Objective The aim of this study was to assess the effect of topical tranexamic acid on blood loss and transfusion rates in acetabular fracture surgery. Methods The medical records of 61 patients who underwent open reduction and internal fixation for acetabular fracture between 2012 and 2015 were retrospectively reviewed. The patients were divided into two groups: Group I consisted of 31 patients (19 men and 12 women, mean age: 52 ± 19 years) who received intraoperatively a topical tranexamic acid solution of 3 g and Group 2 consisted of 30 control patients (17 men and 13 women, mean age: 48 ± 24 years) who received only 0.9% saline solution. The groups were compared based on their intraoperative blood loss, Postoperative drain output at 24 and 48 h, and postoperative hemoglobin levels, and transfusion rates. Results The mean intraoperative blood loss was 410 ± 100 ml in Group 1, compared to 570 ml ± 160 ml of the control group ( p < 0.05). The postoperative drain output after 24 h was 210 ± 70 ml in Group 1 compared to 330 ± 90 ml of the control group ( p < 0.05). The drain output at 48 h was (50 ± 20 ml) in group 1 compared to 90 ± 40 ml of the control group ( p < 0.05). The transfusion rate was significantly low group 1 (42%) than the control group (97%). Hemoglobin drop was again significantly less in tranexamic acid group (2.1 ± 1.1) than the control group (3.2 ± 1.3). The nadir postoperative hemoglobin was higher in the Group 1 (10.4 ± 1.5) than the control group (9.2 ± 1.3). Conclusion Topical administration of tranexamic acid reduces intraoperative and postoperative blood loss in acetabular fracture surgery, decreasing transfusion rates. Level of Evidence Level III, Therapeutic Study.

Alkaptonuria, with its sequel, ochronosis, is a rare disease, with an incidence of 1:125,000 to 1:1 million worldwide. Reported cases of ochronotic arthropathy and other orthopedic manifestations are mostly limited to a single family tree, and few cases have been reported. This study highlights 9 previously unreported patients with sporadic presentation and varied orthopedic manifestations of alkaptonuria. Patient age ranged from 34 to 50 years. One patient who had severe arthropathy of the right hip joint along with subcutaneous nodules over both knees and Achilles tendons underwent total hip replacement. Another patient had intramedullary calcification of the femur. An additional patient had associated caries of the spine at L3, L4, and L5, with resolution of symptoms after antitubercular chemotherapy. Another patient had associated features of hyperthyroidism, which was an incidental finding. A further patient had nonunion fracture of the neck of the femur and underwent total hip replacement. The remaining 4 patients had typical features of low backache and arthritis of the large joints. The parents were nonconsanguineous, and only 2 patients had affected siblings. The remaining 7 patients had sporadic nonfamilial presentation. Diagnosis was established by typical clinical and radiologic findings and biochemical analysis. At 2 years of follow-up, both patients who underwent total hip replacement were normal, with no radiologic signs of loosening or lysis. Clinicians need a high index of suspicion and awareness to make the diagnosis of ochronosis. The current study is unique because of presentation with subcutaneous nodules in 1 patient and associated caries of the spine in another patient.

PurposeCorona mortis is an abnormal arterial or venous anastomosis between the external iliac and the obturator system of vessels and may cause significant hemorrhage during pelvi-acetabular fracture surgeries, hernia repair and laparoscopic gynecological procedures. Previous studies have estimated a prevalence of corona mortis between 34% and 70%. This cadaveric study was conducted to estimate the prevalence of corona mortis in the North Indian population.Materials and MethodsTwelve cadavers (24 hemipelvises; 11 males and 1 female) with a mean age of 68 (range, 54–82) years were included in this study.ResultsCorona mortis was observed in 14 hemipelvises (58.3%). A total of 19 (79.2%) vascular anastomoses of diameter greater than 1 mm were observed; 5 hemipelvises (20.8%) had corona mortis on the right side, 9 hemipelvises (37.5%) on the left side and bilateral in 5 (41.7%) cases. Two hemipelvises (8.3%) had an arterial connection. An aberrant obturator artery was observed in 1 (4.2%) hemipelvis. A venous connection was found in 14 specimens (58.3% of hemipelvises). The average distance of the connecting vein from the symphysis pubis was 41 (35–70) mm. A vessel diameter of greater than 4 mm was observed in 4/24 (16.7%) of hemipelvises.ConclusionThe frequency of venous corona mortis was higher than arterial corona mortis and the majority (83.3%) were small calibre (<4 mm). The presentation pattern and the number of arterial or venous anastomoses were different in the majority of hemipelvises and dissimilar in both hemipelvises of the same cadaver in the majority of cases.

