Venous thromboembolism is rare in pediatric orthopedics, but the incidence is not uniform among young children, adolescents, elective surgery, trauma, and musculoskeletal infections.
A systematic review of 70 studies and 845,010 patients reported an overall median incidence of 0.16%. In patients with musculoskeletal infections, the median incidence rose to 3.5%. [1]
Age and Adolescence
A second systematic review estimated approximately 16.6 events per 10,000 pediatric orthopedic patients and identified age, sex, obesity/BMI, type of intervention, and presence of a central venous catheter among the most studied factors. The risk was higher in trauma cases compared to elective ones. [2]
The ICM-VTE recommendations emphasize that much of the literature uses chronological age as a proxy for puberty and skeletal maturity. In prepubertal children, routine pharmacological prophylaxis is not indicated; in adolescents, especially from 13 years old onwards and in the presence of other factors, the evaluation becomes more selective. [4]
Trauma, Femur, and Pelvis
In a series of over 81,000 pediatric orthopedic surgeries, the postoperative incidence was 0.07%. Age 16–18 years, higher ASA class, preoperative transfusion, arthrotomy, and femur fracture were associated with a higher risk. [3]
More recent studies on lower limb fractures confirm a difference between children and adolescents, with a higher risk in femur and pelvis/hip fractures. [5]
A 2026 meta-analysis specific to lower limb fractures estimated an overall incidence of 0.53%. The authors found insufficient evidence to demonstrate the effectiveness of routine pharmacological prophylaxis in this group and recommend individualized assessment. [6]
Musculoskeletal Infections
The 3.5% reported in Boulet's review for musculoskeletal infections is much higher than the incidence in general orthopedic cases. [1]
Systemic inflammation, immobilization, venous access, and greater clinical complexity can add up. This subgroup therefore warrants a different level of attention compared to a healthy child undergoing a short elective procedure.
Obesity and Other Factors
Obesity frequently appears in risk analyses, although it does not emerge as an independent predictor in all studies. It becomes more relevant when associated with adolescence, trauma, immobilization, major surgery, infection, or a central venous catheter. [2][4]
The assessment must therefore be built on the sum of factors present in the individual patient. A young, healthy child, rapidly mobilized after elective surgery, has a very low risk; an adolescent with a femur fracture, obesity, and prolonged immobilization belongs to a different profile.
Prophylaxis
Pediatric literature does not support universal pharmacological prophylaxis. The thresholds used in adults cannot be automatically transferred to children.
In higher-risk patients, the choice depends on age, type of trauma or intervention, anticipated mobility, individual factors, and bleeding risk. Available recommendations primarily emphasize stratification rather than a single therapeutic regimen. [4][6]
Disclaimer
This content is for informational purposes only and does not replace an individual clinical assessment.
References
[1] Boulet M, Langlais T, Pelet S, Belzile É, Forsythe C. Incidence of venous thromboembolism in pediatric orthopedics: A systematic review. Orthop Traumatol Surg Res. 2025;111(3):103830. doi:10.1016/j.otsr.2024.103830. PMID: 38336248.
PubMed: https://pubmed.ncbi.nlm.nih.gov/38336248/
DOI: https://doi.org/10.1016/j.otsr.2024.103830
[2] Mulpuri N, Sanborn RM, Pradhan P, Miller PE, Canizares MF, Shore BJ. Pediatric Orthopaedic Venous Thromboembolism: A Systematic Review Investigating Incidence, Risk Factors, and Outcome. JBJS Open Access. 2024;9(1):e23.00107. doi:10.2106/JBJS.OA.23.00107. PMID: 38188190.
PubMed: https://pubmed.ncbi.nlm.nih.gov/38188190/
[3] Mets EJ, Pathak N, Galivanche AR, McLynn RP, Frumberg DB, Grauer JN. Risk Factors for Venous Thromboembolism in Children Undergoing Orthopedic Surgery. Orthopedics. 2022;45(1):31-37. doi:10.3928/01477447-20211124-06. PMID: 34846239.
PubMed: https://pubmed.ncbi.nlm.nih.gov/34846239/
DOI: https://doi.org/10.3928/01477447-20211124-06
[4] Recommendations from the ICM-VTE: Pediatric. The Journal of Bone and Joint Surgery. 2022.
Journal page: https://journals.lww.com/jbjsjournal/fulltext/2022/03161/recommendations_from_the_icm_vte__pediatric.7.aspx
[5] Risk of venous thromboembolism in pediatric and adolescent patients undergoing surgical treatment of lower-extremity fractures. The Journal of Bone and Joint Surgery. 2025.
Journal page: https://journals.lww.com/jbjsjournal/fulltext/2025/06040/risk_of_venous_thromboembolism_in_pediatric.1.aspx
[6] Habib Z, Ahmed EM, Zipitis CS, Sutton PM, Malik RA, Charalambous CP. Venous thromboembolism in children with lower limb fractures: A systematic review and meta-analysis. Injury. 2026;113396. doi:10.1016/j.injury.2026.113396. PMID: 42457440.
