ABSTRACT
BACKGROUND: Tranexamic acid (TXA) therapy is effective in reducing postoperative red blood cell (RBC) transfusion in total joint arthroplasty (TJA), yet uncertainty persists regarding comparative efficacy and safety among specific patient subgroups. We assessed the impact of a universal TXA protocol on RBC transfusion, postoperative hemoglobin (Hb), and adverse outcomes to determine whether TXA is safe and effective in TJA, both overall and in clinically relevant subgroups. STUDY DESIGN AND METHODS: A retrospective observational study was performed on patients undergoing TJA at our institution spanning 1 year before and after the implementation of a universal protocol to administer intravenous (IV) TXA. The primary outcome was percentage of patients transfused, and secondary outcomes were perioperative Hb and occurrence of adverse events (death, myocardial infarction, stroke, seizure, pulmonary embolism, deep vein thrombosis, and acute kidney injury ). Outcomes were compared in pre- and post-protocol groups with χ2 analysis. Logistic regression compared risk of transfusion in pre- and post-protocol subgroups of patients with differing risk for transfusion (anemia, body mass index [BMI], and sex). RESULTS: No differences were found in baseline patient characteristics across pre- and post-protocol groups (n = 1084 and 912, respectively). TXA use increased from 32.3% to 92.2% while transfusion rates decreased from 10.3% to 4.8% (p < 0.001). Postoperative Day 3 Hb increased from 95.8 to 101.4 g/L (p < 0.001). Logistic regression demonstrated reduced transfusion in post-protocol subgroups regardless of sex, anemia, or BMI (p < 0.001). No increase in adverse events was observed (p = 0.8451). CONCLUSIONS: Universal TXA was associated with a reduction of RBC transfusion, overall and in clinically relevant subgroups, strengthening the rationale for universal therapy.
Subject(s)
Antifibrinolytic Agents/therapeutic use , Tranexamic Acid/therapeutic use , Anemia/therapy , Blood Transfusion/methods , Body Mass Index , Erythrocytes/cytology , Erythrocytes/drug effects , Female , Humans , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
Implant related infection is relatively unusual in surgery to the hand and distal upper limb. When such infections occur, the consequences can be devastating. We review the latest guidance and research on the prevention, diagnosis, and management of implant-associated infections in the hand and distal upper limb.
Subject(s)
Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Upper Extremity/microbiology , Upper Extremity/surgery , Anti-Infective Agents/therapeutic use , Biofilms , Debridement , Humans , Reoperation , Risk FactorsABSTRACT
BACKGROUND: Spontaneous flexor tendon rupture is rare and most common in the little finger. The pathogenesis of spontaneous tendon ruptures is unclear but may occur through attrition or mechanical abrasion over a bony prominence. Kienböck disease is avascular necrosis of the lunate, with an unknown etiology. METHODS: We present a case of spontaneous rupture of flexor digitorum profundus due to Kienböck disease, which we believe is the first recorded case of flexor tendon rupture attributable to osteonecrosis of the lunate. RESULTS: The patient underwent single-stage reconstruction of FDP and regained a good range of motion at the affected DIPJ. CONCLUSIONS: This case illustrates the the importance of plain radiographs in the assessment of a patient presenting with spontaneous flexor tendon rupture in the hand to exclude bony pathology as a cause.