Eur J Orthop Surg Tr
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Eur J Orthop Surg Tr · Apr 2014
Outcome of unstable isolated fractures of the posterior acetabular wall associated with hip dislocation.
Traumatic hip dislocation with fracture of the posterior acetabular wall is associated with high rates of residual invalidity. ⋯ Our conclusions in light of our experience are that in type 1 lesions, anatomical reduction and stabilization achieve excellent outcomes, both clinical and radiographic; type 2 fractures pose greater prognostic problems because their outcome is determined by the success of the reduction and fixation of a multi-fragment fracture; finally, different considerations apply to type 3 fractures, which present varying degrees of comminution and an impacted acetabular surface: their outcome depends on the quality of the anatomical and morphological restoration of acetabular congruence.
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Eur J Orthop Surg Tr · Apr 2014
Can local administration of tranexamic acid during total knee arthroplasty reduce blood loss and transfusion requirements in the absence of surgical drains?
Blood transfusions are frequently required following total knee arthroplasty. Tranexamic acid (TXA) inhibits fibrinolysis and has been shown to reduce blood loss and transfusion requirements when delivered intravenously. Topical and intra-articular applications directly target bleeding sites whilst limiting systemic uptake and theoretically reduce the risk of thromboembolic complications. ⋯ There was a significant reduction in mean blood loss of 246 ml between the groups (p < 0.01). In addition, the requirement for post-operative allogenic blood transfusion was significantly reduced from 15.5 to 5.4 % after introduction of the tranexamic acid regimen (p = 0.02). This is the largest patient cohort reviewed to measure the efficacy of locally administered tranexamic acid during total knee arthroplasty and demonstrates that this is an effective technique for reducing both blood loss and transfusion requirements in the absence of surgical drains.
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Eur J Orthop Surg Tr · Apr 2014
Bupivacaine and levobupivacaine induce apoptosis in rat chondrocyte cell cultures at ultra-low doses.
Osteoarthritis (OA) is characterized by chondrocyte apoptosis and necrosis which play a key role during the progression of OA. Intra-articular administration of bupivacaine is a practical and effective way of postoperative pain control following various joint surgeries. 0.25 % bupivacaine showed to be safe in terms of chondrocyte toxicity. Around 200 nM of bupivacaine was shown to be effective for peripheral nerve block. This study aims to observe the possible cytotoxic effects of bupivacaine and its enantiomer levobupivacaine on chondrocyte cell culture at 7.69, 76.9, and 384.5 μM or at 0.0125, 0.0025, and 0.00025 % concentrations, respectively. ⋯ Clinicians should be skeptic for the serious long-term side effects of bupivacaine and its analogs, even at ultra-low doses.