Category: Ankle; Other Introduction/Purpose: Tranexamic acid (TXA) has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty (TAA). In light of expanding indications for TAA and its growing utilization, there is a need for more data regarding interventions such as TXA that may reduce perioperative complications and improve patient outcomes for this procedure. The purpose of the current study was to determine if the use of TXA in patients undergoing total ankle arthroplasty impacts the blood loss or overall complication rate. Methods: A retrospective chart review was conducted for 34 patients who underwent TAA with (n=17) and without (n=17) intraoperative TXA from 2016 to 2019 at a single academic medical center. Inclusion criteria were patients who underwent TAA for any clinical indication and had quantified intraoperative blood loss. Patients were excluded if they had a contraindication to TXA (ie. impaired renal function), a history of coagulopathy, no recorded intraoperative blood loss, or intraoperative complications that resulted in excessive bleeding. Estimated blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss and complication rates were recorded and compared between groups. Statistical analysis was performed using SPSS 21.0. Results: There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference or hidden blood loss between the groups (all, p>0.05). A lower rate of wound complications was observed in the TXA group. The difference between the overall complications rates observed for each group was not statistically significant (p>0.05). Conclusion: Intravenous tranexamic acid did not result in decreased blood loss during TAA, as measured in our study. However, tranexamic acid was not associated with any increase in overall complications while a lower rate of wound complications was seen in patients in which TXA was utilized. Based on our findings, further studies are needed to better elucidate the impact of TXA on blood loss and wound healing in TAA. [Table: see text]
Purpose The purpose of this study was to use 3-dimensional magnetic resonance imaging modeling of the skeletally immature knee to help characterize safe and reproducible tunnel positions, diameters, lengths, trajectories, and distances from anatomic landmarks and the physeal and articular cartilage for physeal-sparing anterior cruciate ligament (ACL) reconstructive surgery. Methods Magnetic resonance imaging from 19 skeletally immature knees with normal anatomy were gathered. The 3-dimensional models were created, and the relevant anatomic structures were identified. Cylinders simulating tunnel length, diameter and trajectory were superimposed onto the models, and descriptive measurements were performed. Results A safe position for the creation of an 8 mm diameter femoral tunnel was described in the lateral femoral condyle. The femoral tunnel length averaged 25.5 ± 2.6 mm. The bony entry point was located 3.8 ± 2.4 mm proximally and 12.7 ± 2.2 mm posteriorly to the lateral epicondyle. The shortest distance from the tunnel edge to the physis and femoral articular cartilage was 2.8 ± 0.7 mm and 3.7 ± 0.9 mm, respectively. The safe position for an 8 mm diameter tibial tunnel was also identified and described in the proximal tibia. The epiphyseal tibial tunnel length from the ACL footprint to the physis averaged 15.5 ± 1.6 mm. The proximal tibial epiphysis was found to accommodate a tibial crosspin measuring 63.5 ± 5.9 mm in length and 8.2 ± 1.5 mm in diameter without disrupting the physis or articular cartilage. Conclusions Three-dimensional modeling created from magnetic resonance imaging can help define important anatomic relationships for physeal-sparing ACL reconstructive surgery in skeletally immature knees and may assist in reducing the risk of injury to local anatomic structures. Clinical Relevance Knowledge of the anatomic relationships in skeletally immature knees serves as a valuable reference for surgeons performing physeal-sparing ACL reconstruction surgery.
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Case: We report a case of a 62-year-old woman who presented to our clinic with a displaced transverse comminuted patella fracture. The fracture was repaired using a subchondral transosseous suture cerclage technique which uses the dense subchondral bone to obtain an initial anatomic reduction of the articular surface, contain the comminution, and achieve union while avoiding complications associated with traditional hardware. Conclusion: This case illustrates the potential for the broader implementation of subchondral transosseous cerclage suture fixation techniques for patellar fractures.
Introduction: Glenoid component loosening has remained one of the most common complications for total shoulder arthroplasty. Three-dimensional modeling of the glenoid may reveal novel information regarding glenoid vault morphology, providing a foundation for implant designs that possess the potential to extend the survivorship of the prosthesis. Methods: A three-dimensional digitizer was used to digitize the glenoids of 70 cadaveric scapulae. We identified ideal position, fit, and maximum diameter for cylinders of 5, 10, and 15 mm depths. Maximum diameter and volume were also measured at the glenoid center, and the data were compared. Results: The vault region that accommodates the greatest diameter and volume for 5, 10, and 15 mm depth cylinders were identified in the postero-inferior glenoid. Across all specimens, this region accommodated a cylinder diameter that was 24.82%, 40.45%, and 50.34% greater than that achieved at the glenoid center for 5, 10, and 15 mm depth cylinders, respectively (all, P < 0.0001). The location of this site remains reliable for each cylinder depth, regardless of sex. Discussion: This study presents novel findings pertaining to glenoid morphology through the analysis of a newly characterized glenoid vault region. This region has not been identified or described previously and has potential to serve as an alternative to the glenoid center for peg or baseplate fixation. Our method of vault analysis and findings may be used to guide further research regarding pathologic glenoid anatomy, providing a foundation for alternative approaches to glenoid prosthesis fixation in total shoulder arthroplasty and related procedures.
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