A nomogram to predict postoperative deep vein thrombosis combined with pulmonary embolism in patients with a tibial plateau fracture: a retrospective study.

BACKGROUND

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are serious postoperative complications in patients with tibial plateau fractures. The aim of this study was to investigate the risk factors for postoperative DVT complicated with PE in patients with tibial plateau fractures, establish a risk prediction model and verify its predictive efficacy.

METHODS

We conducted a retrospective study from January 1, 2023, to December 31, 2025. The primary endpoint of this study was the risk factors for DVT complicated with PE after tibial plateau fracture. Univariate analysis and multifactor logistic regression analysis were performed to analyze the relevant risk factors, and nomogram models were established to verify the predictive efficacy of the model via receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curve analysis (DCA) curves.

RESULTS

Among the 224 patients, 36 (16.07%) developed DVT complicated with PE after surgery. Univariate analysis revealed significant differences in age (P = 0.001), time from injury to surgery (P = 0.041), intraoperative blood loss (P = 0.008) and D-dimer level (P < 0.001) between the two groups. Multivariate logistic regression analysis indicated that age (OR = 1.051, 95% CI = 1.003-1.102, P = 0.036) and D-dimer level (OR = 1.001, 95% CI = 1.000-1.001, P < 0.001) were independent risk factors for postoperative DVT complicated with PE in patients with tibial plateau fractures. The ROC curve revealed that the area under the curve (AUC) of the nomogram model was 0.779, the χ2 value of the calibration curve was 11.295, P = 0.186, and the DCA curve indicated that the net clinical benefit of the model was high within the threshold range.

CONCLUSION

Age ≥ 52 years and a D-dimer level ≥ 4131.5 ng/mL are independent risk factors for postoperative deep vein thrombosis (DVT) complicated with pulmonary embolism (PE) in patients with tibial plateau fractures. The constructed nomogram model therefore has a certain predictive efficacy.