Purpose of the study: Total knee arthroplasty (TKA) is associated with important intra- and postoperative bleeding often requiring transfusions, leading to certain risks despite classical methods of haemostasis. The purpose of this study was to estimate the efficacy of a fibrin glue for reducing postoperative blood loss after TKA.

Material and methods: This was a single centre single operator randomised prospective study. Two groups of patients received a first-intention TKA implanted without cement. For a control group (n=24) classical surgical haemostasis was performed; in another group of 22 patients, 4 ml of fibrin glue were vaporised on the internal structures and the subcutaneous tissue intraoperatively, just after insertion of the implants and associated with classical haemostasis. In all cases, the patients had gravity drainage for 48 h; the tourniquet was not removed before dressing. All patients had preventive anticoagulation postoperatively on day 1.

Results: Blood loss was calculated from d−1 to d+4 and was expressed in grams and in percentage in order to overcome the bias of body weight and gender. Mean blood loss was 17 g in the fibrin glue group (raw data) or 24% of the blood mass while it was 211 g in the control group, i.e. 31%. The percentage of blood loss was 31 and 24% with fibrin (p=0.05). Three of 22 patients, 13%, required transfusion in the fibrin glue group versus 11 of 24, 46%, in the control group. We did not take into consideration the rate of seroconversion at three and six months postoperatively.

Conclusion: Use of a fibrin glue can significantly reduce the need for transfusion and reduce blood loss postoperatively after first-intention unilateral uncemented TKA.

Purpose of the study: Within the framework of a regional study, we compared the efficacy of pinning using the PY technique and the Kapandji method for the treatment of fractures of the distal radius with posterior displacement.

Material and methods: This was a prospective study designed as a phase III randomised therapeutic trial in parallel groups. An open monocentric study with multiple operators compared the PY and Kapandji techniques. Two comparable groups were established: the PY group and the Kapandji group (K) for which we measured: quality of reduction using the radiographic frontal and sagittal radial inclination (FRI and SRI), radial length and inferior radioulnar index. Objective and subjective functional outcome assessed range of motion and the DASH and Jakim scores. The quality of the intra-articular reduction of articular fractures was assessed arthroscopically at the time of implant removal during the sixth week.

Results: The series included 97 patients followed for one year. The preoperative FRI was 15.17 with mean posterior shift of −19.2. At one year, the RI was 25.5 in the PY group versus 22.6 in the K group (p=0.009) and the SRI 10.5 in the PY group versus 3.7 in the K group (p=0.04). For fractures with a posteromedian fragment and Gerard-Marchand fractures, the DASH at one year was 2 in the PY group versus 32 in the K group. The Jakim score was 71 in the PY group versus 58 in the K group (p=0.03) for posteromedian fragment fractures. The arthroscopic control at six weeks of articular fractures did not reveal any significant difference in intra-articular reduction. There were no tendon tears in this series.

Discussion: This series shows the quality of pin fixation for wrist fractures, comparable with plating. It emphasizes the importance of adapting the type of pinning to the fracture type and the patient.

Conclusion: Treatment of fractures of the distal radius with posterior displacement with pin fixation remains a treatment of choice, reserving PY osteosynthesis for fractures with a posteromedian fragment and Gerard-Marchand fractures and Kapandji osteosynthsis for simple Colles fractures.