RESUMO
PURPOSE: Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals. METHODS: A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired t-test or Mann-Whitney U test, and categorical data was analyzed by Pearson Chi-square test. RESULTS: The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 vs. 716.89 ± 420.30, p = 0.031). The post-operative transfusion rate was 30.67 % in the TXA group and 47.95 % in the saline group (p = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups. CONCLUSION: We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.
RESUMO
OBJECTIVE: To explore the clinical effects of locking plates in the treatment of intertrochanteric hip fractures. METHODS: From February 2006 to December 2008,108 patients with intertrochanteric hip fractures treated with locking plate and DHS were retrospective analyzed. Fifty-one patients were treated with locking plates, including 23 males and 28 females, aged 45 to 86 years old (averaged 66.0 years old); and fifty-seven patients were treated with DHS, including 26 males and 31 females,aged 43 to 81 years old (averaged 64.1 years old). The outcome measures collected for statistical analysis on the following aspects: operative time, blood loss, drainage, healing time, complications and Harris scores. RESULTS: One hundred and eight patients were followed up ranging from 8 to 24 months (averaged 12.5 months). In locking plate group, the operative time was (87 +/- 14) minutes; blood loss was (367 +/- 213) ml; drainage was (63 +/- 14) ml; healing time was (11.9 +/- 3.4) weeks; 7 patients had complications; and the Harriss score was (85 +/- 6). While in DHS group, the operative time was (115 +/- 23) minutes; blood loss was (582 +/- 243) ml; drainage was (98 +/- 16) ml; healing time was (12.4 +/- 2.5) weeks; 9 patients had complications; and the Harriss score was (84 +/- 8). There were no significant differences in the healing time, complications and Harris scores between two groups (P > 0.05),but there were significant differences in the operative time,blood loss, drainage between two groups (P < 0.05). Comparing with DHS group, the locking plate group was of shorter operative time, fewer blood loss and drainage. CONCLUSION: Proximal femoral locking plate is simple, minimally invasive,stable fixation with fewer complications, and is an effective method for intertrochanteric hip fractures.