Intravenous vs Topical Tranexamic Acid in Total Knee Arthroplasty Without Tourniquet Application: A Randomized Controlled Study.

BACKGROUND: Use of tranexamic acid (TXA) is effective and safe in reducing the blood loss in total knee arthroplasty (TKR) performed using a tourniquet, but, data in TKR performed without tourniquet are limited, and there is no study comparing the topical (T) with intravenous (IV) TXA administration. Our aim was to compare the topical (T) with intravenous (IV) TXA administration in TKR performed without tourniquet. MATERIAL AND METHODS: A total of 120 patients undergoing unilateral TKR for knee osteoarthritis were included in a prospective randomized study. Operations were performed under spinal anesthesia, no tourniquet was used, and the postoperative regime was the same for all patients. Patients were divided into 3 groups; in group C (control), 40 patients received no TXA, in group IV, 40 patients received 1 g of TXA intravenously, and in group L, 1 g of TXA was applied locally to 40 patients. The primary outcome measures included the calculated blood loss, the transfusion rate, and quantity of allogeneic blood units, whereas secondary outcome measures were complications. RESULTS: There was no statistically significant difference in patient's demographics and perioperative results. Calculated blood loss, allogeneic blood transfusion rate, and quantity in group C were significantly higher compared with those of TXA groups (P < .001). There was no significant difference in complications rate between the 3 groups. CONCLUSIONS: According to the results of this study, IV or T administration of 1-g TXA significantly reduced the blood loss and the need for allogeneic blood transfusion in patients undergoing TKR without a tourniquet (with no significant difference between the 2 routes of administration).

Percutaneous repair of the Achilles tendon rupture in athletic population.

AIMS: This review was designed in order to study the percutaneous repair of Achilles tendon rupture in athletic population. We present a comprehensive description of clinical, functional outcomes, complications, with emphasis on patients' level, and time of return to sports. METHODS: We proceeded to a systematic search of Medline (PubMED), Cochrane, and Scopus databases using keywords "Achilles Tendon", "Percutaneous Repair", "Percutaneous suturing", "Subcutaneous repair", "Subcutaneous suturing", "Athletes", and "Athletic" to identify articles or abstracts written in English. RESULTS: Thirteen studies, including 670 patients, could be identified. A variety of percutaneous repair techniques were performed. Re-rupture rate was very low. The most frequent complication was sural nerve damage. Average functional outcomes were satisfying. Up to 91.4% continued practicing sports after surgery. Furthermore, 78-84% returned to the same or higher sports level. Average time of return was 18 weeks in 9 studies. CONCLUSION: Percutaneous repair of Achilles tendon rupture is an excellent perspective for athletic population. Low re-rupture rate and impressing level of return to sports allow athletes to continue their recreational activities or careers.

Physical Improvement and Biological Maturity of Young Athletes (11-12 Years) with Systematic Training.

AIM: The aim of this study was to investigate the influence of systematic training in physical growth and biological maturity in prepubertal males and estimate how this affects the physical growth and skeletal maturity. MATERIALS AND METHODS: 177 primary school students of the fifth and sixth grade, from schools in Alexandroupolis, participated voluntarily in our study. Questionnaires were used in order to measure physical activity levels. The subjects were subdivided into two groups; control group (prepubertal, whose physical activity was the physical education of their school and which had never participated in systematic training, n = 95) and experimental group (prepubertal, whose weekly physical activity included physical education in their schools and additionally 3-4 training units organized training in various sports clubs in the city, n = 82). The following parameters were recorded: biological age measured by determination of skeletal age; bone density measured by ultrasound methods; anthropometric and morphological features such as height, body composition, selected diameters, circumferences and skinfolds; motor ability features. RESULTS: The experimental group exhibited older biological age (p = 0.033), higher bone density (p < 0.001), lower BMI and body fat (p < 0.001), better anthropometric features and higher performance throughout all motor ability tests (p < 0.05), compared to the control group. CONCLUSION: The present study demonstrates that systematic physical activity has a positive effect on both the physical and biological maturity of pre-pubertal children. This effect is mainly expressed in bone strengthening as a result of the increased bone density and in improvement of the kinetic skills of pupils who participated in organized extracurricular sport-activities.

