A Retrospective Comparative Study of Different Methods of Blood Management in Total Knee Replacement.

Perioperative blood management is essential to minimize allogeneic blood transfusion in total knee replacement. The effect of preoperative administration of erythropoietin, intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies on allogeneic transfusion is studied in total knee replacement. A retrospective comparative study of 106 patients who underwent total knee replacement in different time periods was performed. Group A (n 1 = 45) underwent restrictive strategies of transfusion between 2009 and 2010. Group B (n 2 = 24) includes patients where erythropoietin of either 10.000 IU or 20.000 IU was given preoperatively. Patients of Group C (n 3 = 21) underwent autologous washed erythrocytes transfusion through a cell saver. Lastly, in Group D (n 4 = 15) tranexamic acid dose of 1 gr IV was given intraoperatively. The preoperative and discharge hemoglobin together with total units of blood transfusion and creatinine levels was studied. Tranexamic acid noted the least units of blood transfusion (mean = 0.82 units/patient, p < 0.001, CI 95%) in contrast to the two regimens of erythropoietin (1.16 units/patient) OrthoPAT (1.43 units/patient) and restrictive strategies (1.92 units/patient). The mean preoperative hemoglobin was 13.37 g/dL with no statistical difference among the groups of patients. The postoperative mean hemoglobin was 10.59 with no statistical difference among the groups of patients too. Additionally, the mean creatinine level was 0.93 mg/dL; however, no statistical difference among the groups of patients was noted. Finally, tranexamic acid seemed to be the most cost-effective regime. In our study, tranexamic acid proved its superiority concerning the postoperative blood transfusion on patients undergoing total knee replacement, in comparison with the other existing methods of perioperative blood management. This is a Level III, retrospective comparative study.

Complications of open reduction and internal fixation of distal humerus fractures.

Treatment of distal humerus fractures is demanding. Surgery is the optimal treatment and preoperative planning is based on fracture type and degree of comminution.Fixation with two precontoured anatomical locking plates at 90o:90o orthogonal or 180o parallel is the optimal treatment.The main goal of surgical treatment is to obtain stable fixation to allow immediate postoperative elbow mobilization and prevent joint stiffness.Despite evolution of plates and surgical techniques, complications such as mechanical failure, ulnar neuropathy, stiffness, heterotopic ossification, nonunion, malunion, infection, and complications from olecranon osteotomy are quite common.Distal humerus fractures still present a significant technical challenge and need meticulous technique and experience to achieve optimal results. Cite this article: EFORT Open Rev 2018;3:558-567. DOI: 10.1302/2058-5241.3.180009.

The accessory anteroinferior tibiofibular ligament as a cause of talar impingement: a cadaveric study.

BACKGROUND: A distal fascicle of the anteroinferior tibiofibular ligament has been reported as a possible cause of anterolateral ankle impingement. HYPOTHESIS: This fascicle represents an independent accessory ligament in the anterior aspect of the inferior tibiofibular syndesmosis. STUDY DESIGN: Descriptive anatomical study. METHODS: The inferior tibiofibular syndesmosis was exposed in 24 fresh-frozen cadaveric ankles. Morphological characteristics of the inferior tibiofibular ligaments and interactions between the anterior ligaments and the talus were investigated in different degrees of ankle motion. RESULTS: A separate accessory anterior ligament was identified in 22 specimens. Its orientation was parallel and distal to the anterior tibiofibular ligament, from which it was separated by a fibrofatty septum. Its length ranged from 17 to 22 mm, its thickness from 1 to 2 mm, and its width from 3 to 5 mm. Impingement of this ligament against the talar dome was documented in all specimens in neutral ankle position, with bending of the ligamentous bands in dorsiflexion. Distraction maneuvers reproducing traction during arthroscopic approaches relieved contact. CONCLUSIONS: An accessory anteroinferior tibiofibular ligament with distinct anatomical features was recognized. CLINICAL RELEVANCE: Based on its increased incidence in the cadaver ankles, the accessory ligament reflects a normal anatomical finding. Nevertheless, it could lead to anterolateral impingement in cases with coexistent ankle instability.