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Reducing VTE Risk After Hip & Knee Replacement

Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is one of the most common reasons for readmission following primary hip or knee replacement surgery. However, recent studies suggest that only 0.7% to 0.9% of patients undergoing hip or knee replacements require rehospitalization because of VTE in the first 3 months after surgery. “These surgeries put patients at risk for thromboembolic disease because they affect multiple aspects of Virchow’s triad,” explains Joshua J. Jacobs, MD. Virchow’s triad consists of hypercoagulability, venous stasis, and injury to the vascular endothelium. All three components of the triad can be present following hip or knee replacement surgery and predispose individuals to thrombosis, according to Dr. Jacobs. “DVT occurs in about 37% of patients following primary hip or knee replacement surgery who have not been treated with prophylactic agents. The rate of clinically symptomatic VTE events is far less, but VTE should be an important concern of orthopedic surgeons performing these procedures.” New Guidelines on Preventing VTE Dr. Jacobs chaired a workgroup that updated guidelines from the American Academy of Orthopaedic Surgeons (AAOS) on preventing VTE in patients undergoing elective hip and knee arthroplasty. The guidelines were released on September 24, 2011 and are available for free at www.aaos.org/guidelines. “The AAOS felt it was necessary to update these guidelines for the first time since 2007 because of the increasing availability of study data that impacted the previous recommendations and to maintain inclusion in the AHRQ’s National Guideline Clearinghouse, which requires an update every 5 years,” says Dr. Jacobs. The American College of Chest Physicians has also published guidelines on VTE...

Distal Radius Fractures: New Guidelines

Distal radius fractures are among the most common fractures in the body, usually occurring as a result of a fall. The radius is the most commonly broken bone in the arm. Typically, these breaks occur when a person’s fall causes them to land on outstretched hands. Among younger people, distal radius fractures may occur via car, bicycle, and skiing accidents as well as other similar situations. Older individuals are at increased risk for these fractures if they have osteoporosis. Distal radius fractures in people aged 60 and older are frequently caused by falls from a standing position. Their decreased bone density can make relatively minor falls result in broken wrists. According to the American Academy of Orthopaedic Surgeons (AAOS), more than 261,000 emergency room visits in 2007 were caused by distal radius fractures. “These fractures are most commonly seen and treated in emergency departments, but follow-up of these patients is typically performed by primary care providers and orthopedic surgeons,” explains David M. Lichtman, MD. “Currently, there are many treatment options for managing patients with distal radius fractures, ranging from less invasive methods, such as cast treatment, to more invasive techniques, such as fixation devices. Physicians are often challenged by treatment decisions because there is relatively little evidence-based information to guide them along the way.”  A Deeper Look at the Evidence In December 2009, the AAOS approved and released an evidence-based clinical practice guideline on the treatment of distal radius fractures. Available at www.aaos.org, it analyzed over 4,000 journal articles from around the world over 1 year. Each article was graded on a 5-point scale depending on strength and quality...
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