Carpus translocation into the ipsilateral ulna for distal radius recurrence giant cell tumour: A case report and literature review.

Giant cell tumour is a frequent benign neoplasm. It is characterized by local aggressive behaviour and frequent recurrence. The most common localization is the distal femur followed by proximal tibia (40%). The distal radius is the next place (10%). The recurrence in the distal radius in primary cases is reported 10%, in recurrent cases is almost 30% and depends to the kind and the stage of the tumour at the time of treatment. Multiple options have been reported for treatment of Campanacci III giant-cell tumour (GCT) of the distal radius after resection. Actually the treatment of recurrence remains a real dilemma. Several reconstructive options (e.g. resection arthroplasty, prosthetic replacement, arthrodesis, ulnar translocation, centralization of the carpus over the remaining ulna, use of vascularized or nonvascularized fibular graft, with or without, arthrodesis, have been described up to date. We present a case of recurrence of GCT of distal radius after curettage, where we selected the centralization of the ulna into the carpus as a salvage procedure with satisfactory results. The procedure provides a valid option for the management of recurrent GCTs of distal radius offering excellent cosmetic and acceptable functional result.

Systematic effects of surgical treatment of hip fractures: gliding screw-plating vs intramedullary nailing.

AIM: Numerous studies have been published regarding the comparison between intramedullary nail and the dynamic hip screw and plate for the fixation of intertrochanteric fractures in elderly patients. In this paper we present a comparative study of these two methods regarding their systemic effects on this group of patients. MATERIALS-METHODS: This is a randomized trial of 120 consecutive patients with an intertrochanteric fracture treated with either extramedullary fixation (dynamic hip screw and plate; DHS, Synthes-Stratec, Oberdorf, Switzerland) or intramedullary nail (Gamma nail, Stryker Howmedica, Freiburg, Germany and Endovis BA, Citieffe, Bologna, Italy). The parameters that we assessed pre-operatively, in addition to their demographics, included their mental state (MMSE), their nutritional and immune state and their pulmonary function. Intra-operatively we calculated the amount of radiation exposure, the amount of blood loss and the length of operative time for each procedure. Postoperatively we repeated the calculation of the mental and pulmonary state and the blood loss, during days 1, 3, and 10 and related them to the ease of the patient's mobilization. RESULTS: Decreased bleeding and post-operative pain, reduced post-operative morbidity and faster recovery of function were better but not significant in the group of intramedullary fixation (all p>0.05). However, in the same group there were slightly more patients in whom the MMSE was falling, together with their pulmonary function, suggesting that this method probably predisposes to higher chances of pulmonary dysfunction and the possibility of pulmonary embolism. CONCLUSION: We found no significant differences between the two methods of stabilization of these fractures regarding their systemic effects perioperatively. The classic dynamic hip screw can preserve its position as a safe and effective solution for these already vulnerable patients having sustained a trochanteric fracture against the novel intramedullary techniques.

Fractures of the femoral neck treated with hemiarthroplasty. A comparative study.

INTRODUCTION: Hemiarthroplasty is the treatment of choice in the management of displaced intracapsular fractures of the proximal femur in old patients with low functional demands. AIM: To assess the effectiveness of cementless Austin-Moore and the cemented Thompson prostheses used in the treatment of displaced intracapsular fractures of the proximal femur. PATIENTS AND METHODS: We studied retrospectively 376 patients with fresh, displaced, nonpathological femur neck fractures. They were treated with either a cementless Austin-Moore prosthesis or a cemented Thompson prosthesis. Criteria for the choice of the prosthesis were the fracture site on the neck of the femur and the bone quality. The follow-up period was 3 to 8 years and the number of reviewed patients was 122. RESULTS: The Thompson prosthesis group showed slightly better results. Acetabular erosion rate was significantly lower in the uncemented group while loosening rate here was significantly higher. CONCLUSION: Advantages and disadvantages were identified in both groups although we believe that none of the approaches proved definitively superior to the other.

