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Objectives: Venous thromboembolism (VTE) is a well-established complication after many orthopaedic injuries, such as hip and lower limb fractures. The use of direct oral anticoagulants (DOACs, previously termed novel oral anticoagulants) is well-established as thromboprophylaxis after major elective orthopaedic surgery, but not in the nonelective setting. The aim of this study was to investigate the effectiveness and safety of DOACs after nonelective lower limb fracture surgery. Data Sources: A systematic literature search of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases was conducted. No limitation was placed on publication date, with only manuscripts printed in English were eligible. Study Selection: Included studies were either randomized controlled trials or prospective and retrospective comparative studies. Included studies compared DOACs to conventional methods of thromboprophylaxis in the postoperative period after surgical management of lower limb fractures. Data Extraction: Outcomes included VTE, bleeding, wound complications, mortality, and adverse events. Eight studies met inclusion criteria, of which 7 compared direct factor Xa inhibitors (XaIs) with conventional VTE prophylaxis and one study compared a direct thrombin inhibitor with conventional VTE prophylaxis. Data Synthesis: Revman 5.3 (Nordic Cochrane Centre, Denmark) was used to complete the meta-analysis and generate forest plots. Conclusions: XaIs were shown to have lower rates of deep vein thrombosis (Odds ratio 0.59; 95% confidence interval, 0.46–0.76; P < 0.0001) and less pharmacologically attributable adverse events (Odds ratio 0.62; 95% confidence interval, 0.46–0.82; P = 0.0007). There was difference between DOACs and conventional VTE prophylaxis regarding mortality, PE, symptomatic deep vein thrombosis, or bleeding events. The results generally support the use of DOACs for VTE prophylaxis after nonelective lower limb fracture surgery, such after hip fracture. The results more strongly support the use of XaIs; however, more evidence is needed to fully assess DOACs' role in clinical practice. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Distal radius fractures (DRF) in the elderly population above 65 years represent 18% of all fractures and are thereby the second most frequent fracture in the elderly. Fracture dislocation and comminution are often used to determine whether non-operative or operative treatment is indicated. The purpose of this prospective case series of minimally displaced DRF treated with a dorsal cast was to assess the complication rate and patient-reported outcome measures. This single-centre, single-blinded, prospective case series followed 50 conservatively treated DRF patients for one year. Primary outcomes were complications and Quick Disability of Arm Shoulder and Hand (qDASH) score. Secondary outcomes were range of motion (ROM), grip strength and pain, and Patient-Rated Wrist/Hand Evaluation (PRWHE). Results showed only minor complications with a return to prior ROM, qDASH, and pain after 12 months and improvement in outcomes after 6–12 months. In conclusion, the majority of DRF patients who were treated non-operatively with five-week dorsal casting recover fully after minimally displaced DRF. This standard approach is thus considered safe, and the present results provide a reference for other studies.

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The Publisher regrets that errors made during the proofing of this article resulted in the mis-numbering of the figures in both the main article and in the online appendix.There are also mistakes in the figure citations appearing in both the Results and Discussion sections of the published paper.The Publisher would like to apologise for any inconvenience caused. The figures have been corrected in the online appendix. All other figures are reproduced here together with the corrected Results and Discussion sections. ResultsRecords were initially identified through database searching and hand searching of relevant articles. Forty-five duplicate papers were identified and removed. We excluded a further 10 studies with reasons: six studies were retrospective analyses (18-23), one study was not randomised (24), two studies included patients with non-displaced fractures (25, 26) and one study was a protocol only with no published data (27). (See PRISMA Statement, Fig. 1).Seventeen studies met the inclusion criteria, comprising results from 13 controlled trials (28-40), of which four had extended follow up data published (41-44). Overall, the pooled sample size was 1364, of which 704 received a HA and 660 underwent THA. Mean follow-up was five years (range: 1 year to 13 years). See Table 1. Total MortalityOverall mortality data was analyzed using a survival analysis of all-cause mortality from all 1364 interventions from 13 studies. There was no significant difference in overall mortality between HA and THA groups. The overall mortality rate from any cause was 44.6% in the HA group and 44.2% in the THA group. Survival data is plotted in Supplementary Figure 1. 30-day MortalityData was pooled from 519 interventions from four studies (i 2 ¼ 37%) of reported mortality from any cause within the 30 days postoperative period and showed no significant difference between HA and THA groups. RR 0.73 (95% CI 0.33, 1.59, P ¼ .42). Supplementary Figure 2. 1-year MortalityData was pooled from 947 interventions from eight studies (i 2 ¼ 0%) of reported mortality from any cause within the first postoperative year and showed no significant difference between HA and THA groups. RR 1.08 (95% CI 0.79, 1.48, P ¼ .63). Figure 2. Reported DislocationData was pooled from 1221 interventions from 12 studies (i 2 ¼ 0%) of any reported dislocations in the follow up period (mean 4.2 years) and showed a significant difference between HA and THA groups favoring HA. RR 0.37 (95% CI 0.23, 0.60, P < .0001). Figure 3. Post-Operative InfectionData was pooled from 834 interventions from eight studies (i 2 ¼ 0%) of any reported infections within the post-operative period (mean 4.5 years) and showed no significant difference between HA and THA groups. RR 1.06 (95% CI 0.48, 2.33, P ¼ .89). Figure 4. ReoperationData was pooled from 1124 interventions from ten studies (i 2 ¼ 43%) of any reported reoperations or revision operations during the DOI of original article: https://doi.