Tranexamic acid in total knee replacement which protocol? which application form? A prospective randomised study

The aim of this study was to prospectively compare different delivery forms, doses and combined application forms of TXA for the reduction of blood loss and prevention of the allogeneic blood transfusion in patients with TKA and evaluate the results. The study included patients with knee joint osteoarthritis who were unresponsive to conservative management and 168 patients met the inclusion criteria. They were divided into 5 groups randomly as, Control (1), Local (2), Systemic+short infusion (3), Systemic+long infusion (4) and Systemic+oral TXA (5). When compared with the Control group, blood loss was significantly reduced in Groups 2, 3 and 4 (p=0.001, 0.001, 0.003) but not in Group 5. Twenty- four hour drainage output was lower in all treatment groups (p=0.001, 0.001, 0.001, 0.004). Although TXA groups had no difference in terms of blood loss, 24- hour drainage outputs of the local TXA group were less than Group 4 and 5 and it yielded similar amounts in comparison with group 3. It was determined that TXA use whether local or systemic gave rise to decreased blood loss and prevent allogeneic blood transfusion. But, regarding the results above, local TXA seemed to have favorable effects when compared with systemic+long infusion and systemic+oral TXA usage, whereas local use had similar results with systemic+short infusion. Additionally, there found no difference between systemic+short, systemic+long infusion and systemic+oral combined TXA usage with respect to blood loss, transfusion rates and drain follow-up. We recommend further prospective randomized controlled studies to make clear these differences. Systemic+oral combined TXA use have promising results when compared with other systemic multiple deliveries.

Functional and radiological results of percutaneous K-wire aided Métaizeau technique in the treatment of displaced radial neck fractures in children

OBJECTIVES

The aim of the present study was to determine the radiological and functional results and the efficiency of paediatric radial neck fracture fixation following reduction with the Métaizeau technique together with percutaneous K-wire applied under fluoroscopy to ensure minimum soft tissue damage.

METHODS

The study included 20 patients with Judet Type 3, Type 4a and Type 4b fractures operated on with the Métaizeau technique aided by percutaneous K-wire between 2007 and 2014. The mean age of the patients was 9.75 years (range, 4-13 years). Mean preoperative angulation was measured as 52.4° (range, 35°-85°). The average postoperative follow-up time was 34.65 months (range, 13-84) months. Postoperative radiological evaluations were made according to the Ursei classification and functional assessment with the Tibone - Stoltz classification system.

RESULTS

Radiologically, the difference between preoperative and postoperative radius head angulation was found statistically significant (p0.001). In the clinical assessment of injured and uninjured arms, there was no statistically significant difference between flexion-extension (p = 0.330) and supination-pronation range of motion (p = 0.330) and carrying angles (p = 0.094). According to the radiological Ursei evaluation, 17 (85%) patients were in perfect condition and 3 (15%) were good. In the classification of Tibone - Stoltz, 16 (80%) patients were evaluated as perfect, 3 (15%) as good and 1 (5%) as fair.

CONCLUSION

From the results of this study and related literature, the use of the Métaizeau technique in displaced radial neck fractures requiring surgical treatment in children can be recommended since it creates minimum damage to the soft tissue, is easy to apply and the results are satisfactory.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

The effect of local and systemic application of tranexamic acid on the amount of blood loss and allogeneic blood transfusion after total knee replacement

The effect of local and systemic Tranexamic Acid on blood loss and need for transfusion after total knee replacement was compared prospectively. Between 2012-2013, 90 patients with unilateral TKR were included. They were randomly divided into 3 and 15 mg/kg TXA was infused before and 10 mg/kg 1 hour after surgery in Group 1, 2 gr TXA was used topically in 2 and no TXA was applied in 3. Total blood loss and transfusion rate were used as outcome. Mean amounts of blood loss were 898.03 ± 298.21, 823.64 ± 224.33 and 1263.77 ± 298.79 ml in Groups 1, 2 and 3 respectively. There was a decrease in blood loss in TXA groups (p < 0.001). No difference was found between local and systemic groups (p = 0.385). Transfusion was not required in TXA groups but it was 8 in control group. No thromboembolic problem was seen in any patient. Since TXA decreased blood loss and lessen the need for transfusion significantly without increasing thromboembolic events in TKR, we suggest its usage in TKR either systemically or topically whenever possible. Level of evidence: Prospective Randomized Controlled Trial, Level II).