ABSTRACT
Segmental bony defects in open fractures of the tibia are bridged with bone grafting, free vascularized fibular grafts, or an external ring fixator. A 33-year-old man sustained a gunshot injury to his left leg, resulting in Gustillo type IIIB open fractures of the tibia and fibula. The tibia had a segmental massive defect of 19 cm in the midshaft. Debridement and immediate application of an Ilizarov external fixator were performed. The midportion of the ipsilateral fractured fibula served as a bridging vascularized graft for the tibial defect. Good bony union and fibular hypertrophy were obtained. Use of a fractured fibula from a zone previously injured by a gunshot has not been reported. This case demonstrates the successful transfer of a fractured fibula for the bridging of an ipsilateral tibial defect caused by a gunshot injury.
Subject(s)
Fibula/injuries , Fibula/transplantation , Tibial Fractures/surgery , Wounds, Gunshot/surgery , Adult , Bone Transplantation/methods , External Fixators , Fibula/diagnostic imaging , Fracture Fixation , Fractures, Bone/diagnostic imaging , Fractures, Bone/etiology , Fractures, Bone/surgery , Humans , Ilizarov Technique , Male , Radiography , Tibial Fractures/diagnostic imaging , Tibial Fractures/etiology , Wounds, Gunshot/diagnostic imagingSubject(s)
Bone Nails/adverse effects , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/methods , Osteomyelitis/surgery , Prosthesis-Related Infections/surgery , Adult , Device Removal , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/etiology , Humans , Osteomyelitis/complications , Osteomyelitis/diagnostic imaging , Prosthesis-Related Infections/diagnosis , RadiographyABSTRACT
To assess the blood-sparing efficacy of tranexamic acid (TA) administered orally or via a variable IV infusion, 80 healthy patients undergoing elective total knee replacement were studied according to a prospective, controlled, randomized, single-blinded study design. Patients were allocated to one of four treatment groups. In group TA-long, 30 min before deflation of the limb tourniquet, an IV bolus dose of TA 15 mg/kg was administered over 30 min. Thereafter, a constant IV infusion of 10 mg . kg(-1) . h(-1) was administered until 12 h after final deflation of the limb tourniquet. In group TA-short, a similar regimen was followed; however, the constant IV infusion was discontinued 2 h after final deflation of the limb tourniquet (time of discharge from the postanesthesia care unit). Thereafter, oral TA 1 g was administered after 6 and 12 h. In group TA-oral, 60 min before surgery an oral dose of TA 1 g was administered. After surgery, a similar dose of TA was administered every 6 h for the next 18 h. In the control group, TA was not administered. At patient discharge, postoperative allogeneic blood administration was significantly more in group Control when compared with each of the three TA treatment groups. Because oral drug administration is simple and does not require specific infusion equipment, the authors suggest that oral TA is a superior blood-sparing strategy compared with IV drug administration.