Introduction: Harris Hip Score (HHS) is used for assessing functional outcome in patients undergoing total hip replacement (THR). The present study aimed to assess patients who underwent THR for various indications with modified HHS at different stages pre-and post-operatively. Methodology: Patients who were admitted to our indoor ward for THR from December 2008 till December 2010 were included in the study. Detailed history and physical examination was done for all patients. On every follow up day patients were x-rayed and scored according to the Modified HHS. Preoperative and intra-operative details were noted using a pretested semi-structured questionnaire. Results: We analysed 20 hip joints in the study. Most common indication of surgery was osteoarthritis secondary to avascular necrosis head of femur. Average modified HHS was 28 preoperatively, increased to 64 at 6 weeks, 86 at six months, 90 at one year and 92 at the last follow-up. After one year follow up, modified HHS was excellent in 17 patients and good in three patients. Modified HHS was excellent in 11 cases where duration of surgery was 136 to 160 minutes and in 2 cases where duration of surgery was 161-185 minutes. Furthermore, modified HHS was excellent in patients in whom partial and full weight bearing was started early. Conclusions: Patients who underwent early partial and full weight bearing also reported excellent modified HHS at final follow up. We recommend the use of modified HHS for assessing post-THR functional status of patients.

Avascular necrosis of head of femur is a rare presentation in Dyskeratosis Congenita (DC). Aplastic anaemia, increased susceptibility to infections and fatal pulmonary complications often complicate the clinical scenario in these patients leading to short life span and difficulty in performing surgical interventions. The diagnosis initially and subsequent management by total hip replacement posed a great challenge. To our knowledge this is the first case report of any intervention in form of total hip Arthroplasty done in DC. At 5 years of follow up the patient is asymptomatic with no radiographic signs of loosening or lysis.

Antegrade nailing is associated with good union rates and low infection rates and is a good option in open fractures and in polytrauma patients.

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Introduction: Clavicular fractures are relatively common injuries because of its subcutaneous and superficial presence. The annual incidence of clavicle fractures is estimated to be between 29 and 64 per 100,000 populations per year. Males are affected twice as often as females. There is bimodal distribution in incidence of clavicle fractures. Material and Methods: Prospective study of 20 patients operated for fracture of the clavicle and followed for upto 2 years. All the 20 patients were treated by open reduction and internal fixation with precontoured plates and screws. Precontoured S shaped plate was used for middle 1/3 fractures and plate with lateral extension for lateral 1/3 fractures. Final follow up assessed with DASH score, Constant score and Nottingham score. Results: The mean age was 35.15±12.67years. Majority of our patients were in the age group 15 to 30. Out of all the operated patients 55% were males and 45 % females. 55% had road side accident while 45 % had history of fall from height. Commonest complication was stiffness found in 15 % of the patients followed by delayed union and hardware prominence in 10 %. Complication of infection and non union was seen in 5 % cases each. Average Constant score at that final follow up was 79.8 with maximum being 93 and minimum being 63. Conclusion:We conclude that operative fixation of shaft clavicle fractures with precontoured clavicular plate is a very good method for treating fractures of the shaft of clavicle. The overall prognosis in our study was very good with excellent improvement of symptoms following the procedure.