Clinical application of auricular point sticking in perioperative hemostasis for elderly patients with intertrochanteric fractures of the femur

Abstract

We investigated the clinical application of auricular point sticking (APS) combined with tranexamic acid in perioperative hemostasis in elderly patients with intertrochanteric fractures of the femur.This is a prospective cohort study, and we analyzed 86 elderly patients with intertrochanteric fractures of the femur who underwent closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) between January 2016 and December 2016. The patients were divided into auricular point combined with tranexamic acid group (APS group, n = 43) and tranexamic acid alone group (Control group, n = 43). APS was performed for patients using Vaccaria seeds 1 to 2 days before the operation. The 4 acupoints of hemostasis, including spleen, diaphragm, pituitary, and adrenal gland, as well as acupoint of hip joint, were selected. Routine treatment was performed using tranexamic acid alone in the control group. Blood transfusion, intraoperative, postoperative, and total blood loss were compared between the 2 groups.This study enrolled 36 males and 50 females aged 71 to 93 years (average age: 78.5 years). There were no significant differences in gender, age, height, weight, preoperative hematocrit level, fracture classification, operative time, and hospitalization stay (P > .05). Total blood loss was lower in the APS group than the control group (244.26, 197.87–258.50 ml vs 533.94, 424.00–598.09 ml, P < .01). The blood transfusion rate was 14.0% in the APS group and 34.9% in the control group (P = .02).APS can reduce perioperative bleeding and decrease the need for blood transfusion in elderly patients with intertrochanteric fractures of the femur. This noninvasive method can be applied clinically. Randomized trials may be needed to confirm the findings.

Methods of Quantifying Intraoperative Blood Loss in Orthopaedic Trauma Surgery: A Systematic Review

“…Nadler equation includes patient's sex, weight, and height, whereas that by Moore bases the calculation on sex and weight alone. One study found that a BMI of less than 25 was an independent risk factor for significantly increased HBL, whereas others found 57 Hct postop = end of surgery 36 = POD1 63 = POD2 38,67,68 = POD2-3 64,69 = POD3 35,39,43,44,56,58,65,66,70 = POD5 32 Mercuriali 19 Blood loss ðmLÞ ¼ that a high BMI was associated with higher BL and an increased risk for blood transfusion, suggesting that omitting height in BV calculations may have implications for the accuracy of the BL estimation. [32][33][34] Size of patients was believed to influence the accuracy of these calculations for 1 study conducted in China that found despite similar perioperative hemoglobin mass loss as other studies conducted in the US populations, the calculated total blood loss (TBL) and HBL were lower for their smaller patients.…”

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

“…Most doctors agree that conservative treatment of ITFs results in serious complications and sequelae, such as the need for bed rest and limb traction, and a mortality rate within 1 year after injury is relatively high. Surgical treatment achieves firm and stable internal fixation of the fracture and early functional training, and reduces complications due to long‐term bed rest. However, fixation failure or nonunion occasionally occurs, commonly in patients with unfavorable fracture patterns, unsatisfactory reduction quality, poor bone quality, inappropriate choice of internal fixation device, or improper implant position, and surgical intervention is recommended in patients with these types of fractures with the use of various implants.…”