Iranian Journal of Orthopedic Surgery

Abstract Background: The use of prophylaxis for deep vein thrombosis (DVT) in patients with ankle trauma treated with below knee cast is a controversial issue. The purpose of current study was to investigate the incidence of DVT to look into the necessity of thromboprophylaxis in these patients. Methods: Ninty five patients with stable fractures of the foot or ankle or ankle sprains contributed in this cross-sectional study. The level of D-dimer was determined between 7-14 days post-casting. If the level of D-dimer was higher than 0.2 µg/mL, the result of the test was considered positive and patient was referred for further examination for DVT using doppler ultrasonography. The role of risk factors in the development of DVT was evaluated. Results: There were 46 patients with at least one DVT risk factor. The D-dimer test was positive in 21 patients (22.1%). Based on the doppler ultrasonography, 3 patients developed DVT. There was a statistically significant relation between the presence of multiple risk factors (≥3) and increased risk of DVT development (p=.01). Conclusion: DVT is not a common complication in below knee casting and routine thromboprophylaxis is not necessary in patients with less than 3 risk factors.

Abstract Background: Distal radius fracture is among the most common fractures of the long bones that are seen in all age groups. Presence of different treatment protocols explains the challenge and controversy in treatment. Methods: In a clinical trial study, on 100 patients with stable extra articular distal radius fractures, 50 cases were randomly treated with short and 50 with long arm casts in a one year period in three training hospitals in Mashhad-Iran. All the long casts were changed to short casts in the forth week and all the casts discontinued in the sixth week and the patients assessed for the elbow range of motion , forearm supination-pronation, :::union:::, mal:::union:::, the patient satisfaction, and distal radioulnar joint stability in the 6th and 18th weeks after treatment. Results: The severity of fractures in both groups was similar. We didn’t find any case of non:::union:::, unacceptable mal:::union:::, regional pain syndrome, carpal tunnel syndrome or compartment syndrome. All the patients with short arm cast were satisfied in contrast to the other group. Range of motion had been better saved in short arm cast and in younger patients. Conclusion: This study shows that the effectiveness of short arm cast is the same as long arm cast the complications are fewer than long arm cast, and the patient's satisfaction is better in short arm cast. So, we suggest closed reduction and short arm cast for the treatment of stable extraarticular A2 type of OTA distal radius fractures.