Effect of Topical and Intravenously Applied Tranexamic Acid Compared to Control Group on Bleeding in Primary Unilateral Total Knee Arthroplasty

We aimed to answer the following three questions in this study: (1) Does tranexamic acid (TA) reduce the amount of bleeding in total knee arthroplasty (TKA)? (2) Does TA reduce requirement for blood transfusion? (3) Is there any difference on reliability and efficacy between topical and intravenous (IV) applications of TA? Patients were allocated into three groups randomly by a software program as topical, IV, and control group. TA was applied as 20 mg/kg to the IV group and as 3 g/100 mL saline to the topical group. The hemoglobin values were recorded preoperatively and postoperatively on the same day and on day 1 and day 2. Removal of the drain postoperatively and length of hospital stay, as well as any complications such as pulmonary embolism or deep venous thrombosis, were also noted. The study comprised 40 patients in the IV group, 42 in the topical group, and 41 in the control group. The drain output values were similar in the IV and topical groups (p = 0.161), while those of the control group were significantly higher than both the IV and topical groups (p < 0.001 and < 0.001). Transfusion was applied to 19.5% of cases in the control group, 4.8% in the topical group, and 5.1% of the IV group (? 2 = 6.522; p = 0.038). The results of the study showed that 20 mg/kg single-dose IV bolus or 3 g topical TA application reduced blood loss and transfusion requirement without increasing the rate of thromboembolic complications in unilateral primary TKA. © Copyright 2017 by Thieme Medical Publishers, Inc

Traction table versus manual traction in the intramedullary nailing of unstable intertrochanteric fractures: A prospective randomized trial

Introduction The purpose of this prospective randomized study was to compare traction table with manual traction for the reduction and nailing of unstable intertrochanteric femur fractures. Design Prospective, randomized, two-center trial. Materials and methods 72 elderly patients with AO/OTA 31A2 and 31A3 proximal femur fractures were randomized to undergo surgery with either manual traction (MT) or traction table (TT) facilitated intramedullary nailing. The demographics and fracture characteristics, duration of preparation and surgery, total anaesthesia time, fluoroscopy time, blood loss, number of assistants, early post-operative radiological evaluations and 6th month functional and radiological outcomes were evaluated. Data of 64 patients attending 6th month follow-up examination were evaluated statistically. Results No significant differences were observed between groups regarding demographics and fracture characteristics. In the manual traction group, there was a significant time gain in respect of the positioning and preparation period (18.0 ± 1.6 min in MT group, 29.0 ± 2.4 min in TT group) (p < 0.05). In terms of total anaesthesia time (Preparation + surgery) approximately 6 min of difference was observed in favor of MT group (72.8 ± 14.0 min for MT and 78.6 ± 6.5 min for TT, [p < 0.05]). Median number of assistants needed was significantly lower in TT group (2 assistants [1-3]) in MT group and (1 assistant [1,2]) in TT group [p < 0.05]). There was no significant difference between two groups regarding other surgical and outcome parameters. Conclusions Manual traction reduced the preparation time and total anaesthesia duration, despite an increase in number of surgical assistant. Level of evidence Level II. © 2016 Elsevier Ltd. All rights reserved