Successful single stage management of trifocal femoral fracture associated with distal medial condyle and Hoffa’s component by a novel technique

Isolated fractures of the shaft of the femur are relatively common injuries. Ipsilateral multifocal fractures of the femur are less common with an additional proximal femoral fracture estimated to occur in up to 5% of diaphyseal fractures and additional distal femoral fracture occurring in 3-4%. Trifocal femoral fractures consisting of ipsilateral fractures of the proximal, diaphyseal, and distal femur are extremely rare. These fracture patterns are seen in the young adult population following high velocity trauma such as fall from height and road traffic accidents. The sequence of fracture type to be fixed first and the type of implant to be used are questions yet to be answered as one implant used for fixation of one fracture may not be amenable for fixation of the other fracture. These fractures are associated with significant complications and delayed rehabilitation. We describe a novel method in one such trifocal fracture pattern where the distal femoral intra-articular medial condyle with a hoffas element was stabilised by open reduction with a 4.5 proximal tibial ipsi-lateral anterolateral LCP and 2 inter-fragmentary compression screws which has not been reported in literature before. The advantages of such an implant is easy contour ability to the medial femoral condyle and adequate strength and achieving satisfactory absolute stability with options of using uni-cortical locking screws, all of which facilitates early knee ROM and rehabilitation.

Intraarticular use of tranexamic acid during primary total knee arthroplasty

Background: Tranexamic acid (TXA) is effective in reduction of blood loss after major surgical procedures. In TKA surgeries, it is commonly administered intravenously. Since there are contraindications of systemic use of TXA, local/intraarticular TXA can also be used. The efficacy of both systemic and local TXA administration is demonstrated in the literature. The aim was to assess the effect of intraarticular TXA during total knee arthroplasty in terms of total blood loss and transfusion rate. Methods: A total of 50 TKA in 34 patients were included in this prospective study.  Patients received one dose of intraarticular TXA of 3 g after skin closure and before deflation of the tourniquet. Results: The mean total blood loss in intra-articular TXA was 456.9 ml. None of the patients required transfusion postoperatively including those who underwent bilateral staged TKR. Mean postoperative hemoglobin loss was 1.07. Conclusions: TXA reduced blood loss and transfusion requirement. Intra-articular administration of TXA seems to be more effective in terms of reducing total blood loss and transfusion rates. We recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss

A prospective study on functional outcome of uncemented total hip arthroplasty in patients with inflammatory arthropathies

Background: Although medical management has improved the outcome and may have reduced the need for surgery, total hip arthroplasty (THA) is often required to manage pain and restore function and mobility. The successful functional outcome of THA in patients with inflammatory arthropathies is essential in understanding the need for THA, and its benefits in those undergoing it. Objective of the study is to evaluate the functional outcome of total hip arthroplasty in patients suffering from inflammatory arthritis using Harris hip score (HHS) and to assess the post operative complication in these patients.Methods: In a prospective study conducted on patients with inflammatory arthritis treated with THA between a study period of January 2018 to January 2020. All the patients after assessing them clinically and radiologically were operated with uncemented THA through posterolateral approach. Functional outcomes of hip were evaluated using HHS at various intervals.Results: In this study, patients were followed up to 24 months. About 46.7% of patients were diagnosed with rheumatoid arthritis, 33.3% of patients were diagnosed with ankylosing spondylitis, 20% of patients were diagnosed with sero negative arthritis. 90% of patients had no limb length discrepancy, no other post-operative complications were noted. The final functional outcome of hip according to HHS were 13.3% of excellent, 56.7% good results and 30% of fair results.Conclusions: This study concludes that THA in patients with inflammatory arthritis with restricted activities of life had improved in short term follow up and ease of rehabilitation and return to function