INTRODUCTION

Tranexamic Acid (TA) has been shown to decrease peri-operative bleeding in primary Total Knee Replacement (TKR) surgery. There are still concerns with regards to the increased risk of thromboembolic events with the use of TA. The aim of this study was to assess whether the use of pre-operative TA increased the incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in TKR.

Introduction: Reinfusion drains are used to minimise the need for allogenic blood transfusion, and its potential complications. Tranexamic acid {TA} is an antifibrinolytic agent that is used to decrease blood loss in total knee arthroplasty surgery. The effect of TA on reinfusion volume of drained blood has received little attention. The aim of our study is to measure the effect of TA on reinfusion volumes in primary total knee replacement {TKR}.

Methods: A cohort of consecutive patients undergoing primary total knee replacement between November 2006 and January 2008 were studied. Each patient was operated upon by the same surgeon, and had the same pros-thesis inserted. Patients operated upon before June 2007 did not receive TA but had reinfusion drains, while those who underwent surgery after June 2007 received TA along with the reinfusion drain. We measured pre and post operative haemoglobin {Hb}, drainage volume and reinfusion volume. The need for allogenic blood transfusion was recorded. TA and non TA groups were compared.

Results: Seventy patients were included in the study. There was no significant difference between the TA and non TA groups in pre operative Hb {13.2, 13.1g/dl} or post operative Hb {10.95, 10.9}. There was a significantly lower drainage volume {250 v 600ml} and subsequent reinfusion volume {100 v 465ml} in the TA group versus non TA groups respectively. There were no cases of thromboembolism or allogenic blood transfusion in either group.

Conclusion: Tranexamic acid significantly decreased post operative blood loss and subsequent reinfusion volumes in TKR. TA and reinfusion drains greatly decrease the demand for allogenic blood transfusion. Drainage volume is so low when TA is used in routine primary TKR, that the need for reinfusion drains is questionable. TA is cost-effective compared to reinfusion drains in TKR.

Background and objectives: Total knee replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of a sciatic nerve block as an adjunct to a femoral nerve block is controversial. The aim of this study was to compare femoral with femoral and sciatic nerve blocks in postoperative pain management of patients undergoing total knee arthroplasty (TKA).

Methods: 42 patients were involved in the study. 20 patients received only a femoral nerve block, consisting of 20ml of 0.5% Chirocaine and 22 patients received femoral and sciatic nerve blocks, consisting of 20ml of 0.375% Chirocaine for the femoral nerve and 10ml of 0.5% Chirocaine for the sciatic nerve. The primary outcome measures used were visual analogue scale (VAS) scores for pain at 24 hours, 48 hours and 72 hours after the surgery, opiates consumption post-operatively and PCA use. The secondary outcomes were post-operative nausea and vomiting, sensory deficit, quadriceps contraction, straight leg raise, knee flexion, independent mobility and discharge from the hospital.

Results: The results showed no difference in opiate consumption, PCA use, independent mobility and time of discharge from the hospital between the two groups.

Conclusion: The study shows that the addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

Aim: A retrospective study to analyse the treatment of paediatric diaphyseal forearm fractures over the preceding 6 years and to assess if there was any difference in outcome between plate and elastic stable intra-medullary nailing (ESIN).

Material and Methods: Between January 1997 and December 2002, 144 unstable fractures required surgical fixation. 59 patients were treated with both-bone plate fixation, 55 patients were treated with single-bone plate fixation and 30 patients were treated with ESIN.

The mean age of surgery was approximately 12 with peaks at age 8 and 13 years.

In the plate group, 70% to 80% were undertaken by the SpRs and in the nailing group, approximately 50% were undertaken by staff grades; 30% by Consultants and 20% by SpRs.

Results: Between each group there was no difference in time spent in plaster, clinic attendance, time to clinical union and time to restoration of normal movements. On radiographic reviews, single-bone plate fixation patients united quicker than the both-bone plate fixation or ESIN groups. Average anaesthetic times became more prolonged from single-bone to ESIN to both-bone plate fixation.

Compound fractures were approximately 10% in both groups. There were hyper-trophic scars in approximately 10% in the plate group and 3% in the nail group. There were 3 compartment syndromes in the plate group and 2 compartment syndromes in the nail group.

In the plating groups, there was a higher rate of peri-prosthetic fracture, mal-union, hyper-trophic scarring, infection and neuro-vascular complications.

Conclusion: ESIN is superior to plating in relation to surgical complications. It is therefore recommended that elastic stable intra-medullary nailing should be used for displaced paediatric diaphyseal forearm fractures.