Abstract
Introduction: Peritrochanteric fractures are common injuries occurring in elderly patients. Surgeries for these fractures are associated with significant blood loss. Intravenous tranexamic acid has a proven track record in many orthopaedic surgeries including trauma, arthroplasty and spine surgeries.Objective: To study the effect of local subfascial and intramuscular infiltration of tranexamic acid in reducing blood loss and the requirement for blood transfusion in intertrochanteric fracture surgery.Study Design: Single centre prospective analytical study.Materials and Methods: One hundred and thirty seven patients above 65 years of age were included in the study, divided into two groups: the intervention group received subfascial and intramuscular infiltration of 2g tranexamic acid before wound closure and the control group of alternate patients did not receive any tranexamic acid infiltration. The postoperative drain output was recorded, as well as the haemoglobin level and the patients needing blood transfusion.Results and Conclusions: The preoperative and postoperative haemoglobin values were recorded. The mean preoperative haemoglobin was 10.9% and 10.8% (p=0.79) in the trial and control groups respectively. The mean postoperative haemoglobin was 9.5gm% and 9.2gm% (p=0.36) in the two groups. The total postoperative blood loss in the tranexamic acid group and the control group was 190.3ml and 204.3ml respectively (p=0.25). Ten patients (14.9%) in the intervention group and 12 patients (17.1%) in the control group required blood transfusion. We conclude that tranexamic acid does not play a significant role in reducing postoperative blood loss and blood transfusion when used locally in peritochanteric fracture surgery. However a larger double blinded study comparing various modalities of use of tranexamic acid is needed to conclusively establish its role.
Highlights
Peritrochanteric fractures are common injuries occurring in elderly patients
Peritrochanteric fractures commonly occur in the elderly population 1
Dynamic hip screw with barrel plate and cephalomedullary nails are the usual methods of internal fixation in these fractures. The former method is associated with significant exposure and dissection for application of the plate. This may be associated with significant blood loss
Summary
Peritrochanteric fractures commonly occur in the elderly population 1. Dynamic hip screw with barrel plate and cephalomedullary nails are the usual methods of internal fixation in these fractures The former method is associated with significant exposure and dissection for application of the plate. The elderly population with their age and diminished cardiopulmonary reserves are highly susceptible to cardiovascular decompensation in the event of blood loss .2,3. This might necessitate blood transfusions which are associated with a plethora of harmful effects. Intravenous tranexamic acid has a proven track record in many orthopaedic surgeries such as total knee arthroplasty , 6-10 total hip arthroplasty 6,11 and spine surgery[12,13,14] It is being increasingly used in various fracture surgeries[15,16,17,18,19]. We have conducted a prospective study to evaluate the effect of local injection of tranexamic acid in reducing blood loss in surgeries for intertrochanteric fractures
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