Purpose. To evaluate the effectiveness of the perioperative erythropoietin administration, as an alternative to homologous banked blood transfusions, in total hip arthroplasty. Material and Methods. In a prospective randomized, controlled study, 101 patients who underwent unilateral total hip replacement, during the period 2004–2009, were evaluated. In all these patients, the same surgical team applied the same surgical technique (hybrid THA) and they followed the same rehabilitation program. In 50 patients (group A or study group) we administered 40,000 units of erythropoietin subcutaneously one day before the operation followed by 40,000 units (sc) every 3 days in a total scheme of 4 doses. All these patients received intraoperatively one unit of homologous blood transfusion (1 unit/patient) and additional blood transfusions postoperatively when required. A control group of 51 patients (group B) received intraoperatively one or two units of homologous blood transfusion (1.35 units/patient), according to the volume of blood collected in the suction device and to the anaesthesiologists estimation, and also additional blood transfusions postoperatively when required. The admission of banked blood transfusion was determined by the haemoglobin value (< 9mg/dl) and/or clinical signs (blood pressure, pulse etc.). The values of haemoglobin,
Background. In the literature are different data about the allogenic blood transfusion rate after total knee replacement. The common intention in orthopedic surgery is to reduce the requirement for allogenic blood transfusions by optimizing the blood management. The aim of this study is to determine the efficacy of the mechanical autotransfusion system OrthoPAT® to reduce the postoperative allogenic blood transfusion (ABT) rate. Method. According to the preliminary performed power analysis we did a prospective controlled study including 151 patients which were randomized in a group A (OrthoPAT® for intra- and postoperative blood salvage and retransfusion, n=76 patients) and a control group B (no retransfusion system was used, n=75 patients). All patients had a primary osteoarthritis of the knee and were operated on without use of a tourniquet. We implanted in all patients a cemented posterior stabilized total knee prosthesis design. In group A the autotransfusion system was used for 6 hours (intra- and postoperatively) and the collected blood was retransfused. The retransfused blood was anticoagulated, filtered and centrifuged to separate waste products. Red cells were washed with saline and reconcentrated to a high
Little is known about the effect of haemorrhagic shock and resuscitation
on fracture healing. This study used a rabbit model with a femoral
osteotomy and fixation to examine this relationship. A total of 18 male New Zealand white rabbits underwent femoral
osteotomy with intramedullary fixation with ‘shock’ (n = 9) and
control (n = 9) groups. Shock was induced in the study group by
removal of 35% of the total blood volume 45 minutes before resuscitation
with blood and crystalloid. Fracture healing was monitored for eight weeks
using serum markers of healing and radiographs.Aims
Materials and Methods
The aims of this study were to characterize the frequency of
missing data in the National Surgical Quality Improvement Program
(NSQIP) database and to determine how missing data can influence
the results of studies dealing with elderly patients with a fracture
of the hip. Patients who underwent surgery for a fracture of the hip between
2005 and 2013 were identified from the NSQIP database and the percentage
of missing data was noted for demographics, comorbidities and laboratory
values. These variables were tested for association with ‘any adverse
event’ using multivariate regressions based on common ways of handling
missing data.Aims
Patients and Methods
This study compared the quality of reduction
and complication rate when using a standard ilioinguinal approach and
the new pararectus approach when treating acetabular fractures surgically.
All acetabular fractures that underwent fixation using either approach
between February 2005 and September 2014 were retrospectively reviewed
and the demographics of the patients, the surgical details and complications
were recorded. A total of 100 patients (69 men, 31 women; mean age 57 years,
18 to 93) who were consecutively treated were included for analysis.
The quality of reduction was assessed using standardised measurement
of the gaps and steps in the articular surface on pre- and post-operative
CT-scans. There were no significant differences in the demographics of
the patients, the surgical details or the complications between
the two approaches. A significantly better reduction of the gap,
however, was achieved with the pararectus approach (axial: p = 0.025,
coronal: p = 0.013, sagittal: p = 0.001). These data suggest that the pararectus approach is at least equal
to, or in the case of reduction of the articular gap, superior to
the ilioinguinal approach. This approach allows direct buttressing of the dome of the acetabulum
and the quadrilateral plate, which is particularly favourable in
geriatric fracture patterns. Cite this article:
Exsanguination is the second most common cause
of death in patients who suffer severe trauma. The management of
haemodynamically unstable high-energy pelvic injuries remains controversial,
as there are no universally accepted guidelines to direct surgeons
on the ideal use of pelvic packing or early angio-embolisation.
Additionally, the optimal resuscitation strategy, which prevents
or halts the progression of the trauma-induced coagulopathy, remains
unknown. Although early and aggressive use of blood products in
these patients appears to improve survival, over-enthusiastic resuscitative
measures may not be the safest strategy. This paper provides an overview of the classification of pelvic
injuries and the current evidence on best-practice management of
high-energy pelvic fractures, including resuscitation, transfusion
of blood components, monitoring of coagulopathy, and procedural
interventions including pre-peritoneal pelvic packing, external
fixation and angiographic embolisation. Cite this article:
The types of explosive devices used in warfare
and the pattern of war wounds have changed in recent years. There has,
for instance, been a considerable increase in high amputation of
the lower limb and unsalvageable leg injuries combined with pelvic
trauma. The conflicts in Iraq and Afghanistan prompted the Department
of Military Surgery and Trauma in the United Kingdom to establish
working groups to promote the development of best practice and act
as a focus for research. In this review, we present lessons learnt in the initial care
of military personnel sustaining major orthopaedic trauma in the
Middle East.
