A Single Dose Versus Two Doses of Tranexamic Acid for Extracapsular Hip Fractures.

Objective In this study, we aimed to compare the effectiveness of one dose of tranexamic acid (TXA) at the time of hospital admission versus two doses of TXA (one at the time of hospital admission and another dose intraoperatively) in reducing perioperative total blood loss in patients with extracapsular hip fractures. Methods This retrospective cohort study included 80 patients from a single institution who underwent surgical fixation for extracapsular hip fractures. Forty patients received a single dose of 1 gram of TXA at the time of hospital admission (per standardized protocol of an ongoing research study at the time), and 40 patients received the same dose of TXA on hospital admission as well as a second dose of 1 gram of TXA intraoperatively at the time of incision (per standard practice change following the completion of the research study). The primary study outcome of interest was total blood loss, which was calculated by estimating blood volume via Nadler's formula followed by calculating the total blood loss with the hemoglobin dilution method. Secondary outcomes included blood transfusion rates, hospital length of stay (LOS), and 30-day mortality. Results Patient gender, age, the American Society of Anesthesiologists (ASA) score, procedure length, fracture type, hardware type, and hemoglobin on hospital arrival were similar across the study groups (all p>0.05), though the twice-dosed group had a higher average BMI (26.4 kg/m2 vs. 24 kg/m2, p=0.04). When adjusting for BMI, the twice-dosed group was estimated to have a slightly larger but non-significant difference in total blood loss (115-ml difference, 95% CI: 158.2-389.3, p=0.40) compared to the single-dose TXA group. More patients in the twice-dosed group required blood transfusion compared to the single-dose TXA group, though this was not statistically significant (30.0% vs. 17.5%, adjusted OR=1.64, 95% CI: 0.55-5.12, p=0.38). The distribution of hospital LOS and 30-day mortality rates were similar across the groups (p=0.13 and p>0.99). Conclusion In the setting of surgically treated extracapsular hip fractures, patients who received one dose of TXA at the time of hospital admission and a second intraoperative dose of TXA did not demonstrate significant differences in total blood loss or a need for blood transfusion compared to patients who only received a single dose of TXA at the time of hospital admission.

Total shoulder arthroplasty for glenohumeral arthritis associated with posterior glenoid bone loss: results of an all-polyethylene, posteriorly augmented glenoid component.

BACKGROUND: Posterior glenoid bone loss is commonly encountered in total shoulder arthroplasty (TSA). The purpose of our study is to report the clinical and radiographic findings of patients with a minimum of 2 years' follow-up treated with an all-polyethylene, augmented glenoid component. METHODS: Twenty-two shoulders with posterior glenoid bone loss were treated by a single surgeon. All underwent primary TSA using a posteriorly augmented, all-polyethylene, stepped glenoid component. Outcome data included visual analog scale, Western Ontario Osteoarthritis of the Shoulder index, and Short Form 36 scores. Radiographic analysis was performed to evaluate bone-cement interface lucency, implant seating, and osseous integration of the central peg. RESULTS: The mean follow-up period was 36 months. Average preoperative retroversion measured with computed tomography scan was 23.5°. In addition to statistically significant increases in forward flexion and external rotation, the visual analog scale score, Western Ontario Osteoarthritis of the Shoulder score, and Short Form 36 physical component summary score all improved significantly (P < .001). Twelve shoulders had osseous integration between the central-peg flanges, 6 had bone adjacent to the central-peg flanges but without identifiable osseous integration, and 1 showed osteolysis. The mean Lazarus score was 0.5. All glenoids had perfect seating scores. Two patients sustained a total of 3 episodes of prosthetic instability. CONCLUSIONS: Early results of a posteriorly augmented, all-polyethylene, stepped prosthetic glenoid component to address posterior glenoid loss in TSA are encouraging. Continued evaluation will determine prosthetic longevity and maintained clinical improvement.

Radiographic evidence of regression of a solitary osteochondroma: a report of 4 cases and a literature review.

Solitary osteochondromas are considered to be the most common benign bone tumor. Slow progressive osteochondroma growth is the rule in skeletally immature patients, at times prompting surgical excision. Significant growth of a lesion beyond skeletal maturity is commonly considered to be a harbinger of malignant transformation. Although spontaneous regressions of these lesions are sporadically reported in the literature, most practitioners consider spontaneous regression of an existing solitary osteochondroma to be extremely unlikely. The purpose of this case report was to offer a collection of 4 new well-documented cases of radiographic evidence of regression of solitary osteochondromas in skeletally immature patients. A review of the literature is also presented. Twenty cases have been reported in the literature on spontaneously regressing solitary osteochondromas, with approximately 50% of the cases in radiology journals, and never more than 2 cases having been reported at one time, until now. Asymptomatic solitary osteochondromas may not be diagnosed or lack long-term follow-up, thereby contributing to the true unknown incidence of resolving osteochondromas. Although there are now only 24 documented cases in the literature of solitary osteochondromas that have spontaneously regressed, the rarity of this lesion is completely uncertain, as most go undiagnosed. The review of the suggested mechanisms by which solitary osteochondromas spontaneously regress is presented. Surgical excision is not without risk, with reported complication rates as high as 12.5%. These cases demonstrate that osteochondromas can actually resolve, and that conservative treatment by observation and yearly radiographs is an option for these lesions, especially in an asymptomatic pediatric patient. From the review of the literature most lesions were resolving before skeletal maturity and within 3 years of identification. Lesions that are symptomatic can be treated according to the patient's symptoms. This information should prove to be useful for patients and treating physicians when discussing treatment options for solitary osteochondromas, and reduce unnecessary surgery for these lesions.