Effect of Downsized Screw Selection on Bone Healing and Postoperative Complications in Volar Plating of Distal Radius Fractures.

When performing volar plating of distal radius fractures, selecting downsized subchondral screws may prevent dorsal screw penetration (DSP), which is a risk factor for extensor tendon rupture. However, downsizing may cause loss of reduction or poor bone healing. This prospective study investigated the effect of downsized screw selection on bone healing and postoperative complications. A total of 115 patients with postoperative follow-up longer than 6 months comprised the study population. Using a depth gauge, screws that were 2-mm shorter than the measured value were selected. The DSP then was checked using dorsal tangential view (DTV) radiographs during surgery and at final follow-up. Baseline data included bone healing, loss of reduction of radiological parameters, DSP location, and postoperative complications. To assess DSP on DTV radiographs, the dorsal surface of the radius was divided into the radial and ulnar sides at the Lister tubercle, and each was further divided into 2 equal regions. These 4 regions were defined as zones 1 to 4 from the radial side. A total of 114 patients (99%) showed bone healing. Mean loss of reduction was approximately 1° and within 1 mm in radiological parameters. Eleven patients (9.6%) showed DSP during surgery or at final follow-up despite using 2-mm downsized screws. The most common site of DSP was zone 3. Extensor pollicis longus rupture occurred in 2 patients (1.7%) despite no DSP. Downsized screw selection provided a high rate of bone healing with minimum loss of reduction and a low complication rate. The extensor tendon can be torn regardless of DSP. [Orthopedics. 2021;44(2):e259-e265.].

[Case of trimalleolar ankle fracture managed by placement of a temporary inferior vena cava filter by an anesthesiologist].

A patient with trimalleolar ankle fracture was preoperatively diagnosed with deep vein thrombosis (DVT); after induction of general anesthesia, a temporary inferior vena cava filter (TIVCF) was intraoperatively placed by an anesthesiologist. This contributed to safe anesthesia management. A 65-year-old woman was scheduled to undergo surgery for a trimalleolar ankle fracture sustained in an accidental fall. Two days before surgery, leg venous ultrasonography showed DVT. On the day of surgery, after induction of general anesthesia, a TIVCF was inserted by the anesthesiologist. After surgery, the TIVCF was removed, and anesthetic management was completed. On the day after the surgery, anticoagulant treatment was administered. Approximately 3 weeks later, thrombus disappearance was confirmed, and treatment was terminated. DVT is a serious complication that may cause pulmonary thromboembolism. TIVCF is effective in the treatment of DVT, and insertion of the TIVCF used in the present study is relatively simple. TIVCF placement by anesthesiologists, who have reliable knowledge on the various approaches to veins, contributes greatly to securing perioperative patient safety. The collaboration and cooperation of several medical departments are essential for DVT treatment and enhancing perioperative patient safety.