Identifying Risk Factors of Venous Thromboembolism in Adolescents With Lower Extremity Fractures Treated Surgically

Background: Venous thromboembolism (VTE) is uncommon in adolescents but remains a serious postoperative complication in orthopaedic surgery. Current prophylaxis practices are largely based on adult data. This study evaluated independent risk factors of postoperative VTE in adolescents undergoing lower extremity (LE) fracture surgery using a large multicenter data set. Methods: A retrospective case-control study using the TriNetX Research Network identified adolescents aged 13 to 20 years who underwent LE fracture surgery from 2003 to 2025. Patients were grouped by the presence or absence of VTE within 90 days. Demographics and comorbidities were analyzed with univariate and multivariate logistic regression. Results: Of 86,134 patients, 627 (0.73%) developed VTE. Overweight/obesity, diabetes, and tobacco use were significant on univariate analysis, but only overweight/obesity remained independently associated with VTE (adjusted OR 1.8). Conclusion: Obesity was the only independent predictor of postoperative VTE. These findings highlight the need to incorporate BMI into preoperative risk assessment and develop adolescent-specific prophylaxis guidelines. Level of Evidence: Therapeutic Level III.