ABSTRACT
Background: The aim is to assess effect of tranexamic acid on haemoglobin level during surgeries around hip.Material & Methods:This was a prospective follow up study conducted in Mahender Reddy Institute of medical sciences, Chevella over a period of two years from June 2020 to June 2022. A total number of 123 patients who underwent hip surgeries by four different surgeons were selected for this study. Proximal femoral nailing (PFN) for intertrochantric fractures by surgeon A, dynamic hip screw (DHS) for intertrochantric fractures by surgeon B, total hip replacements by surgeon C and hemiarthroplasty by surgeon D were included for this study. The patients were grouped as treatment and control group. The treatment group and control group were selected by purposive sampling. In the treatment group, the patients undergoing surgeries around hip joint received single dose of intravenous tranexamic acid 10 mg/kg body weight 10 minutes before skin incision and equal volume of saline was injected in the control group. Intra operative blood loss was calculated by galvanometric method, weighing the sponges used and soiled by blood during surgery and measuring the amount of blood collected in suction apparatus used during the surgery. The haemoglobin level assessed post operatively and compared with preoperative haemoglobin level. The amount of fluid collected in the post-operative drain were also measured. Results:In the treatment group, 11 patients out of 16 had blood loss below 300 ml, and 5 patients had blood loss more than 300 ml. In control group 5 patients out of 15 had blood loss below 300 ml. 10 patients had blood loss more than 300 ml. Among the 25 patients of hemiarthroplasty group, 11 out of 13 patients of treatment group had drain below 100 ml on the first post operative day. In control group only 2 patients out of 12 had drain less than 100 ml. In DHS group, in the treatment group, 10 out of 11 patients had preoperative and post operative haemoglobin difference less than 1mg/dl. In control group, 12 out of 12 patients had preoperative and post operative Hb difference more than 1mg/dl.Conclusions:Tranexamic acid administrated before surgical incision is efficient in reducing bleeding during common surgeries around the hip joint. Especially surgery where more amount of blood loss was expected, like total joint replacement and hemiarthroplasty, the drug had shown significant benefit compared with the control group.
ABSTRACT
Background: Patellar fractures are more common in country like India due to the activity of daily life and constitute 1% of all skeletal injuries by direct or indirect mechanism. Direct injuries due to the subcutaneous location of patella and indirect injuries because of forceful contraction of quadriceps with knee in flexed position are common. Thus, improper operative procedure can lead to disability in the patient. Therefore, this study was conducted to assess of advantages and complications associated with fixation technique so as to manage the fracture of patella. Methods: The study was conducted on 60 cases of transverse patellar fracture treated by Modified tension band wiring. All patients who had closed and open type I displaced transverse patellar fractures, acute fractures and who were medically fit for operative procedures were included in the study. Results: The most common age group in our study was 41-50 years. Male patients were 46 (76.7%) and female patients were 14(23.3%). Fracture due to direct injury was seen in 12(20%) patients and 48(80%) cases were with indirect trauma. Right side injury was seen in 26(43.3%) patients while 34 (56.7%) patients had injuries on the left side. The outcome of our study was excellent in 90% of cases, 8.3% was good and only 1.7% was poor. Conclusion: According to our study modified tension band wiring showed better outcome for the early mobilization and management of displaced transverse patellar fracture.
ABSTRACT
Background: Fractures of neck of femur are a major cause of morbidity and mortality in elderly population. Intertrochanteric fractures in elderly people are usually comminuted and unstable because of osteoporosis. Unstable intertrochanteric fractures in elderly patients are associated with high rates of morbidity and mortality2 although the results have improved with the use of Bipolar Hemi-Arthroplasty. Methods: All the patients were selected from among the admissions in the Department of Orthopaedics, MNR Medical college and hospital, Mediciti institute of medical sciences, Archana hospital, Hyderabad, from june 2013 to 2015 May. Cemented bipolar hemiarthroplasty (Non modular bipolar hip prosthesis of OSIM) with or without greater and lesser trochanter fixation by tension band wiring was done. The follow up was carried out at 6 weeks, 3 months, 6 months, and 1 year. The results were evaluated using Harris Hip Score Rating. Results: The average age of patients in our series was 65 years with a range of 60 years to 75 years. Out of 70 patients 42 (60%) were female and 28 (40%) male. Left side is more commonly involved with 38 patients (54%) than right side (46%). The average duration of hospital stay was 10 days, with a range of 10-25 days. Out of 70 patients 35 (50%) had excellent outcome, 14(20%), 14(20%), 7(10%), had good fair and poor outcomes respectively. Conclusion: Cemented bipolar hemi-arthroplasty with anatomical reconstruction of trochanteric region preserves abductor mechanism thus allowing early mobilization, safe early weight bearing on the injured hip and had a relatively low rate of complications.