Blog Elements – Page 26 – Trauma International

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 10-13 |Muhammad Muzzammil, Muhammad Saeed Minhas, Jahanzeb Effendi, Syed Jahanzeb, Muhammad Ovais, Azeem Jamil, Ayesha Mughal, Abdul Qadir Author: Muhammad Muzzammil[1], Muhammad Saeed Minhas[2], Jahanzeb Effendi[3], Syed Jahanzeb[2], Muhammad Ovais[1], Azeem Jamil[2], Ayesha Mughal[2], Abdul Qadir[2] 1Department of Orthopedics, Dr. Ruth K M Pfau Civil […]

A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 23-27 | Niraj Ranjan, Arvind Agarwal, Atul Garg Author: Niraj Ranjan [1], Arvind Agarwal [1], Atul Garg [1] [1] Department of Orthopaedics , Maharaja Agrasen Hospital, New Delhi Address of Correspondence Dr. Niraj Ranjan, Department of Orthopaedics , Maharaja Agrasen Hospital, New Delhi E-mail: niraj.ranjan333@gmail.com […]

The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Full Sized Blog Element (Big Preview Pic)

The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 10-13 |Muhammad Muzzammil, Muhammad Saeed Minhas, Jahanzeb Effendi, Syed Jahanzeb, Muhammad Ovais, Azeem Jamil, Ayesha Mughal, Abdul Qadir

Author: Muhammad Muzzammil[1], Muhammad Saeed Minhas[2], Jahanzeb Effendi[3], Syed Jahanzeb[2], Muhammad Ovais[1], Azeem Jamil[2], Ayesha Mughal[2], Abdul Qadir[2]

1Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
2Department of Orthopedics, Jinnah Post Graduate Medical Centre, Rafiqui Shaheed Road, Karachi.
3Department of surgery, MC 7742, San Antonio.

Address of Correspondence
Dr. Muhammad Muzamil,
Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
Email: muzzammil_sangani@hotmail.com

Abstract

Background: In traumatic patients there is increase loss of blood and requires excessive blood transfusion as compared to other diseases. Clinical efficacy and clinical safety of tranexamic acid in decreasing blood loss assess during this study in post traumatic patients.
Method: Prospectively conducted randomized doubleblind placebo controlled study carried out. Patients were blindly randomized into two groups to receive either intravenous 1gm tranexamic acid 20 min or similar volume of 0.9% saline as placebo (P). Inclusion criteria was based on pulse rate >110 per min or systolic pressure level <90mmHg, hemorrhage or in danger of serious hemorrhage.Patients’ total blood loss was measured, needs of transfusion and hospital stay recorded. The post traumatic hemoglobin, hematocrit values, serum creatinine, activated thromboplastin time, prothombin time, platelets count and pulmonary embolism symptoms were comparatively evaluated.
Results: The total measured blood loss in tranexamic acid group (276 ± 53 mL) when comparing to control group (523 ± 74 mL) was less significantly. The requirement of blood transfusion in comparison was high in the control group and post traumatic hematocrit values were higher with in the tranexamic acid group. After administration of tranexamic acid in traumatic patients there have been no clinically relevant differences within the vital signs and no thromboembolic complications were detected in either group.
Conclusion: In traumatic patients, the prophylactic usage of tranexamic acid has effectively decreased blood loss, transfusion needs and hospital stay without any complication or adverse effects of thrombosis. Thus, TXA can be used safely and effectively in trauma subjects.
Keywords: trauma, tranexamic acid, blood loss, transfusion, hospital stay.

