This study aims to investigate that a single dose of tranexamic acid (TXA) will reduce blood loss and transfusion rates in elderly patients, undergoing intertrochanteric (IT) or femoral neck fractures surgery. Consecutive elderly patients receiving hip fracture surgery for stable or unstable IT fracture, treated with short intramedullary nail (IMN) insertion as well as cemented hemiarthroplasty for acute femoral neck (subcapital) hip fracture, were screened for inclusion in this single-centre randomized trial.

Patients were randomly allocated to a study group by sealed envelope. One TXA dose of 15 mg/kg i.v. diluted in 100 ml N/S or one placebo dose i.v. in 100 ml N/S were administered 5 mins before the skin cut. Haemoglobin (Hb) concentration was measured at admission time and prior to surgery. Post-operatively it was measured on a daily basis until day 4, giving a total of four Hb measurements (days 1 to 4). The transfusion trigger point was determined in accordance with the French guidelines for erythrocyte blood transfusion. The transfusion trigger was 10 g/dl for patients at risk, while in all other cases, it was 9 g/dl. Information regarding the transfusions number was assessed directly by the hospital blood bank database. Blood loss was calculated by the Hb dilution method. Nadler's formula was used to calculate patients' blood volume. For calculation of total blood loss (TBL) expressed to total Hb loss and total Volume loss, the number of transfusions (55 grams of Hb per transfusion), the Hb concentration on preoperatively (Hgbi) and the Hb concentration on the last measure (Hgbe) were used. (Hb balance method).

The primary efficacy outcome was the number of transfusions of allogeneic RBC from surgery up to day 4. The secondary ones were the total blood loss from surgery to day 4 as it was calculated by Hb-balance method. After randomization, 35 patients with femoral neck fracture and 30 patients with IT fracture received TXA prior to surgery. Respectively, 30 patients with femoral neck fracture and 55 with IT fracture didn't receive TXA. The groups did not differ significantly in their basic demographics (age, gender, BMI, injury mechanism, ASA score, co-morbidities). Results showed that patients undergoing hemiarthroplasty after receiving TXA, were transfused with less allogeneic RBC and had less total blood loss than patients that didn't receive TXA, but without statistical significance. While patients treated with IMN in the TXA group received a significantly lower number of RBC units than the control group (1.28 ± 1.049 vs 2.075 ± 1.685), (P = 0.0396), had a significantly lower loss of Hb (98.59 ± 55.24 vs 161.6 ± 141.7), (P = 0.0195) and a lower total blood volume loss (951.3 ± 598.9 ml vs 1513 ± 1247 ml), (P = 0.023).

This trial confirmed TXA administration efficacy in reducing blood loss and transfusion rate in elderly patients undergoing hip fracture surgery. A TXA single dose may be a safer option, taking into account these patients' physiological status and co-morbidities.

Background

We searched -in transverse ultrasound view- the value of the difference (Delta) between -proximal to the tunnel- CSA (a) and -in the tunnel's inlet- CSA (b) for separating normal from abnormal median nerves.

Aims: The evaluation of the results becoming from the use of demineralized bone matrix (DBM) in the bone defects.

Methods: In the present study the above substance was implanted during the period 2000–2002 (28 months) to 24 patients, 11 males and 13 females average age 39.1 for the males and 60 for the females. As a cause was referred in 12 patients the fall, in 3 patients the car crash, in 5 patients following the removal of osteosynthesis materials, in 2 patients the bone cysts, in 1 patient fracture of ankle joint following fusion and in 1 patient a pseudarthrosis. The implantation of DBM concerned 8 hips, 4 femurs, 6 knees, 1 humerus, 1 forearm, 1 ankle, 2 metacarpal and 1 phalanx. All the fractures as well the fusion were treated through internal fixation. There was a regular post op follow-up and concerned the clinical and x-ray examination per month until the total incorporation of the graft (12 weeks).

Results: In all patients the total incorporation of the DBM was accomplished in a brief period of time, depended on the place of implantation without having local or systemic side effects. We have to remark the early signs of bone shadow around the 3rd week, as well the incorporation of the matrix around the 12th week in the x-ray findings.

Conclusions: The use of DBM in bone defects could play an important role to the filling of bone defects due to fractures or benign cysts as a result of its incorporation and without inducing local or systematic side effects.

Purpose: To investigate the accuracy of the MRI of the knee for the detection of injuries of the meniscus, cruciate ligaments and articular cartilage, in comparison with the preoperative clinical examination and intraoperative findings.

Material and methods: During 2002 88 patients underwent surgical arthroscopy in our institution, with the diagnosis of meniscal and or cruciate tear. 56 from these patients had preoperative MRI of the affected knee. The accuracy, sensitivity and specificity of the MRI findings were correlated with the lesions identified during arthroscopy. Furthermore, the predictive value of the preoperative MRI was compared with the preoperative clinical evaluation, as well as definitive intraoperative findings.

Results : The accuracy for tears of the medial, lateral meniscus, anterior and posterior cruciate ligaments and articular cartilage was 81%, 77%, 86%, 98% and 60% respectively. The specificity was 69%, 88%, 89%, 75% and 73% respectively. The positive predictive value was 83%, 81%, 90%, 100% and 53% respectively. Finally, the clinical examination had less reliability in the detection of these injuries.

Conclusions: As seen in this retrospective study the accuracy of the MRI in detecting injuries to the knee is superior to the clinical examination. The arthroscopy still remains the gold standard for definitive diagnosis.