The American journal of orthopedics
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Review Comparative Study
Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty: the role of aspirin.
Venous thromboembolic disease (VTD), which consists primarily of deep venous thrombosis (DVT) and pulmonary embolism (PE), is of significant concern to orthopedic surgeons who perform total hip and total knee arthroplasties. DVT and PE can be prevented in multiple ways; each method or combination of methods has its benefits and drawbacks. ⋯ Examining this balance and understanding the benefits and risks associated with each medication or intervention may allow surgeons to make educated decisions about prophylaxis for their patients. Furthermore, risk stratification and multimodal management may prove to be the safest and most effective way to manage VTD prevention.
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Comparative Study
Vascular risk associated with bicortical tibial drilling during anteromedial tibial tubercle transfer.
For select patients with persistent patellofemoral pain, the anteromedial tibial tubercle transfer (Fulkerson osteotomy) provides excellent clinical results. This procedure, indicated for patients with patellar malalignment, has become one of the most popular distal realignment procedures. One potential concern with this technique is the proximity of the posterior vascular structures during bicortical tibial drilling for screw placement. ⋯ Repeat AP radiographs were obtained, and digital calipers were used to measure the distance from the drill bits to the popliteal vessels. The vascular structure closest to the exit point of the superior drill bit was the bifurcation of the popliteal artery (mean distance, 8.3 mm; SD, 9.3 mm; range, 0.0-21.3 mm), and in 2 knees this structure directly overlay the bifurcation on the AP radiograph; the vascular structure closest to the exit point of the inferior drill bit was the posterior tibial artery (mean distance, 9.0 mm; SD, 8.0 mm; range, 0.0-20.0 mm), and again in 2 knees the drill bit lay directly over the artery on the AP radiograph. Bicortical drilling for screw placement during the anteromedial tibial tubercle transfer procedure may come precariously close to the posterior vascular structures of the knee, so orthopedic surgeons must take extreme caution not to drill past the posterior cortex during this part of the operation.
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Case Reports Comparative Study
Guide-wire exchange before insertion of intramedullary nails.
In the past, before a reamed intramedullary nail was inserted, it was mandatory to exchange the beaded-tip reaming guide wire with a smooth-tip wire. This additional step is optional in most new nail designs. ⋯ Intramedullary nail designs that avoid extra steps and thereby promote simplicity and reliability of insertion are potentially advantageous to both patient and surgeon. Eliminating the exchange tube and the smooth wire, however, should be approached with caution, as no time may be saved, and the procedure may be made much more difficult technically.