ABSTRACT
BACKGROUND: This study compared outcomes of the direct anterior approach (DAA) and direct lateral approach (DLA) for treating displaced femoral neck fractures in active elderly patients. METHODS: This retrospective study included active elderly patients who sustained a displaced femoral neck fracture and underwent a cementless total hip arthroplasty either with a supine DAA or a decubitus DLA. Patients were assessed using the Harris hip score at discharge and at a 6-week follow-up. RESULTS: A total of 41 women and 18 men were included in the study. Of those, 22 underwent DLA and 37 received DAA, all performed by the same team. In both groups, 69% were women, mean age was 70 years, and mean BMI was 25.2. Mean hemoglobin loss was 2.3 g/dl between admission and the first post-operative day in both groups. Similar numbers in each cohort were discharged home rather than to a rehabilitation center. The patients who underwent the DAA experienced a 2-day reduction in their hospital stay compared to the DLA group (4.2 ± 1.9 vs. 6.8 ± 3.7, respectively; p < 0.001). The Harris hip score in the DAA group was significantly higher at the 6-week follow-up than in the DLA group (87.23 ± 7.75 vs. 81.23 ± 7.67, respectively; p < 0.031). CONCLUSIONS: The patients who underwent THA with the DAA demonstrated better short term outcomes compared to the alternative approach for displaced femoral neck fractures in active elderly patients. DAA helped patients regain independence faster and might decrease hospitalization and rehabilitation costs. Based on these results, we recommend using the DAA for active elderly patients with a displaced femoral neck fracture.
ABSTRACT
Sterile elastic exsanguination tourniquets (HemaClear; OHK Medical Devices, Haifa, Israel) are relatively new on the market but are widely used because of the ease and speed of their application. The sterile elastic exsanguination tourniquet consists of a silicon ring wrapped in a stockinet sleeve with pull straps. The physician places the ring on the patient's fingers or toes and then pulls the straps proximally. The silicon ring rolls up the limb, and the stockinet sleeve unrolls onto the limb. During proximal rolling, the device displaces blood out of the limb (exsanguination). When the elastic ring reaches the preferred occlusion location, the pulling motion is stopped. The ring exerts suprasystolic pressure on the limb, thereby blocking arterial blood flow into the limb and thus acts as a tourniquet. HemaClear tourniquets are thin and sterile and therefore provide a large operative field. The authors report 2 cases of pulmonary embolism after HemaClear tourniquet application in patients with traumatic injuries (fractures of the patella and tibial plateau). Exsanguination applies mechanical stress that might dislodge a preexisting deep venous thrombosis, leading to the serious complication of pulmonary embolism. The authors want to increase awareness of this possible fatal complication during procedures performed on the lower limbs, when the HemaClear tourniquet is used for exsanguination of the affected limb. Careful consideration should be given to the use of HemaClear tourniquets in high-risk patients and those with traumatic injuries, especially when there has been a delay in surgery.
