Direct oral anticoagulant (DOAC) use is becoming more widespread in the geriatric population. Depending on the type of DOAC, several days are required for its anticoagulant effects to resorb, which may lead to surgical delays. This can have an important impact on hip fracture patients who require surgery. The goal of the current study is to compare surgical delays, mortality and complications for hip fracture patients who were on a DOAC to those who were not.

A retrospective cohort study was conducted at a university hospital in Sherbrooke. All hip fracture patients between 2012 and 2018 who were on a DOAC prior to their surgery were included. These patients were matched with similar patients who were not on an anticoagulant (non-DOAC) for age, sex, type of fracture and date of operation. Demographic and clinical data were collected for all patients. Surgical delay was defined as time of admission to time of surgery. Mortality and complications up to one year postoperative were also noted.

Each cohort comprised of 74 patients. There were no statistically signification differences in Charleson Comorbidty Index and American Society of Anesthesiologists scores between cohorts. Surgical delay was significantly longer for DOAC patients (36.3±22.2 hours vs. 18.6±18.9 hours, p < 0 .001). Mortality (6.1%) and overall complication (33.8%) rates were similar between the two cohorts. However, there were more surgical reinterventions in DOAC patients than non-DOAC ones (16.2% vs. 0.0%, p < 0 .001). Among DOAC patients, mortality was greater for those operated after 48 hours (23.1% vs. 3.3%, p < 0 .05) and complications were more frequent for those operated after 24 hours (52.0% vs. 37.5%, p < 0 .05).

Direct oral anticoagulant (DOAC) use in hip fracture patients is associated with longer surgical delays. Longer delays to surgery are associated with higher mortality and complication rates in hip fracture patients taking a DOAC. Hip fracture patients should have their surgery performed as soon as medically possible, regardless of anticoagulant use.

Direct oral anticoagulant (DOAC) use is becoming more widespread in the geriatric population. Depending on the type of DOAC, several days are required for its anticoagulant effects to resorb, which may lead to surgical delays. This can have an important impact on hip fracture patients who require surgery. The goal of the current study is to compare surgical delays, mortality and complications for hip fracture patients who were on a DOAC to those who were not.

A retrospective cohort study was conducted at a university hospital in Sherbrooke. All hip fracture patients between 2012 and 2018 who were on a DOAC prior to their surgery were included. These patients were matched with similar patients who were not on an anticoagulant (non-DOAC) for age, sex, type of fracture and date of operation. Demographic and clinical data were collected for all patients. Surgical delay was defined as time of admission to time of surgery. Mortality and complications up to one year postoperative were also noted.

Each cohort comprised of 74 patients. There were no statistically signification differences in Charleson Comorbidty Index and American Society of Anesthesiologists scores between cohorts. Surgical delay was significantly longer for DOAC patients (36.3±22.2 hours vs. 18.6±18.9 hours, p < 0 .001). Mortality (6.1%) and overall complication (33.8%) rates were similar between the two cohorts. However, there were more surgical reinterventions in DOAC patients than non-DOAC ones (16.2% vs. 0.0%, p < 0 .001). Among DOAC patients, mortality was greater for those operated after 48 hours (23.1% vs. 3.3%, p < 0 .05) and complications were more frequent for those operated after 24 hours (52.0% vs. 37.5%, p < 0 .05).

Direct oral anticoagulant (DOAC) use in hip fracture patients is associated with longer surgical delays. Longer delays to surgery are associated with higher mortality and complication rates in hip fracture patients taking a DOAC. Hip fracture patients should have their surgery performed as soon as medically possible, regardless of anticoagulant use.

Blood loss is a major concern in total knee arthroplasty (TKA) along with postoperative knee function. The present study explores the impact of tourniquet and closed-suction drains on blood loss as well as knee function in TKA.

