Eficacia del ácido tranexámico tópico en la artroplastia invertida de hombro / The efficacy of topical tranexamic acid in reverse shoulder arthroplasty

Introducción: El ácido tranexámico (ATX) tópico ha demostrado disminuir de forma significativa el sangrado en artroplastia de cadera y rodilla. A pesar de que en la artroplastia de hombro la mayoría de trabajos han demostrado su eficacia por vía intravenosa, la eficacia y dosis por vía tópica aún no está determinada. El objetivo fue comprobar si 1,5g de ATX en bajo volumen (30mL) administrado de manera tópica disminuiría el sangrado tras la artroplastia invertida de hombro (AIH). Material y métodos: Se revisaron de manera retrospectiva 177 pacientes consecutivos intervenidos de AIH por artropatía y fractura. Se recogieron datos de ΔHb y ΔHto a las 24h, débito del drenaje (mL), estancia media y complicaciones. Resultados: Los pacientes que recibieron ATX presentaron menor débito del drenaje tanto en artroplastia electiva (AIHE) (104 vs. 195mL, p=0,004) como por fractura (AIHF) (47 vs. 79mL, p=0,01). Aunque fue ligeramente menor en el grupo de ATX, no se observaron diferencias estadísticamente significativas en el sangrado sistémico (AIHE ΔHb 1,67 vs. 1,90mg/dL, AIHF 2,61 vs. 2,7mg/dL, p=0,79), estancia media (AIHE 2,0 vs. 2,3 días, p=0,34; 2,3 vs. 2,5, p=0,56) o necesidad de transfusión (0% en AIHE; AIHF 5% vs. 7%, p=0,66). Los pacientes intervenidos por fractura presentaron mayor tasa de complicaciones que aquellos que lo hicieron por artropatía (7% vs. 15,6%, p=0,04). No se observaron complicaciones asociadas al uso de ATX. Conclusión: La administración tópica de 1,5g de ATX reduce el sangrado de manera significativa en el sitio quirúrgico sin observarse complicaciones asociadas. La disminución del hematoma posquirúrgico permitiría evitar el uso sistemático de drenajes posquirúrgicos.(AU)

Introduction: Topical tranexamic acid (TXA) has been shown to decrease blood loss in knee and hip arthroplasty. Despite there is evidence about its effectiveness when administered intravenous, its effectiveness and optimal dose when used topically has not been established. We hypothesized that the use of 1.5g (30mL) of topical TXA could decrease the amount of blood loss in patients after reverse total shoulder arthroplasty (RTSA). Material and methods: One hundred and seventy-seven patients receiving a RSTA for arthropathy or fracture were retrospectively reviewed. Preoperative-to-postoperative change in hemoglobin (ΔHb) and hematocrit (ΔHct) level drain volume output, length of stay and complications were evaluated for each patient. Results: Patients receiving TXA has significant less drain output in both for arthropathy (ARSA) (104 vs. 195mL, p=0.004) and fracture (FRSA) (47 vs. 79mL, p=0.01). Systemic blood loss was slightly lower in TXA group, but this was not statistically significant (ARSA, ΔHb 1.67 vs. 1.90mg/dL, FRSA 2.61 vs. 2.7mg/dL, p=0.79). This was also observed in hospital length of stay (ARSA 2.0 vs. 2.3 days, p=0.34; 2.3 vs. 2.5, p=0.56) and need of transfusion (0% AIHE; AIHF 5% vs. 7%, p=0.66). Patients operated for a fracture had a higher rate of complications (7% vs. 15.6%, p=0.04). There were no adverse events related to TXA administration. Conclusion: Topical use of 1.5g of TXA decreases blood loss, especially on the surgical site without associated complications. Thus, hematoma decrease could avoid the systematic use of postoperative drains after reverse shoulder arthroplasty.(AU)

[Translated article] The efficacy of topical tranexamic acid in reverse shoulder arthroplasty / Eficacia del ácido tranexámico tópico en la artroplastia invertida de hombro

Introducción: El ácido tranexámico (ATX) tópico ha demostrado disminuir de forma significativa el sangrado en artroplastia de cadera y rodilla. A pesar de que en la artroplastia de hombro la mayoría de trabajos han demostrado su eficacia por vía intravenosa, la eficacia y dosis por vía tópica aún no está determinada. El objetivo fue comprobar si 1,5g de ATX en bajo volumen (30mL) administrado de manera tópica disminuiría el sangrado tras la artroplastia invertida de hombro (AIH). Material y métodos: Se revisaron de manera retrospectiva 177 pacientes consecutivos intervenidos de AIH por artropatía y fractura. Se recogieron datos de ΔHb y ΔHto a las 24h, débito del drenaje (mL), estancia media y complicaciones. Resultados: Los pacientes que recibieron ATX presentaron menor débito del drenaje tanto en artroplastia electiva (AIHE) (104 vs. 195mL, p=0,004) como por fractura (AIHF) (47 vs. 79mL, p=0,01). Aunque fue ligeramente menor en el grupo de ATX, no se observaron diferencias estadísticamente significativas en el sangrado sistémico (AIHE ΔHb 1,67 vs. 1,90mg/dL, AIHF 2,61 vs. 2,7mg/dL, p=0,79), estancia media (AIHE 2,0 vs. 2,3 días, p=0,34; 2,3 vs. 2,5, p=0,56) o necesidad de transfusión (0% en AIHE; AIHF 5% vs. 7%, p=0,66). Los pacientes intervenidos por fractura presentaron mayor tasa de complicaciones que aquellos que lo hicieron por artropatía (7% vs. 15,6%, p=0,04). No se observaron complicaciones asociadas al uso de ATX. Conclusión: La administración tópica de 1,5g de ATX reduce el sangrado de manera significativa en el sitio quirúrgico sin observarse complicaciones asociadas. La disminución del hematoma posquirúrgico permitiría evitar el uso sistemático de drenajes posquirúrgicos.(AU)

