For closed, Sanders III-IV calcaneal fractures, open reduction internal fixation (ORIF) is the standard treatment. However, a large amount of perioperative blood loss is usually associated with the surgeries to repair calcaneal fractures as it is a cancellous bone with abundant blood supply, which increases the chance of blood transfusion and the associated risks to patients with calcaneal fractures. Moreover, the large amount of postoperative blood loss around the affected calcaneus will also increase the risk of wound complications.
Lang Zhong et al conducted a study to investigate whether local administration of tranexamic acid (TXA) is effective in postoperative blood loss reduction in surgeries for Sanders III–IV calcaneal fractures. The article has been published in Indian Journal of Orthopaedics.
Calcaneal fracture patients who underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the study.
53 patients were randomly divided into three groups, groups A (17), B (17) and C (19). Twenty milliliters of 10 mg/ml and 20 mg/ml TXA solution were perfused into the incision of patients in group A and group B, respectively. Twenty milliliters of saline were perfused into the incision of patients in group C as control. The volume of postoperative drainage, postoperative blood test, coagulation test, and wound complications were analyzed to evaluate the effectiveness of local administration of TXA on blood loss reduction.
Key findings of the study were:
• The amount of drainage at 24 and 48 h after the procedure was 110±170, 30±10 ml and 130±160, 20±17 ml for patients in group A and group B.
• The corresponding numbers for patients in group C were 360±320, 20±10 ml.
• The difference between group A and group C was statistically significant, so was the difference between group B and group C.
• No statistically significant difference was found between group A and group B.
• Postoperative blood test results revealed that the levels of hemoglobin and hematocrit were significantly higher in group A and group B when each compared to that of group C. In contrast, no difference was found between group A and group B.
• No significant difference was found between each experimental group and the control group in terms of platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications.“
In the present study, we validated that local administration of TXA effectively reduced the postoperative blood loss in surgeries for Sanders III–IV types of calcaneal fractures without increasing the incidence of wound complications, suggesting the potential benefits of local administration of TXA in treatment for calcaneal fractures” the authors commented.
Further reading:
Effects of Local Administration of Tranexamic Acid on Reducing Postoperative Blood Loss in Surgeries for Closed, Sanders III–IV Calcaneal Fractures: A Randomized Controlled Study Lang Zhong , Yu Liu et al Indian Journal of Orthopaedics (2021) 55 (Suppl 2):S418–S425https://doi.org/10.1007/s43465-021-00417-2