To observe the effect of tranexamic acid in different application methods on the amount of drainage after femoral head replacement in elderly femoral neck fractures.

A prospective study was performed in 75 cases of femoral neck fractures who had underwent femoral head replacement in Xiangya Medical College of Central South University, Department of orthopedics center of Haikou Hospital. Patients were randomly divided into group A, group B and group C, 25 cases in each group. Group A gave 1 g 1% tranexamicacid though intravenous drip infusion before closing the incision + local injection of 20 ml 5% tranexamic acid into periarticular soft tissue before closing the incision + a bolus of 20 ml 5% tranexamic acid through drainage tube after suturing the wound and soaking 2 hours. Patients in group B gave intravenous drip infusion of 100 ml normal saline before closing the incision and local injection of 20 ml 5% tranexamic acid into periarticular soft tissue before closing the incision + a bolus of 20 ml 5% tranexamic acid through drainage tube after suturing the wound and soaking two hours. In group C intravenous drip infusion of 100 ml normal saline was given before closing the incision and local injection of 20 ml normal saline to periarticular soft tissue before closing the incision + a bolus of 20 ml normal saline through drainage tube after suturing the wound and soaking 2 hours. The wound drainage of three groups at 24 hours after operation and the hemoglobin changes after 48 hours were evaluated.

Twenty-four hours postoperative drainage, hemoglobin variation in 48 hours after operation of group A [(47±10)ml, (10±4)g/L] was significantly lower than group B [(110±25)ml, (16±5)g/L] and group C[(131±22)ml, (18±6)g/L], the differences were statistically significant (P<0.05). 24 hours postoperative drainage of group B was lower than that of group C, difference was statistically significant (q=5.241, P<0.05). Hemoglobin variation in 48 hours after operation of group B was not significantly reduced compared with group C (q=0.721, P>0.05).

The intravenous drip of 1 g 1% tranexamic acid and local injection of 20 ml 5% tranexamic acid in periarticular soft tissue + local injection of 20 ml 5% tranexamic acid into periarticular soft tissue before closing the incision + a bolus of 20 ml 5%tranexamic acid through drainage tube after suturing the wound and soaking 2 hours can significantly reduce drainage and hemoglobin change value in elderly femoral neck fracture patients with artificial femoral head replacement. Local injection of tranexamic acid in periarticular soft tissue during artificial femoral head replacement and injection of tranexamic acid though drainage tube after suturing the wound and soaking for 2 hours can reduce the postoperative drainage, but have no effect on the hemoglobin change.

Femoral neck fractures; Arthroplasty, replacement, hip; Hemostasis; Tranexamic acid; Drainage