The American journal of orthopedics
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Patients with a fracture of the proximal femur are at high risk for thromboembolic complications necessitating some form of preoperative and postoperative thromboembolic prophylaxis. Despite the knowledge that patients with a proximal femur fracture are at particularly high risk for both deep venous thrombosis and pulmonary embolism, there is no consensus on which strategy is most effective at preventing thromboembolic events in this patient population. The pathophysiology and associated risk factors for thromboembolic complications in this patient population are discussed. We present a review of studies that address the efficacy and safety of both mechanical and pharmacological methods of thromboembolic prophylaxis to assist the orthopedic surgeon in selecting among the different modalities available for thromboembolic prophylaxis.
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A bioresorbable syndesmotic screw was used successfully for fixation in 4 patients, 3 with a bimalleolar Weber type-C ankle fracture and 1 with a Maisonneuve-type injury. The 5-mm screw consisted of a polyglycolic acid/polylactic acid copolymer placed in standard fashion at the time of open reduction and internal fixation. The patients healed without difficulty, and follow-up radiographs showed anatomic maintenance of the syndesmotic space. ⋯ Signs of minimal irritation were noted at the screw-head site in 2 patients at 3 to 4 months after surgery, but the irritation did not hamper activity or rehabilitation. The screws maintained alignment. Preliminary results suggest that a larger study to further evaluate the effect of this screw is appropriate.