Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials

There is still debate over the use of drains following hip fracture surgery. We have performed a systematic review and meta-analysis of the literature for randomised trials that related to the use of closed suction drains following hip fracture surgery. Six studies involving 664 patients were identified. There was no statistically significant difference in the occurrence of wound healing complications, re-operations or requirement for blood transfusion between drained and un-drained wounds. All other outcomes reported failed to show any benefit from the use of drains. Further randomised trials are required and until they have been undertaken the efficacy of closed surgical drainage systems in hip fracture surgery is unknown

Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations

Introduction: Evidence to support or refute closed suction drainage (CSD) in primary total hip replacement (THR) is not conclusive. Our anecdotical experience was that persistent ooze from the drainage hole often delayed wound recovery. We hypothesized that, without CSD, wound care would be simplified without short or long term disadvantage. Materials and methods: Hundred patients scheduled for primary THR were randomly assigned for CSD or non-drainage. Drains were withdrawn at day2. Pain, wound hematoma, number of dressing changes, time of persistent discharge from the operation site (skin incision and drain hole), total blood loss and number of blood transfusions were prospectively recorded. Hip function, presence of heterotopic ossifications (HTO) and complications were recorded at a follow visit 1year after surgery. Results: Wound sites managed without CSD needed significantly less wound dressings (P<0.001) and were dry at an earlier time (P<001). Despite a significant bigger subfascial hematoma in the non-drained group (P<0.05), in terms of pain, thigh swelling, total blood loss, number of transfusions needed, hip function and HTO no difference was recorded between the groups (P=0.2-0.82). Conclusion: To omit CSD in primary THR results in simplified and more rapid wound management without any disadvantage at short and long ter

Hemi- versus bipolar shoulder arthroplasty for chronic rotator cuff arthropathy

Both bipolar and hemiarthroplasty have been used to treat rotator cuff arthropathy (RCA) of the shoulder in patients with low functional demands. In this study, 41 patients treated with either a bipolar or hemiarthroplasty were selected retrospectively to detect possible differences in the functional outcome and to evaluate radiological properties of the implants. Patients were examined before and 30 ± 6 months after surgery. There were no differences in the Constant scores between the groups treated with hemiarthroplasty and bipolar arthroplasty, 58.9 ± 13.1 points and 55.8 ± 13.5 points, respectively (P = 0.457). We found a significant increase in abduction postoperatively in both groups (P = 0.041 bipolar, P = 0.000 hemiarthroplasty) but without statistical significance between the hemiarthroplasty and bipolar arthroplasty groups (P = 0.124, F = 2.6). This result is related in the bipolar group due to movement between the shell and inner head (P = 0.042) and in the hemiarthroplasty group due to movement between the humeral head component and the glenoid (P = 0.000). In conclusion, we found that both hemiarthroplasty and bipolar arthroplasty are effective treatment options for carefully selected patients with RCA and low functional demands, with no differences between the groups