Purpose Changes to routine clinical approaches during the corona virus disease 2019 (COVID-19) pandemic are necessary to decrease the risk of infection in patients and healthcare providers. Because the treatment of many conditions is time sensitive, it is crucial to modify the management of paediatric orthopaedic cases by minimizing any subsequent morbidity. Our purpose was to describe the different measures and management strategies that have been applied by paediatric orthopaedic surgeons and to show how paediatric orthopaedic practice is affected in Turkey. Methods All active practicing members of the Turkish Society of Children’s Orthopedic Surgery (TSCOS) were contacted via telephone and asked to fill out a survey (24 questions). For participants, either an email or web link was sent to their mobile phones. An online survey generator was used. Results A total of 54 survey responses were collected, for a response rate of 55%. In all, 62% reported a 75% decrease in their outpatient frequency, whilst 75% reported a 75% decrease in their surgery frequency. A total of 86% of the performed surgeries were emergency cases. None of the participants performed elective surgeries, and 61% did not have the consent form specific to COVID. Choice of protective measures have changed considerably; 96% stated that they needed an algorithm to follow for situations such as pandemic. Conclusion This national survey revealed that the COVID-19 pandemic has had a detrimental effect on paediatric orthopaedic practice and practitioner response varies in terms of reactions and precautions. The necessity of creating a protocol based on what we have learned must be taken into consideration. Level of evidence V

Relationship between the tilt angle of bipolar radial head prostheses and radiological radiocapitellar instability

Relationship between the tilt angle of bipolar radial head prostheses and radiological radiocapitellar instability

K nee replacement surgery is one of the most common procedures for knee osteoarthritis. This procedure can lead to significant blood loss, and the blood transfusion rate is high. In 34% of patients who underwent total knee replacement (TKR), perioperative blood transfusions are being performed at least once. [1] Allogeneic blood transfusion is associated with a variety of risks such as transfusion reaction, volume overload of the heart, and inhibition of immune system. [2-4] Blood transfusion increases hospitalization cost. [5] In clinical practice, different protective measures such as autologous blood transfusion have been used to reduce postoperative blood transfusion rates. [6-8] Other methods for prevention of perioperative blood loss include preoperative administration of erythropoietin, preoperative administration of iron supplements, normovolemic hemodilution, controlled hypotension, tourniquet use, and application of antifibrinolytic agents. [9-12] Tranexamic acid (TA) is a lysine analog that blocks plas-Objectives: This study aimed to analyze the efficacy of single-dose tranexamic acid (TA) 20 mg/kg preoperatively to reduce blood loss in patients undergoing total knee replacement (TKR). Methods: A total of 387 patients (82 males, 305 females) undergoing TKR between January 2014 and December 2018 were included in the study. The T + group was administrated intravenous (iv) TA 20 mg/kg 20 min before the skin incision. We determined perioperative blood loss, the amount of drainage postoperative 24 h, the amount of drainage after postoperative 24-48 h, total volume of drains, total volume of blood loss, postoperative hemoglobin and hematocrit levels, and amount of total blood transfusion. Results: In terms of demographic data, no statistically significant difference was observed between the groups. Perioperative blood loss and total volume of blood loss was found statistically higher in T − group compared to T + group. Postoperatively, the mean hemoglobin and hematocrit levels of T − group were statistically significantly lower than T + group. Conclusion: A single 20 mg/kg iv TA administration before TKR reduces bleeding during surgery and within 24 h postoperatively.

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