Talar body fracture combined with bimalleolar fracture.

The incidence of talar fractures is relatively low affecting usually young patients, while recent epidemiological studies have shown that talar body fractures represent a significant proportion of the total number of talar fractures. Talar body fractures are usually high-energy injuries and often a combined talar neck and body fracture is noted. An association between talar body fractures and ankle fractures has also been recorded involving the medial or lateral malleolus. The only report of a talar fracture combined with a bimalleolar ankle fracture that was found in the literature is referred to a talar neck fracture. In this report, a combination of a talar body fracture and bimalleolar ankle fracture in a polytraumatised young patient is presented. This combined injury pattern seems to be very rare, since a similar case was not found in the literature. An open reduction and internal fixation of the talar body fracture as well as the bimalleolar fracture, followed by a prolonged non-weight bearing, led to a fracture healing with no evidence of osteonecrosis. Minimal osteoarthritic changes of the tibiotalar joint were noted at 3 years follow-up with satisfactory functional results.

Factors affecting the timing of recovery from whiplash neck injuries: study of a cohort of 134 patients pursuing litigation.

INTRODUCTION: A cohort of 134 patients presenting in medico-legal practice with whiplash neck injury following a motor vehicle accident was studied prospectively by personal interviewing. MATERIALS AND METHODS: Injury- and patient-related factors with possible influence to the timing of recovery were analysed with univariate and multivariate statistical methods. RESULTS: Logistic regression showed significant association between high physical demand patient occupation and recovery within 6 months from injury (P = 0.036, coefficient 1.5, odds ratio 4.47) while initiation of physiotherapy treatment was associated with prolongation of symptoms for more than 6 months following injury (P < 0.001, coefficient -2.6, odds ratio 0.08). An association between development of arm pain (P = 0.01), upper limb numbness or paraesthesia (P = 0.03) and bilateral trapezius pain (P = 0.04) and persistence of whiplash-related symptoms was also observed. These findings must be taken into account in evaluation and treatment of patients with acute whiplash injuries pursuing litigation.

Peroneal nerve damage by oblique proximal locking screw in tibial fracture nailing: a new emerging complication?

Interlocking intramedullary nailing currently is the preferred treatment for most tibial fractures requiring operative treatment. Good results with a relative low complication rate have been reported in large clinical series, as well as in comparative series. The reported incidence of neurological complications after tibial nailing varies, involving mainly the peroneal nerve. The mechanism of peroneal nerve damage in tibial fracture nailing is usually indirect, caused by leg traction or compartment syndrome. Direct peroneal nerve damage related to the proximal locking screw seems to be very rare since we were able to identify only one report in the English literature. We report a case of partial peroneal nerve damage caused by a long oblique proximal locking screw. Removal of the proximal locking screw leaded to a gradual improvement of the nerve function and a complete resolution at one year. This seems to be a new emerging iatrogenic complication related to nails designed with oblique proximal locking screws. We feel that the placement of the oblique proximal screw from medial to lateral side needs an extra care. Even fluoroscopy, does not give enough safety due to the spatial geometry of the proximal tibia and the known problems of viewing oblique interlocking screws with a two-dimensional image-intensifier.

Safety and efficacy of commercially available demineralised bone matrix preparations: a critical review of clinical studies.

Demineralised bone matrix (DBM), a form of allograft, possesses the properties of osteoinductivity and osteoconductivity. A large body of data obtained from extensive preclinical studies have clearly supported the utility of DBM in human clinical settings. However, it is now recognized that various DBM configurations may differ considerably with regard to their bone inductive activity. Several factors could account for such variability, including the biologic properties of the graft, the host environment, and the methods of allograft preparation. The differing efficacy of DBM products may also depend on differences in particle size and shape, donor selection criteria, protocols for collection and storage, as well as DBM carrier materials. Several comparative studies have confirmed the differences in the osteoinductive potential of various DBM preparations. The purpose of the present review is to provide a critical overview of the current applications of DBM in a clinical setting.