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.
Background: Conventional cementless THA is associated with stress shielding of the proximal femur and thigh pain. Short femoral stem can conserve bone, reduce stress shielding in the femur and reduce thigh pain. The present study aims to describe the functional outcomes associated with short stem metaphyseal implant in THA in our department. Methods: This prospective study was conducted in the Department of Orthopaedic Surgery, Indira Gandhi Medical College, Shimla among patients who needed THA for painful disabling hip. Modified Harris hip scores (HHS) were assessed for all patients pre-operatively and at their final follow up. Results: During the study period, a total of 20 patients were included in the study, 20% of them were females. The most common indication for THA was avascular necrosis head of femur with secondary osteomyelitis (n=14), of which 12 cases had excellent Hip Harris Score while two were in good category. Modified Harris hip score was excellent in patients where early partial and full weight bearing was started. Per-operatively, there was only one complication of fracture greater trochanter which was fixed with cerclage wire. In early post-operative period, two cases of superficial infection were noted and one case of varus malposition was present. In late post operative period, there were three cases of varus malposition and one case of deep infection as sinus. Conclusions: Total hip replacement with short anatomical metaphyseal loading stem improved the modified Harris Hip score significantly, with very few complications. Future multicentric studies are needed to evaluate the efficacy of short stem implants over a long follow up period.
Introduction: Total hip replacement (THR) is a procedure whereby the diseased articular surfaces are replaced with synthetic materials, thus relieving pain and improving joint kinematics and function. We aimed to describe our experience of using a short anatomical metaphyseal loading stem femoral implant for THR at our hospital. Methodology: This prospective study was conducted in the Department of Orthopaedic Surgery, Indira Gandhi Medical College, Shimla, in which 20 hips underwent THR using a short anatomical metaphyseal loading stem femoral implant. Baseline demographic, pre-and intra-and post-operative findings were noted and analysed. Results: Mean age was 40.93 years (standard deviation 11.29), the most common age group of patients was 41 to 50 years (65%) and majority of them were males (80%). Most common indication for undergoing surgery in our patient population was avascular necrosis head of femur with secondary osteoarthritis (70%). Average blood loss during surgery was about 500 ml with average drainage of about 200 ml. Pre-operatively all patients had modified Harris Hip score (HHS) of less than 70, while postoperatively 80% of the patients had an excellent modified HHS and rest had a good modified HHS Conclusions: THR using small anatomical metaphyseal loading stem is an ideal procedure in younger patients, who present late beyond the scope of surface replacement and who will need revision surgeries in future.
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