Acta Orthop Belg
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Randomized Controlled Trial Comparative Study
IA comparison of two minimally invasive procedures for intra-articular displaced calcaneal fractures in older children.
The purpose of this study was to compare the clinical outcomes of displaced intra-articular calcaneal fractures in older children treated with poking reduction and cannulated screws fixation or with plate fixation using a sinus tarsi approach. From June 2008 to May 2012, fifty patients were randomised to operative stabilisation either by poking reduction and cannulated screws fixation (Group A, 28) or by plates fixation using a sinus tarsi approach (Group B, 22). The two groups were comparable with respect to age, gender, BMI, the affected side, cause of injury, fracture type, time from injury to surgery and follow-up time. ⋯ Postoperative incision pain was more frequent in Group B than in Group A (P<0.05). Our results indicated that both cannulated screws and plates were efficient methods for intra-articular calcaneal fractures in older children. However, poking reduction and cannulated screws fixation had the advantages of a shorter operative time, fewer hospital costs and less incision pain.
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Randomized Controlled Trial
Local Infiltration Analgesia reduces pain and hospital stay after primary TKA : randomized controlled double blind trial.
Postoperative analgesia following Total Knee Arthroplasty (TKA) with the use of parenteral opioids or epidural analgesia can be associated with important side effects. Good perioperative analgesia facilitates faster rehabilitation, improves patient satisfaction, and may reduce the hospital stay. We investigated the analgesic effect of a locally injected mixture of drugs, in a double blinded RCT in 80 primary TKA. ⋯ In addition, they had lower VAS for pain during rest and activity and higher visual analog scores for patient satisfaction 72 hours postoperatively. No major complication related to the drugs was observed. Intraoperative periarticular injection with multimodal drugs following TKA can significantly reduce the postoperative pain and hence the requirements for PCA and hospital stay, with no apparent risks.
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Randomized Controlled Trial
The effect of local and systemic application of tranexamic acid on the amount of blood loss and allogeneic blood transfusion after total knee replacement.
The effect of local and systemic Tranexamic Acid on blood loss and need for transfusion after total knee replacement was compared prospectively. Between 2012-2013, 90 patients with unilateral TKR were included. They were randomly divided into 3 and 15 mg/kg TXA was infused before and 10 mg/kg 1 hour after surgery in Group 1, 2 gr TXA was used topically in 2 and no TXA was applied in 3. ⋯ No thromboembolic problem was seen in any patient. Since TXA decreased blood loss and lessen the need for transfusion significantly without increasing thromboembolic events in TKR, we suggest its usage in TKR either systemically or topically whenever possible. Level of evidence: Prospective Randomized Controlled Trial, Level II).
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Randomized Controlled Trial Comparative Study
Randomized controlled trial comparing stabilization of fresh close femoral shaft fractures in children with titanium elastic nail system versus stainless steel elastic nail system.
In vitro mechanical studies have demonstrated equal or superior fixation of pediatric femoral fractures with use of titanium elastic nails (TENS) as compared with stainless steel elastic nails (SSEN). SSEN are less expensive as compared to TENS. However, there are only two studies in the English literature which have compared the results of TENS and SSEN in paediatric femoral shaft fracture. ⋯ Both groups showed a similar rate of complication, most common being prominent hardware. TENS and SSENS are equally effective treatment modalities for paediatric femoral shaft fracture with similar rate of complications. However, SSENS is less costly as compared to TENS and can be considered as an alternative in a resource constrained setup.
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Randomized Controlled Trial
No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients.
We performed a prospective, randomised controlled trial to assess the differences in the use of a conventional suction drain, an Autologous Blood Transfusion (ABT) drain and no drain, in 168 patients. There was no significant difference between the drainage from ABT drains ( mean : 345 ml) and the suction drain (314 ml). ⋯ Patients that did not have a drain inserted stayed in hospital a significantly shorter period of time, compared with drains. We feel the benefits of quicker drying wounds, shorter hospital stays and the economic savings justify the conclusion that no drain is required after hip replacement.