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Low molecular weight heparin (LMWH) is used in orthopaedic surgery largely for prophylaxis of venous thromboembolism (VTE). The purpose of this study was to review the available evidence to better define its role. The most recent American College of Chest Physicians Evidence-Based Practice guidelines for the most current recommendations for the application of LMWH to orthopaedic surgery are reviewed. A systematic review of the literature was undertaken using MEDLINE database and manual searches, the terms low molecular weight heparin, orthopaedic procedures, venous thromboembolism, and thromboprophylaxis were used as keywords. A total of 34 studies were identified, including prospective, randomized controlled clinical studies comparing LMWH with other treatment methods in orthopaedic surgery patients, meta-analysis and health economic related studies. There is clear supporting evidence for the application of LMWH for DVT prophylaxis in orthopaedic surgery. Although newer agents such as oral thrombin inhibitors are being developed for DVT prophylaxis, it will take some time to adequately assess the clinical efficacy, safety, and cost-effectiveness of these newer agents. Whether these agents will ultimately supplant the widespread application of LMWH to orthopaedic surgery remains to be seen.

Educational Objectives As a result of reading this article, physicians should be able to: 1. Describe the pathoanatomy of Maisonneuve injuries. 2. Discuss the various mechanisms of injury that can cause Maisonneuve injuries. 3. Explain the various treatment options available. 4. Identify the common complications of Maisonneuve injuries.

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