Does the Proximal Femur Geometry Predict Early Functional Outcome after Plate Fixation of Geriatric Pertrochanteric Fractures?

BACKGROUND: The proximal femur geometry determines the hip force distribution. The femoral neck axis length (FNAL), the hip axis length (HAL), the femoral head diameter, and the femoral neck-shaft angle (FNSA) could influence the risk and outcome of pertrochanteric fractures. Restoring these parameters to their prefracture values could predict early hip function. AIM: To determine if the postoperative proximal femur geometry of geriatric patients with plating for pertrochanteric fractures predicts the early functional outcome. MATERIALS AND METHODS: The study was a prospective study carried out at the National Orthopaedic Hospital Enugu for 18 months. Geriatric patients who had Proximal Femoral Locking fixation for pertrochanteric fractures were recruited. Radiological parameters of the proximal femur in the unaffected and fixed hips were measured and compared. The functional outcomes of the patients were measured at 3 months postoperative period using the Harris hip score (HHS). Multiple linear regression was conducted on the parameters to determine the HHS. RESULTS: Thirty patients participated in the study, with a significant difference (P < 0.001) in the mean FNSA between unaffected (M = 128.69, standard deviation (SD) =2.93) and operated hips (M = 121.81, SD = 8.86). The FNSA was the only significant predictor of hip function, with a 1-degree increase improving the HHS by 1.30. CONCLUSION: There is a significant difference in the FNSA between the unaffected and the operated hips. The FNSA significantly predicts the early hip function and should be reconstructed to within normal range during surgery.

Discharge against Medical Advice in Eight Tertiary Hospitals in Nigeria: A Prospective Study.

BACKGROUND: Discharge against medical advice (DAMA) is when a patient decides to leave the hospital without the consent of the treating physician. It poses serious clinical, ethical, and legal challenges to the individual physician as well as the hospital. AIM: To determine the prevalence and reasons for DAMA in orthopedic departments of eight tertiary hospitals in Nigeria. MATERIALS AND METHODS: This was a prospective multi-center descriptive study undertaken in eight tertiary Nigerian hospitals. Consecutive patients who requested for DAMA within 1 year of the study and who consented to participate in the study had face-to-face interviews. Data obtained were documented in a questionnaire and analyzed with SPSS version 20. RESULTS: The total number of patients studied was 373 with a mean age 34.7 ± 17.5 years. About a quarter of them (25.5%) were between 31 and 40 years. A prevalence rate of 1.9% was found with financial constraint being the predominant reason for DAMA (40.8%). Other reasons include family preference for unorthodox treatment (18.8%) and treatment dissatisfaction (7.0%) among others. CONCLUSION: The study findings indicate a low DAMA rate when compared to previous studies in this region. It also indicates that financial constraints, family preference for unorthodox care, and low educational status are major drivers of DAMA. Deepened health insurance and other measures that can reduce the prevalence of DAMA should be prioritized to improve treatment outcomes.

Preliminary outcome of use of parenterally administered tranexamic acid during primary total knee replacement.

Background: Perioperative blood loss and the need for blood transfusion following total knee arthroplasty (TKA) has been a source of concern for many arthroplasty surgeons and patients over the years. Tranexamic acid (TXA) is increasingly being used by surgeons in limiting perioperative blood loss and the subsequent need for transfusion during TKA. Aim: This study aims to determine the efficacy of TXA in preventing perioperative blood loss, transfusion needs of patients that underwent TKA, complications, and its financial implications of its use in our institution. Patients and Methods: The study was a clinical comparative audit of perioperative blood loss and transfusion needs in primary TKA patients. The study population was divided into two groups of equal numbers (n = 40). Group A, who did not receive perioperative TXA, had TKA prior to the adoption of TXA in our institution, whereas group B, who received TXA, had TKA after TXA was adopted. Results: The mean postoperative hemoglobin was 9.49 g/dl for group A and 10.15 g/dl for group B (P = 0.021). The mean postoperative blood drainage was 888.25 ml for group A and 821.67 ml for group B (P = 0.397). The number of patients transfused in group A was 17 (42.5%) against 7 (17.5%) in group B. The mean postoperative transfusion volume was 270 ml and 101.25 ml for group A and B, respectively (P = 0.014). The mean total transfusion volume was 450 ml and 277 ml in group A and B, respectively (P = 0.063). Conclusions: The use of TXA in TKA was shown to be beneficial in our study as it resulted in a statistically significant reduction in the postoperative transfusion volumes and higher postoperative hemoglobin levels.