A prospective clinical trial was conducted on 111 patients admitted for TKA. Subjects were divided into three groups based on duration of tourniquet use (T+: whole-course tourniquet, T-: cementation only tourniquet) and usage of closed-suction drain (D+: drain use, D-: no drain). Thirty-six subjects were included in group T+D+, 42 in T-D+ and 33 in T-D-. Data from study population was analysed for pre and post-operative hemoglobin level (Hb), perioperative and total blood loss, blood transfusion rates, knee range of motion (ROM), and pain level assessment. Direct and indirect costs associated to nursing time and drains were calculated. Results are presented in mean ± SD.

No statistically significant differences were observed among the three groups (T+D+, T-D+ and T-D-) concerning total blood lost (calculated using Gross' formula), Hb levels over the first six postoperative weeks, blood transfusion rates and intra-articular hematomas. Intraoperative bleeding was significantly reduced in T+ subjects compared to T- subjects (100 ± 88 mL vs. 279 ± 235 mL respectively, p < 0.001), yet length of surgery was unaffected by the different tourniquet inflation strategies. Hidden blood loss was lower in D+ subjects compared to D- subjects (1161 ± 554 mL vs. 1667 ± 554 mL respectively, p < 0.001), but it was compensated by the blood loss in the drains. Early post operative ROM (flexion: 79.1 ± 14.8°, extension: −5.0 ± 6.7°) was superior in group T-D- compared to group T+D+ (flexion: 71.9 ± 17.1°, p = 0.071°; extension: −9.9 ± 6.4°, p = 0.004). Nevertheless, ROM six weeks postoperative was not statistically different between groups (flexion: 114.0 ± 13.3°, extension: 0.4 ± 5.2°). Patient-reported postoperative pain was also similar in all groups. Nursing time dedicated to drain management was 30 min/patient (330h total for 660 patients/year). Total costs related to drains were $31.92CAD/patient ($21,067CAD total for 660 patients/year).

Our results suggest that whole-course tourniquet and closed-suction drain use in TKA do not yield beneficial results in total blood loss, blood transfusion rates, complication rates and knee rehabilitation. Their clinical relevance in TKA is questionable. Moreover, nursing time and costs related to drains should have been allocated elsewhere in patient care.

Objectives: To develop a non-invasive method to assess the wire tension quantitatively which can be used in clinic.

Background: Fine-wire external fixators are widely used in the fixation of fractures and limb reconstruction. A requirement of stable fixation is that the wires maintain their tension. Recent lab tests have shown that substantial reduction in wire tension occurred during the simulated operative procedures. Clinical experience also indicated that wire site discomfort might be related to loss in wire tension. It would be very helpful if the wire tension could be assessed quantitatively by a non-invasive method.

Methods: An apparatus based on a LVDT (Linear Variable Differential Transformer) was developed to apply a constant transverse force to a wire and measure its deflection with respect to another parallel wire. An unstable oblique fracture was created in a Sawbones tibia and stabilized by a Sheffield Ring Fixator. The deflection of the testing wire was measured in four tests: (1) Two parallel wires fixation, tensioned reference wire, variable clamp to bone distance; (2) Two parallel wires fixation, loose reference wire, 80mm clamp-bone distance. (3) Two groups of parallel wires fixation with 70° crossing angle, tensioned reference wire, 80mm clamp-bone distance; (4) Two groups of parallel wires fixation with 70° crossing angle, tensioned reference wire, 80mm clamp-bone distance, osteotomy site fixed with a lag screw to simulate a stable fracture or a healing fracture. Fracture stiffness in the above conditions was derived from previous work. Stepwise multiple variable regression analyses were performed to determine the relationship between wire deflection and wire tension, clamp-bone distance, number of wires, reference wire tension, and fracture stiffness.

Results: The reference wire tension and fracture stiffness was excluded from the regression equation, indicating that they did not affect the wire deflection. The regression equation containing only the testing wire tension had an adjusted R-square value of 0.521, while the equation containing the testing wire tension and clamp-bone distance had the R-square values of 0.854. The addition of the number of wires to the regression equation resulted in a slight increase of the R-square value (0.862).

Conclusion: The wire deflection and the clamp-bone distance are the two most important factors that affect wire deflection. The measurement of wire deflection has the potential to predict wire tension and the effect of clamp-bone distance must be considered. Further work is required to refine the apparatus for clinical use.