Pornchai Mulpruek

Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial

BackgroundRecently, a number of studies using intra-articular application of tranexamic acid (IA-TXA), with different dosage and techniques, successfully reduced postoperative blood loss in total knee replacement (TKR). However, best of our knowledge, the very low dose of IA-TXA with drain clamping technique in conventional TKR has not been yet studied. This study aimed to evaluate the effectiveness and dose-response effect of two low-dose IA-TXA regimens in conventional TKR on blood loss and blood transfusion reduction.MethodsBetween 2010 and 2011, a triple-blinded randomized controlled study was conducted in 135 patients undergoing conventional TKR. The patients were allocated into three groups according to intra-articular solution received: Control group (physiologic saline), TXA-250 group (TXA 250 mg), and TXA-500 group (TXA 500 mg). The solution was injected after wound closure followed by drain clamping for 2 hours. Blood loss and transfusion were recorded. Duplex ultrasound was performed. Functional outcome and complication were followed for one year.ResultsThere were forty-five patients per groups. The mean total hemoglobin loss was 2.9 g/dL in control group compared with 2.2 g/dL in both TXA groups (p > 0.001). Ten patients (22%, control), six patients (13%, TXA-250) and none (TXA-500) required transfusion (p = 0.005). Thromboembolic events were detected in 7 patients (4 controls, 1 TXA-250, and 2 TXA-500). Functional outcome was non-significant difference between groups.ConclusionsCombined low-dose IA-TXA, as 500 mg, with 2-hour clamp drain is effective for reducing postoperative blood loss and transfusion in conventional TKR without significant difference in postoperative knee function or complication.Trial registrationClinicalTrials.gov NCT01850394.

Spontaneous Recovery of Trigger Thumbs in Children

Forty-two children with trigger thumb were reviewed to determine the possibility of spontaneous recovery and the outcome of treatment. There were 22 boys and 20 girls. All of them had a normal physical examination at birth. Ten patients had spontaneous recovery within 3 months of their initial visit. Thirty-two patients underwent surgical release. All of them had satisfactory results. Our findings suggest that spontaneous recovery of trigger thumb in children is possible and may be related to a traumatic cause for the condition. Delaying operation until after the age of 3 years will not affect the outcome.

The heel-pad compressibility.

Heel-pad thickness and compressibility were studied in the feet of 400 normal subjects by loaded and unloaded lateral radiographs. The normal unloaded heel-pad thickness was 18.70 +/- 2.46 mm. The thickness was greater in men than in women and increased with age. The heel-pad compressibility index was 0.53 +/- 0.09. The compressibility increased with age, but there was no significant difference with gender. An increase in body weight led to an increase in heel-pad thickness and loss of elasticity.

Trigger finger in children

Trigger finger in children is a rare condition. Thirty-three patients with 45 trigger fingers (40 thumbs and five other fingers) were reviewed. As no case was detected at birth, the condition was suggested to be developmental. Surgi cal release was performed in 31 cases, with satisfactory results in all cases. Ten of 31 cases were older than 3 years (range, 3-5 years). The age of the patient when the operation was indicated could be between 1 and 5 years.

Using humeral nail for surgical reconstruction of femur in adolescents with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformities. While the treatment for these fractures was recommended as using intramedullary fixation for minimizing stress concentration, the selection of the best implant in the adolescent OI patients for the surgical reconstruction of femur was still problematic, due to anatomy distortion and implant availability. We are reporting the surgical modification by using a humeral nail for femoral fixation in three adolescent OI patients with favorable outcomes.

Case Report: Closed Posteromedial Dislocation of the Ankle without MedialMalleolar Fracture

Closed ankle dislocation without associated fractures of malleoli is a very rare condition and has been reported sparsely in literatures. We present two cases of this type of injury. All patients were treated conservatively with immediate closed reduction and immobilization in a short leg slab. Mechanism of injury, MRI findings, management, functional outcome and possible complications were discussed. Sufficient immobilization period with gradual ankle joint motion exercise with brace support resulted in good to excellent clinical outcomes. A review of the literature is also presented in this paper.

Modification of spinal pedicle screw-plate fixation for bilateral pediatric pelvic ring injury in 2-year-old girl

Unstable pelvic fractures in children are an uncommon injury and are typically associated with high-energy trauma, such as an automobile accident or motor vehiclepedestrian injury [1–3]. Results from recent studies concluded that these unstable injuries needed to be treated with operative management [4–9], to achieve as near anatomical reduction as possible, with stable fixation to prevent longterm poor outcomes following non-operative treatment, such as residual pain, limb length discrepancy and scoliosis [10, 11]. Nevertheless, to date, there is still no consensus treatment option for surgical management in pediatric pelvic fracture, especially in very young children with displaced sacroiliac (SI) fracture-dislocation or bilateral SI joint injury. Traditional surgical fixation methods of SI joint disruptions, such as SI screw and anterior retroperitoneal SI plate, have several limitations because of the small bony anatomy in children, which requires an experienced surgeon and advanced imaging techniques. Moreover, there are still possible catastrophic intraoperative complications such as extensive blood loss, neurovascular injury, and implant jam due to the small bony architecture [12]. Therefore, in this present study, the authors aimed to introduce a new alternative surgical fixation procedure by modifying a spinal pedicle screw-plate (PSP) system to treat a complex bilateral unstable SI joint fracture-dislocation in a very young pediatric patient with a minimally invasive technique, and to report the mid-term result.