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Elbaseet HM, Aldeen AJ, Irahim AKH. Efficacy of intraoperative use of tranexamic acid in reducing blood loss from telescoping nail application in osteogenesis imperfecta. A randomized controlled trial. Orthop Traumatol Surg Res 2024:103927. [PMID: 38987031 DOI: 10.1016/j.otsr.2024.103927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/04/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Osteogenesis imperfecta (O.I) is a rare disease caused by an abnormality in type 1 collagen synthesis leading to repeated fractures after low-energy trauma and progressive long bones deformity. Telescoping nail application and surgical correction of these deformities usually necessitates multiple osteotomies and significant bleeding occur due to weakened capillaries and impaired platelet activity. Tranexamic acid (TXA) has an antifibrinolytic effect which is useful in reducing bleeding and need for blood transfusions following several orthopaedic procedures. HYPOTHESIS The use of intraoperative (Local and Intravenous) tranexamic acid reduces blood loss during femoral telescoping nail application in O.I. PATIENTS MATERIAL AND METHODS A prospective randomized controlled study was carried out on 40 patients during applying femoral telescoping nail divided into Group A: (case TXA); 20 patients receiving intraoperative TXA and Group B: (control); 20 patients not receiving TXA. Blood loss and perioperative Hemoglobin (Hb) and Hematocrit Level (Hct) were assessed. RESULTS The study included 29 males and 11 females with mean age 7.98 years. The number of osteotomies in both groups ranged from zero to 3 osteotomies with a median one osteotomy. A significant decrease in blood loss was observed in TXA group (mean 241.5 cc) compared to control group (mean 461.5 cc). Postoperative Hb was significantly lower in control group (mean 12.30 g/dL changed to 10.45 g/dL) compared to TXA group (mean 12.26 g/dL changed to 11.52 g/dL). Also, postoperative Hct was significantly lower in control group (m:ean 37.37 % changed to 32.03%) compared to TXA group (mean 36.53 % changed to 34.66 %). DISCUSSION The use of TXA during femoral telescoping nail application in OI patients has contributed to a remarkable reduction in overall blood loss. Consideration of adding it to management protocol is advised. LEVEL OF EVIDENCE II; Randomized Controlled Trial (RCT).
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Affiliation(s)
- Hesham Mohamed Elbaseet
- Pediatric Orthopaedic Unit, Orthopaedic and Traumatology Department, Assiut University, 71515, Egypt.
| | - Ammar Jamal Aldeen
- Pediatric Orthopaedic Unit, Orthopaedic and Traumatology Department, Assiut University, 71515, Egypt
| | - Abdel Khalek Hafez Irahim
- Pediatric Orthopaedic Unit, Orthopaedic and Traumatology Department, Assiut University, 71515, Egypt
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Micicoi G, de Geofroy B, Chamoux J, Ghabi A, Gauci MO, Bernard de Dompsure R, Bronsard N, Gonzalez JF. Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach. Orthop Traumatol Surg Res 2024:103911. [PMID: 38801888 DOI: 10.1016/j.otsr.2024.103911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 09/25/2023] [Accepted: 02/16/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates. HYPOTHESIS Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach. MATERIAL AND METHODS This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative "hidden" blood loss. The risk of early dislocation (less than 6 months) was also analyzed. RESULTS Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03). CONCLUSION This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk. LEVEL OF PROOF III, comparative study of continuous series.
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Affiliation(s)
- Grégoire Micicoi
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France.
| | - Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Julien Chamoux
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Ammar Ghabi
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Marc-Olivier Gauci
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Régis Bernard de Dompsure
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Nicolas Bronsard
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Jean-François Gonzalez
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
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Besnard M, Léger J, Babusiaux D, Marty F, Ropars M, Rosset P, Le Nail LR. Comparison of bleeding during trochanteric fracture fixation with mini-invasive or conventional side plate fixation: A randomized controlled trial. Orthop Traumatol Surg Res 2023; 109:103661. [PMID: 37474020 DOI: 10.1016/j.otsr.2023.103661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 03/04/2023] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Trochanteric fractures are a public health issue due to the aging of the population. Treatment aims to reduce their related morbidity and mortality and to allow an early return to independence. Postoperative anemia is associated with poorer functional recovery and an increased mortality rate. The aim of this study was to assess whether minimally invasive side plate fixation (Minimal Invasive Screw System, MISS™) resulted in reduced perioperative bleeding compared with conventional fixation (Pertrochanteric Hip Screw, PHS™). HYPOTHESIS We hypothesized that minimally invasive side plate fixation (MISS) would result in reduced perioperative bleeding compared with conventional fixation (PHS). PATIENTS AND METHODS We conducted an open randomized controlled trial with blinded assessment of the primary outcome. Inclusion criteria were patients aged over 65 years with isolated reducible trochanteric fracture. The 2 surgical implants were of the same shape, the only difference between them being the locking mode of the femoral neck screw on the plate of the MISS device, allowing a percutaneous approach. Primary outcome was perioperative bleeding evaluated with Mercuriali's formula. Secondary outcomes included operating time, scar length, length of hospital stay, radiological criteria such as quality of fracture reduction, implant positioning, bone healing, complications and functional recovery compared between the 2 groups. RESULTS One hundred and eight patients met the inclusion criteria and were randomized to receive either PHS (n=54) or MISS (n=54). Osteosynthesis with MISS significatively reduced perioperative bleeding (median 243mL, interquartile range [152-410] vs. 334mL [247-430] [p=0.0299]), operating time (65min [57-73] vs. 79min [66-89] [p=0.0002]) and scar length after 45 days (7cm [5-8] vs. 14cm [12-15] [p<0.0001]). There was no statistically significant difference between groups in postoperative complications, revision surgery or serious adverse events. CONCLUSION Compared with PHS, MISS reduced operating time, perioperative bleeding and scar length with no observed functional difference. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Marion Besnard
- Service de chirurgie orthopédique, centre hospitalier Robert-Debré, rue des Ursulines, 37403 Amboise cedex, France; Service de chirurgie orthopédique, hôpital Trousseau, centre hospitalier régional universitaire de Tours, 37044 Tours cedex 9, France.
| | - Julie Léger
- Centre hospitalier régional universitaire de Tours, Inserm CIC1415, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - Damien Babusiaux
- Service de chirurgie orthopédique, hôpital Trousseau, centre hospitalier régional universitaire de Tours, 37044 Tours cedex 9, France
| | - François Marty
- Service de chirurgie orthopédique, hôpital Trousseau, centre hospitalier régional universitaire de Tours, 37044 Tours cedex 9, France; Service d'orthopédie, centre hospitalier d'Albi, 22, boulevard du Général-Sibille, 81000 Albi, France
| | - Mickael Ropars
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - Philippe Rosset
- Service de chirurgie orthopédique, hôpital Trousseau, centre hospitalier régional universitaire de Tours, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, PRES centre-Val de Loire université, 60, rue du Plat d'Étain, 37020 Tours cedex 1, France
| | - Louis-Romée Le Nail
- Service de chirurgie orthopédique, hôpital Trousseau, centre hospitalier régional universitaire de Tours, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, PRES centre-Val de Loire université, 60, rue du Plat d'Étain, 37020 Tours cedex 1, France; CNRS ERL 7001 Leukemic niche & redox metabolisme (LNOX)/Niche leucémique et métabolisme oxydatif, EA 7501 GICC, université de Tours, 60, rue du Plat d'Étain, 37020 Tours cedex 1, France
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Haubruck P, Heller RA. Ongoing refinement remains key in dealing with shifting challenges in traumatological patient care. Orthop Traumatol Surg Res 2023; 109:103653. [PMID: 37391016 DOI: 10.1016/j.otsr.2023.103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Patrick Haubruck
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; Raymond-Purves Bone and Joint Research Laboratories, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, 2065, Australia.
| | - Raban A Heller
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; Bundeswehr Hospital Berlin, Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, 10115 Berlin, Germany; Department of General Practice and Health Services Research, Heidelberg University Hospital, 69120 Heidelberg, Germany
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