Introduction: Topical tranexamic acid (TXA) has been shown to decrease blood loss in knee and hip arthroplasty. Despite there is evidence about its effectiveness when administered intravenous, its effectiveness and optimal dose when used topically has not been established. We hypothesized that the use of 1.5g (30mL) of topical TXA could decrease the amount of blood loss in patients after reverse total shoulder arthroplasty (RTSA). Material and methods: One hundred and seventy-seven patients receiving a RSTA for arthropathy or fracture were retrospectively reviewed. Preoperative-to-postoperative change in hemoglobin (ΔHb) and hematocrit (ΔHct) level drain volume output, length of stay and complications were evaluated for each patient. Results: Patients receiving TXA has significant less drain output in both for arthropathy (ARSA) (104 vs. 195mL, p=0.004) and fracture (FRSA) (47 vs. 79mL, p=0.01). Systemic blood loss was slightly lower in TXA group, but this was not statistically significant (ARSA, ΔHb 1.67 vs. 1.90mg/dL, FRSA 2.61 vs. 2.7mg/dL, p=0.79). This was also observed in hospital length of stay (ARSA 2.0 vs. 2.3 days, p=0.34; 2.3 vs. 2.5, p=0.56) and need of transfusion (0% AIHE; AIHF 5% vs. 7%, p=0.66). Patients operated for a fracture had a higher rate of complications (7% vs. 15.6%, p=0.04). There were no adverse events related to TXA administration. Conclusion: Topical use of 1.5g of TXA decreases blood loss, especially on the surgical site without associated complications. Thus, hematoma decrease could avoid the systematic use of postoperative drains after reverse shoulder arthroplasty.(AU)

The efficacy of topical tranexamic acid in reverse shoulder arthroplasty. / Eficacia del ácido tranexámico tópico en la artroplastia invertida de hombro.

INTRODUCTION: Topical tranexamic acid (TXA) has been shown to decrease blood loss in knee and hip arthroplasty. Despite there is evidence about its effectiveness when administered intravenous, its effectiveness and optimal dose when used topically has not been established. We hypothesized that the use of 1.5g (30mL) of topical TXA could decrease the amount of blood loss in patients after reverse total shoulder arthroplasty (RTSA). MATERIAL AND METHODS: One hundred and seventy-seven patients receiving a RSTA for arthropathy or fracture were retrospectively reviewed. Preoperative-to-postoperative change in hemoglobin (ΔHb) and hematocrit (ΔHct) level drain volume output, length of stay and complications were evaluated for each patient. RESULTS: Patients receiving TXA has significant less drain output in both for arthropathy (ARSA) (104 vs. 195mL, p=0.004) and fracture (FRSA) (47 vs. 79mL, p=0.01). Systemic blood loss was slightly lower in TXA group, but this was not statistically significant (ARSA, ΔHb 1.67 vs. 1.90mg/dL, FRSA 2.61 vs. 2.7mg/dL, p=0.79). This was also observed in hospital length of stay (ARSA 2.0 vs. 2.3 days, p=0.34; 2.3 vs. 2.5, p=0.56) and need of transfusion (0% AIHE; AIHF 5% vs. 7%, p=0.66). Patients operated for a fracture had a higher rate of complications (7% vs. 15.6%, p=0.04). There were no adverse events related to TXA administration. CONCLUSION: Topical use of 1.5g of TXA decreases blood loss, especially on the surgical site without associated complications. Thus, hematoma decrease could avoid the systematic use of postoperative drains after reverse shoulder arthroplasty.

Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plate. / Resultados medidos con captura de movimiento en las fracturas de húmero proximal tratadas mediante osteosíntesis con placa bloqueada.

OBJECTIVE: To evaluate the results after locking plate internal fixation of proximal humerus fractures by means of a motion capture system, and functional scales. MATERIAL AND METHOD: Retrospective study of a cohort of 47 elderly patients undergoing surgery from January 2010 to December 2014. After a minimum follow-up of two years, two functional scales (Constant-Murley and Quick DASH), and a quality of life scale (EQ-5D) were used for clinical evaluation. For objective evaluation of the range of motion a kinematic marker-free analysis with cameras was performed. RESULTS: The average age was 74.85 years. Average functional scores were: Constant-Murley 70.06 points, Quick DASH 35.74 points and EQ-5D 6.79 points. The average range of motion was: flexion, 111.49°; extension: 24.13°; abduction: 109.40°; adduction: 15.13°; external rotation: 38.96°, and internal rotation: 49.28°. Correlation was found between the two functional scales, between them and the EQ-5D, and between range of motion and functional scales (except for external rotation) as well as between range of motion and EQ-5D (except for flexion and external rotation). CONCLUSION: Locking plate osteosynthesis in proximal humerus fragility fractures achieved good functional and quality of life scores. Motion capture systems can be a useful tool for the functional assessment of shoulder pathology allowing an objective evaluation of range of motion.

[Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching]. / Evaluación de resultados funcionales y Notching tras el tratamiento de fracturas de húmero mediante artroplastia total invertida a medio plazo.

OBJECTIVE: An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. METHODS: A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. RESULTS: Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. CONCLUSION: Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching.