Effect of intravenous tranexamic acid on blood loss and blood transfusion in total knee replacement: a prospective, randomized study in Indian population

Background: Tranexamic acid (TXA) is antifibrinolytic drug which has the property to reduce intraoperative and postoperative bleeding. There are several studies supporting the use of tranexamic acid in total knee replacements (TKR) and few in total hip replacements. Our study was intended to establish the effects of tranexamic acid in minimizing the intra operative and post-operative blood loss in uncomplicated primary total knee replacement.Methods: This was a prospective follow up study conducted in Rajarajeshwari Medical College and Hospital Bangalore, over a period of 14 months from June 2015 to August 2016. A total number of 60 patients who underwent unilateral primary total knee replacement were included for this study. They were randomly divided into 2 groups. Group I patients infused (intravenous) with 20 mg/kg TXA before incision and 3 hours after surgery whereas no TXA was administered in Group II. Total blood loss and transfusion rate were used as outcome. Results: Mean amounts of blood loss were 578 ml in Group 1 and 946 ml in Group 2. There was a decrease in blood loss in TXA groups (p<0.001). Transfusion was required in 6 patients of Group I and 17 patients of Group II (p<0.001). No thromboembolic problem was seen in any patients.Conclusions: Since TXA decrease perioperative blood loss and lessen the need for blood transfusion significantly, without increasing thromboembolic events in TKR. We suggest using intravenous (IV) TXA in TKR.

Evaluation of functional outcome of displaced fracture neck of femur in elderly treated with cemented bipolar prosthesis by modified Harris hip score

Background: The current research was conducted to determine the functional outcome of the displaced fracture neck of femur in elderly patients treated with cemented bipolar hip prosthesis.Methods: The present research was a prospective study of 44 cases of displaced fracture neck of femur admitted to our institute between October 2017 and October 2019. Cases were chosen on the basis of inclusion and exclusion criteria. Cases were surgically treated with cemented bipolar hip hemiarthroplasty and functional findings were recorded with modified Harris hip score.Results: In our series of 44 cases there were 30 females and 14 males, with a maximum age of 92 years, minimum age of 65 years, and the average age was 72.72 years. At one-year follow-up, the average modified Harris hip score was 86.75% (maximum score of 95 and a minimum score of 66), overall, 20 patients (45.46%) achieved excellent, 16 patients (36.36%) achieved good, 5 patients (11.36%) achieved fair and 3 patients (6.82%) achieved poor results. 81.82% of the patients returned to the pre-fracture level of activity and independent ambulation. Patients had few complications like limb length discrepancy, 36.3% of patients had limb lengthening between 1 to 1.5 cm.Conclusions:  In elderly patients with displaced neck femur fractures, cemented bipolar hip prosthesis provides good functional outcome. However further study for a longer period in a larger sample with a direct comparison between the cemented versus uncemented groups is required

Functional outcome of closed metacarpal shaft fractures managed by low-profile miniplate osteosynthesis: A prospective clinical study

BACKGROUND: Fractures of the metacarpal bones of the hand are one of the most frequently encountered orthopedic injuries constituting between 14% and 28% of all visits to the hospital. They can be treated conservatively or surgically depending on the nature of injuries, fracture pattern, and the fracture stability. OBJECTIVES: This study was done to assess the functional outcome of metacarpal fractures managed by low-profile miniplate fixation. METHODS: Thirty patients with closed metacarpal shaft fractures were managed by open reduction and internal fixation with mini fragment plate fixation in our hospital between 2012 and 2015. Radiographs of affected hand both anteroposterior and lateral views were obtained before surgery, after surgery, and at follow-ups. Early active motion was begun in all cases postoperatively. Patients were permitted to use their hands in daily activities 4 weeks after surgery. For objective assessment, total range of joint motion was measured. Rotational deformity of the fingers was assessed. RESULTS: There were 24 male and 6 female patients. The mean age was 30 years. Transverse fracture pattern was the most common. Nearly 70% of cases had an excellent result, 20% patients with good results, and 10% had a fair result. Finger stiffness was the most frequently encountered complication. CONCLUSION: Open reduction and low profile miniplate fixation in metacarpal fractures obtain an anatomical and stable reduction, fracture union, and early mobilization to avoid the loss of function