• For patients undergoing major orthopedic surgery, the American College of Chest Physicians recommends outpatient thromboprophylaxis for a duration of up to 35 days.
  • Older recommendations for 10–14 days of prophylaxis were based on studies performed when this was the usual hospital stay.
  • This is still recommended as the minimum length for prophylaxis, but a longer period of time is preferred.

Dupuytren’s disease

  •  characterized by shortening and thickening of the palmar fascia.
  • It is initially asymptomatic, but may progress and cause difficulty with function of the hand, and may eventually lead to contracture.
  • Early asymptomatic disease does not require treatment.
  • A series of cortisone injections over a period of months may lead to disease regression, and is useful in patients with mild to moderate symptoms.
  • Surgery is indicated if a metacarpal joint contracture reaches 30°, or with a proximal interphalangeal joint contracture of any degree.
  • If surgery is delayed, irreversible joint contracture may occur.
  • There is a strong association between diabetes mellitus and Dupuytren’s disease, with up to a third of diabetic patients having evidence of the disease.
  • It is also associated with alcohol use and smoking. 

Elderly Falls

Based on U.S. Preventive Services Task Force recommendations, what intervention has the strongest evidence for preventing falls in community-dwelling older adults at increased risk for falls?


When is osteoporosis treatment indicated?


Scoliosis treatment

  • Definition: lateral curvature of the spine (Cobb angle) is at least 10 degrees in the absence of underlying congenital or neuromuscular abnormalities.
  • For Cobb angle of:
  • 10-19 degrees – radiograph every 6 months and observation recommended.
  • 20-29 degrees – radiography every 6 months with Risser grading, refer for consideration of bracing and physical therapy esp. at Risser grade 0 or 1*
  • 30-39 degrees – refer to specialist for bracing and/or PT
  • >40 degrees (severe scoliosis) – refer for surgery

Tibial Stress Fracture

You suspect a patient has a tibial stress fracture. What imaging modality is preferred to identify the stress fracture?


Ottawa Ankle Rules