Objective: To review the efficacy and safety of a single dose of intravenous tranexamic acid (TXA) given preoperatively. Summary Background Data: TXA is a synthetic antifibrinolytic that has been used in various surgical disciplines to reduce blood loss, blood transfusions, ecchymosis, and hematoma formation. However, there is no universal standard on the most effective dose and route of TXA administration, limiting its routine use in many centers. This study evaluates the current evidence for the efficacy and safety of a single preoperative dose of TXA on surgical blood loss in all surgical disciplines. Methods: With the guidance of a research librarian, in accordance with the Cochrane Handbook Medline, Cochrane Central and Embase were searched in November 2018. Search terms included “Tranexamic Acid” AND “Intravenous,” with studies limited to randomized controlled trails in adult humans. Two independent reviewers and an arbitrator assessed articles for inclusion. Criteria included a single preoperative bolus dose of intravenous TXA, surgical patients, and intraoperative blood loss measurement or perioperative blood loss up to 24 hours postsurgery. Quality assessment was done using the Cochrane Collaboration risk-of-bias tool by 2 reviewers. Statistical analysis was carried out using Cochrane Review Manager 5.3. The primary outcome was surgical blood loss. Secondary outcomes included venous thromboembolic complications, transfusion requirements, and dosing. Results: A total of 1906 articles were screened, 57 met inclusion criteria. The majority of included studies were orthopedic (27), followed by obstetric and gynecological (16), oral maxillofacial and otolaryngology (10), cardiac (3), and 1 plastic surgery study focusing on acute burn reconstruction. Across all surgical specialties (n = 5698), the perioperative estimated blood loss was lower in patients receiving TXA, with a standard mean difference of −153.33 mL (95% CI = −187.79 to −118.87). Overall, surgical patients with TXA had a 72% reduced odds of transfusion (odds ratio = 0.28 [95% CI = 0.22–0.36]). The most frequently used dose of TXA was 15 mg/kg. There was no difference in the incidence of venous thromboembolic events between TXA and control groups. Conclusions: While there is a growing body of evidence to support benefits of perioperative TXA use, this is the first meta-analysis to identify the efficacy and safety of a single preoperative dose of IV TXA. The potential implications for expanding the use of preoperative TXA for elective day surgery procedures is substantial. Preoperative intravenous TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events. Therefore, it should be considered for prophylactic use in surgery to reduce operative bleeding.

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Introduction: A suture enlocation (SE) approach is proposed to manage comminuted intra-articular mandibular condyle fractures not amenable to open reduction internal fixation approaches. The SE approach is an effective operative option for the treatment of condylar fractures with the combination of fracture dislocation, malocclusion, comminution, and inadequate surface area for open fixation techniques. This study describes the SE approach, outcomes, and complications. Methods: The SE technique is described, and the health records of patients treated with the SE approach are reviewed. Outcome data were collected for diet, interincisal opening, occlusion, pain, and complications. Results: Technique: The SE approach involves reducing the fractured condylar fragment using a hole drilled through the fragment to secure it to the periosteum with a polydioxanone suture. This allows the reduced fragment to be managed as a nondisplaced fracture with mandibulomaxillary fixation and class 2 elastics. Outcomes: A chart review involving 8 patients (11 condyles) illustrates the outcomes of the SE approach from 2006 to 2021. Age at the time of injury ranged from 12 to 51 years and the follow up ranged from 2 to 68 months. At final follow up, 7 patients were eating a regular diet, 7 had normal interincisal opening, 4 had normal occlusion, and 4 reported ongoing mandibular discomfort. Failure of fixation occurred in 1 case, which required further operative management. Conclusions: The SE technique shows promise as an effective way to reduce fracture components, manage occlusion, and facilitate secondary bone healing in comminuted and displaced mandibular condyle fractures.

Objective: The number of patients requiring arthroplasty increases annually. Joint replacement surgery can improve a patient's (QOL) quality of life. The effectiveness of this care from a patient's own perspective assessed by patient reported outcome measures is just as important as the clinical measures. The aim of our study was to evaluate patients' satisfaction following total joint replacement procedures. Methods: A cross sectional study was performed in a major regional hospital, (Port-of-Spain General Hospital, Trinidad). Between September 1 st 2013 and December 31 st 2014, Seventy three patients were enrolled in the study. Two groups were created: a preoperative group (with thirty nine patients) and a post operative group (of thirty-four patients). The postoperative group of patients received either total hip replacement or total knee replacement surgery from at least three months post procedure. The main outcome measures reported were: (i) Orthopaedic patient reported outcome measures, Oxford hip and knee scores. (ii) Health related quality of life instrument, short form 12 (SF12) for mental and physical components of health gained (MCS and PCS). (iii) Visual analogue scores to assess current pain. (iv) Patient satisfaction levels with peri-operative management. (v) Fulfillment of patients' expectations with respect to pain, mobility and independence. Results: The pre-operative group had a mean Oxford hip score (OHS) score of 18.71, standard deviation (SD) 10.09. The postoperative group had a statistically significant higher level of functionality in terms of a mean Oxford hip score (OHS) 41.45, standard deviation (SD) 7.42. The preoperative group had more disability (lower function) in terms of a mean oxford knee score (OKS) of 15.52, SD 7.10. The post operative group's mean oxford knee score (OKS) was 37.27, SD 7.32.With respect to the short form 12 (SF12) quality of life assessment tool, the difference in mean PCS between groups was significant, pre op 28.57 (SD 7.52), post op 40.12.27 (SD 11.16). The difference in mean MCS between groups was also significant, pre op 48.76 (SD 9.02), post op 53.76 (SD 6.77). The difference in mean pain scores (VAS) between groups was significant, pre op eight (SD 1.86), post op 1.42 (SD 2.19). Postoperative patients were generally satisfied with their peri-operative management. Patient expectations were met in terms of pain, mobility and independence (92.31%, 94.87% and 94.87% respectively). Conclusion: Although multiple factors impact on patient satisfaction with respect to TJR surgery, statistically significant results showed increased function (improved Oxford scores), decreased pain (VAS) and general improvement in mental and physical health gained (SF12) between independent pre and post operative groups. Clinically significant results indicate that postoperative patients were satisfied with peri-operative management and fulfillment of ex.