References

1. Astedt B. Clinical pharmacology of tranexamic acid. Scandinavian Journal of Gastroenterology. 1987; 22: 22–5.
2. Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, McClelland B, et al. Antifibrinolytic use for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007;4:CD001886.
3. “Lysteda (tranexamic acid) Package Insert” (PDF). (online)(Cited 2 June 2016). Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/022430s004lbl.pdf.
4. Roberts I. Tranexamic acid: a recipe for saving lives in traumatic bleeding. J Tehran Heart Cent 2011; 6:178.
5. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999; 57:1005-32.
6. CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet 2010; 376: 23–32.
7. TXA implementation pages—how to do it. (online) (Cited 2 June 2016). Available from: http://www2.le.ac.uk/departments/cardiovascular-sciences/research/population-research-and-clinical-trials/emergency-medicine-group/research/injury/txa-implementation-pages-how-to-do-it.
8. Committee on Tactical Combat Casualty Care. Tranexamic acid (TXA) in tactical combat casualty care. Guideline revision recommendation. 2011. (Online) (cited 2 June 2016). Available from: http://www.medicalsci.com/files/tranexamic_acid__txa__in_tactical_combat_casualty_care.pdf.
9. Luz L, Sankarankutty A, Passos E, Rizoli S, Fraga G, Nascimento Jr B. Tranexamic acid for traumatic hemorrhage. Rev Col Bras Cir.2012;39:77-80
10. CRASH-2 collaborators; Guerriero C, Cairns J, Perel P, Shakur H, Roberts I. Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLoS One 2011; 6:e18987.
11. Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. British Journal of Surgery 2013; 100: 1271–9.
12. Horrow JC, Van Riper DF, Strong MD, Grunewald KE, Parmet JL. The dose-response relationship of tranexamic acid. Anesthesiology 1995; 82: 383–92.
13. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38(2):185-93.
14. Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008;65(4):748-54.
15. Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth 2004;93:842-58
16. Godier A, Roberts I, Hunt B. Tranexamic acid: less bleeding and less thrombosis. Crit Care2012;16:135.
17. Jiménez J, Iribarren J, Lorente L, Rodríguez J, Hernandez D, Nassar I, et al. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care2007;11:R117.
18. “The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial.” The Lancet 377(9771): 1101.e1101-1101.e1102.
19. Weber, C. F., et al. “Tranexamic acid partially improves platelet function in patients treated with dual antiplatelet therapy.” European Journal of Anaesthesiology (EJA) 2011;28(1): 57-62
20. Bekassy Z, Astedt B. Treatment with the fibrinolytic inhibitor tranexamic acid-risk for thrombosis? ActaObstetGynecolScand1990;69:353-4.
21. World Health Organization. Injuries and violence: the facts 2014. (Online). Available from URL: http://apps.who.int/iris/bitstream/10665/149798/1/9789241508018_eng.pdf?ua=1&ua=1&ua=1
22. Murray C, Lopez A: The Global Burden of Disease. Volume 1. Cambridge, MA: Harvard University Press; 1996
23. Minhas MS, Khan KM, Effendi J, et al. Improvised explosive devise bombing police bus: Pattern of injuries, patho-physiology and early management [J]. J Pak Med Assoc, 2014, 64 ( 12 Suppl 2 ): S49-S53
24. Minhas M S, Mahmood K, Effendi J, Kumar R, Bhatti A . Terrorist Bomb Blasts: Emergency department management of multiple incidents. Trauma International July-Sep 2015;1(1): 36-40.)
25. Khan, A., et al. “Transfer delay and in-hospital mortality of trauma patients in Pakistan.” International Journal of Surgery 8(2): 155-158.

How to Cite this article: Muzzammil M, Minhas M S, Effendi J, Jahanzeb S, Ovais M, Jamil A, Mughal A, Qadir A. The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan. Trauma International Jan-April 2019;5(1):10-13.

(Abstract)(Full Text HTML) (Download PDF)

A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 23-27 | Niraj Ranjan, Arvind Agarwal, Atul Garg

Author: Niraj Ranjan [1], Arvind Agarwal [1], Atul Garg [1]

[1] Department of Orthopaedics , Maharaja Agrasen Hospital, New Delhi

Address of Correspondence
Dr. Niraj Ranjan,
Department of Orthopaedics , Maharaja Agrasen Hospital, New Delhi
E-mail: niraj.ranjan333@gmail.com

