The effect of tranexamic acid on the reduction of intraoperative and postoperative blood loss and thromboembolic risk in patients with hip fracture.

The aim of this study is to determine whether the use of tranexamic acid (TXA) in patients with hip fracture reduces intraoperative and postoperative blood loss, and on the other hand, whether it increases thromboembolic risk. The study was performed on patients with hip fracture for a period of one year. Patients were divided into two groups (1:1): the first group receiving TXA and the second group receiving placebo. The amount of blood aspiration during the surgery was measured as well as drainage in the postoperative period of 24 h. The occurrence of deep vein thrombosis (DVT) was monitored before and after the surgery by ultrasound of the lower extremities. The amount of total blood loss was two times lower in patients who received TXA (291.8 ± 65.5 mL of blood vs 634.7 ± 150.5 mL of blood). Among the patients who developed DVT, one patient was from the group that did not receive TXA, and two patients were from the group that received TXA. The use of TXA in patients with hip fracture significantly reduces intraoperative and postoperative blood loss, without a significant thromboembolic risk.

Bacterial infections associated with allogenic bone transplantation.

BACKGROUND/AIM: Bone allografts are frequently used in orthopedic reconstructive procedures carrying a high risk for recipients. To assess the nature and frequency of allograft contamination and associated surgical infection the case records from our institutional bone bank were reviewed. METHODS: We retrospectively analyzed the microbiology of discarded bone allografts and the surgical site of the recipients. A case series of patients who acquired surgical site infection after allogenic bone transplantation was presented. Swab culturing was conducted on 309 femoral heads from living donors who underwent partial and total hip arthroplasty between January 2007 and December 2013. To prevent potential bone allograft contamination we used saline solution of 2.0 mg/ml of amikacin during thawing. The overall infection rate was analyzed in 197 recipients. RESULTS: Of the 309 donated femoral heads, 37 were discarded due to bacterial contamination, giving the overall contamination rate of 11.97%. The postoperative survey of 213 bone allotransplantations among 197 recipients showed the infection rate of 2.03%. The coagulase-negative Staphylococcus was the most commonly identified contaminant of bone allografts and recipient surgical sites. CONCLUSION: The allograft contamination rate and the infection rate among recipients in our institution are in accordance with the international standards. The coagulase-negative Staphylococcus was the most commonly identified contaminant of bone allografts,and recipient surgical sites. There is no strong evidence that surgical site infections were associated with bone allograft utilization. We plan further improvements in allograft handling and decontamination with highly concentrated antibiotic solutions in order to reduce infection risk for recipients.

The effectiveness of bone banking in Central Serbia: audit of the first seven years.

We analyzed the incidence and predisposing factors for overall discard rate after retrieval of 295 femoral head allografts. The aim of the present study was to evaluate the quality system of institutional bone banking and to ensure that we can provide high standard allografts with low infection rate. Audit of bone banking was conducted on 295 donors and 180 recipients. Of the 295 donated femoral heads 77 were discarded, giving an overall discard rate of 26.1 %. At retrieval, 37 allografts were positive, giving an overall contamination rate of 12.54 %. The organism most commonly identified was Staphylococcus species. Seven (2.37 %) of the 295 allografts failed the blood screening tests. Twelve allografts (4.06 %) were discarded because of suspected damage of the packaging or disuse during surgery. Due to donor death or inability to perform serology retests, 21 (7.11 %) allografts were discarded. In the postoperative survey an infection rate of 2.22 % was found. After 7 years of bone banking, our results show that overall discard rate and allograft related infection rate are in accordance with the international standards. The leading cause of allograft discarding was bacterial contamination influenced by the surgical team. We suggest stringent aseptic allograft handling during harvesting and thawing within highly concentrated antibiotic solution to reduce a possibility of its contamination.

Unstable intertrochanteric fractures: how to prevent uncontrolled impaction and shortening of the femur.

BACKGROUND/AIM: Unstable intertrochanteric (IT) fractures, especially fractures with a reverse or transverse fracture line, have tendencies to make significant impaction on shortening of the femoral neck and lower extremity. The biomechanical complexity of the fracture, the type and the position of the implant are known to influence postoperative outcome. The aim of this study was to compare characteristics of two versions of dynamic hip implants in controlling the dynamization of unstable IT fractures of the femur. METHODS: In the prospective study that included 1,115 patients with fractures of the proximal femur, 61 patients had IT fractures with a reverse or transverse fracture line. All the patients were treated surgically with the same implant in two versions: Dynamic Hip Screw - DHS-MB-S implant with a rigid part of standard length (40 mm) and DHS-MB-I implant, with a rigid part of the implant individualized for each patient depending on the transverse diameter of the proximal femur. The patients were under gradual radiographic and clinical control. Six months postoperatively we measured the length of the extremity and the degree of the medialization of the distal part of the femur. RESULTS: All the fractures healed six months after the operation. Medialization and shortening of the extremity were significantly less in the group with fractures fixed by the DHS-MB-I implant, in which length of the rigid part of the implant was preoperatively measured individually for each patient. CONCLUSION: In order to achieve a desired functional result, the control of dynamisation in unstable IT fractures is significant in the fixation of these fractures of the femur. We presented possible methods to realize it by the contact of the rigid part of our implant with medial cortex of the proximal fragment of the femur.