X. Tao, Y. Chen, Z. Fan, Y. Li, Bed rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis: a meta-analysis, PloS one 10(4) (2015) e0121388.\u003c/li\u003e\n\u003cli\u003eJ. Trujillo-Santos, E. Perea-Milla, A. Jim\u0026eacute;nez-Puente, E. S\u0026aacute;nchez-Cantalejo, J. del Toro, E. Grau, M. Monreal, Bed rest or ambulation in the initial treatment of patients with acute deep vein thrombosis or pulmonary embolism: findings from the RIETE registry, Chest 127(5) (2005) 1631-6.\u003c/li\u003e\n\u003cli\u003eJ.D. Douketis, A.C. Spyropoulos, M.H. Murad, J.I. Arcelus, W.E. Dager, A.S. Dunn, R.A. Fargo, J.H. Levy, C.M. Samama, S.H. Shah, M.W. Sherwood, A.J. Tafur, L.V. Tang, L.K. Moores, Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline, Chest 162(5) (2022) e207-e243.\u003c/li\u003e\n\u003cli\u003eJ.M. Bright, K.B. Fields, R. Draper, Ultrasound Diagnosis of Calf Injuries, Sports health 9(4) (2017) 352-355.\u003c/li\u003e\n\u003cli\u003eG.H. Utter, T.S. Dhillon, E.S. Salcedo, D.J. Shouldice, C.L. Reynolds, M.D. Humphries, R.H. White, Therapeutic Anticoagulation for Isolated Calf Deep Vein Thrombosis, JAMA surgery 151(9) (2016) e161770.\u003c/li\u003e\n\u003cli\u003eJ. Garry, A. Duke, N. Labropoulos, Systematic review of the complications following isolated calf deep vein thrombosis, The British journal of surgery 103(7) (2016) 789-96.\u003c/li\u003e\n\u003cli\u003eC.J. Carter, The natural history and epidemiology of venous thrombosis, Progress in cardiovascular diseases 36(6) (1994) 423-38.\u003c/li\u003e\n\u003cli\u003eChun, Kit, Lai, Qunn, Jid, Lee, Yiu, Chung, Wong, Yuk, Incidence of Deep Vein Thrombosis and Its Natural History Following Unilateral Primary Total Knee Replacement in Local Chinese Patients\u0026mdash;A Prospective Study, Journal of Orthopaedics Trauma \u0026amp; Rehabilitation 21(1) (2016) 35-38.\u003c/li\u003e\n\u003cli\u003eK.T. Delis, N. Hunt, R.K. Strachan, A.N. Nicolaides, Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy, Thrombosis and haemostasis 86(3) (2001) 817-21.\u003c/li\u003e\n\u003cli\u003eP.S. Macdonald, S.R. Kahn, N. Miller, D. Obrand, Short-term natural history of isolated gastrocnemius and soleal vein thrombosis, Journal of vascular surgery 37(3) (2003) 523-7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Calf muscular vein thrombosis, geriatric patients, deep vein thrombosis, hip fracture, propensity score-matched analysis","lastPublishedDoi":"10.21203/rs.3.rs-2931055/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2931055/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eCalf muscular vein thrombosis (CMVT) is a type of distal deep vein thrombosis, which is common in geriatric hip fracture patients. However, studies focusing on whether the orthopedic operation has an impact on the prognosis of geriatric hip fracture patients with CMVT are very limited. Therefore, the aim of this study was to explore whether geriatric hip fractures with CMVT affect the mortality of patients within one year postoperatively. The difficulty of the operation, postoperative complications, the status of thrombosis, and long-term function were also compared.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eGeriatric hip fracture patients who underwent surgery between January 2019 and January 2021 were included. Patients were divided into groups with and without CMVT by preoperative color Doppler ultrasound examination. Propensity score-matching (PSM) was performed in a ratio of 1:1 between the patient with and without CMVT groups. Baseline characteristics, laboratory results, perioperative indicators and prognosis of patients were collected retrospectively. Intraoperative and long-term postoperative comparisons were conducted between patients with and without CMVT.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwo hundred and sixty geriatric hip fracture patients were included. Eighty-nine patients in each group were matched after PSM. There was no significant difference in mortality between the two groups at one-month, three-month, six-month, and one-year postoperatively. However, patients with CMVT had longer hospital stays, a higher incidence of postoperative complications, and a higher incidence of thrombosis progression than patients without CMVT in long-term follow-up.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCMVT in Chinese geriatric hip fracture patients is not associated with mortality within one year postoperatively. In addition, when orthopedic surgeons treat geriatric hip fracture patients with CMVT, enhanced postoperative rehabilitation, meticulous nursing, and thrombosis management are recommended to achieve better clinical outcomes and long-term prognosis.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eChinese Clinical Trial Registry (ChiCTR2300069411). Registered March 15, 2023, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.chictr.org.cn/showproj.html?proj=192079\u003c/span\u003e\u003cspan address=\"https://www.chictr.org.cn/showproj.html?proj=192079\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e","manuscriptTitle":"The effect of calf muscular vein thrombosis on the prognosis within one year postoperatively of geriatric hip fracture patients: a propensity score-matched analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-18 13:12:32","doi":"10.21203/rs.3.rs-2931055/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cee1d21-4192-4c8c-bf8e-c9e53a7c696e","owner":[],"postedDate":"May 18th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-08-21T10:14:18+00:00","versionOfRecord":[],"versionCreatedAt":"2023-05-18 13:12:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2931055","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2931055","identity":"rs-2931055","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}