Abstract

Introduction: Since long, closed midshaft clavicle fractures, whether undisplaced or displaced, have been treated conservatively with figure of “8” bandage and sling. However, in the past few decades, management trends show an uprise in surgical management of displaced midshaft clavicle fracture with rigid internal fixation providing early pain relief and avoiding deformity, non-union (NU), and sequelae.
Materials and Methods: A total of 60 patients with displaced midshaft clavicle fracture were included in the study. Patients were randomly allocated to the non-operative and operative group with 30 patients in each group. Non-operative management was performed with clavicle brace (figure of 8 bandage) while open reduction internal fixation with plate fixation was the preferred operative treatment. Patients were followed up at 2, 4, and 6 weeks and then at 3, 6, and 12 months. Outcome analysis included standard clinical follow-up, the constant shoulder (CS) score and the disabilities of the arm, shoulder, and hand (DASH) score, and plain radiographs. Statistical analysis was done using Student’s “t” test and SPSS software. The results were considered to be significant at P < 0.05.
Results: There was a statistically significant difference in functional outcome between the two groups at 3-month follow-up (CS; P = 0.0469 and DASH; P = 0.0406), though no such difference was recorded at 1-year follow-up (CS; P = 0.2731 and DASH; P = 0.4915). It implies that the patients in operative group improved functionally and returned to normal activities earlier than the non-operative group. Even patient satisfaction regarding shoulder appearance (cosmesis) was more in the operative group (100%) than in non-operative group (60%). The complications were more in the non-operative group (23), such as symptomatic malunion in 2 cases (8%), NU in 5 cases (20%), shortening in 3 cases (12%), and muscle wasting in 2 cases (8%), whereas only four complications were recorded in the operative group, of which two were implant related.
Conclusion: Surgical management of displaced midshaft clavicle fracture has definite short-term benefits with respect to functional outcome, early return to preinjury activities, and a lower rate of malunion and NU. Furthermore, due to difficulties of non-operative treatment including pain and instability at fracture site, tightness of clavicle brace, difficulties in self-hygiene, and high percentage of NU, especially in high-energy fractures; operative treatment is a good option in displaced midshaft clavicle fracture, especially in active adult patients.
Keywords: Clavicle fracture, Conservative management, Surgical management.

References

1. Neer C. Fractures of the clavicle. In: Rockwood CA Jr., Green DP, editors. Fractures in Adults. 2nd ed. Philadelphia, PA: Lippincott; 1984. p. 707-13.
2. Lenza M, Faloppa F. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev 2015;5:CD007428.
3. Nordqvist A, Petersson CJ. Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elbow Surg 1995;4:107-12.
4. Crenshaw AH. Fractures of the shoulder girdle, arm and forearm. In: Crenshaw AH, editor. Campbell’s Operative Orthopedics. 8th ed. St Louis: Mosby; 1992. p. 989-1053.
5. NEER CS 2nd. Nonunion of the clavicle. J Am Med Assoc 1960;172:1006-11.
6. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 1968;58:29-42.
7. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Evidence-Based Orthopaedic Trauma Working Group. et al. Treatment of acute midshaft clavicle fractures: Systematic review of 2144 fractures: On behalf of the evidence-based orthopaedic trauma working group. J Orthop Trauma 2005;19:504-7.
8. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997;79:537-9.
9. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: A prospective study of 222 patients. Acta Orthop 2005;76:496-502.
10. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 2004;86-A:1359-65.
11. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am 2003;85-A:790-7.
12. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 2006;88:35-40.
13. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009;2:CD007121.
14. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007;89:1-0.
15. Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg 2004;13:479-86.
16. Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: A multicenter, randomized, controlled trial. J Bone Joint Surg Am 2013;95:1576-84.
17. Judd DB, Pallis MP, Smith E, Bottoni CR. Acute operative stabilization versus nonoperative management of clavicle fractures. Am J Orthop (Belle Mead NJ) 2009;38:341-5.
18. Smekal V, Irenberger A, Attal RE, Oberladstaetter J, Krappinger D, Kralinger F, et al. Elastic stable intramedullary nailing is best for mid-shaft clavicular fractures without comminution: Results in 60 patients. Injury 2011;42:324-9.
19. Böhme J, Bonk A, Bacher GO, Wilharm A, Hoffmann R, Josten C, et al. Current treatment concepts for mid-shaft fractures of the clavicle results of a prospective multicentre study. Z Orthop Unfall 2011;149:68-76.
20. Kulshrestha V, Roy T, Audige L. Operative versus nonoperative management of displaced midshaft clavicle fractures: A prospective cohort study. J Orthop Trauma 2011;25:31-8.

How to Cite this article: Ranjan N, Agarwal A, Garg A. A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture. Trauma International Jan – Apr 2019;5(1):23-27

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture

The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture

Full Sized Blog Element (Big Preview Pic)

The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

Author: Muhammad Muzzammil[1], Muhammad Saeed Minhas[2], Jahanzeb Effendi[3], Syed Jahanzeb[2], Muhammad Ovais[1], Azeem Jamil[2], Ayesha Mughal[2], Abdul Qadir[2]

Abstract

References

(Abstract)(Full Text HTML) (Download PDF)

A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture

Author: Niraj Ranjan [1], Arvind Agarwal [1], Atul Garg [1]

Abstract

References

(Abstract)(Full Text HTML) (Download PDF)

Contact

Important Links

LICENSE