Jiabao Jiang

Background: Tranexamic acid (TXA) is commonly used to reduce perioperative bleeding in various surgeries, including acetabular and pelvic fractures treated with open reduction and internal fixation (ORIF). However, research on TXA’s effectiveness and safety in this context is conflicting. To address this, we conducted a systematic review and meta-analysis on TXA’s efficacy and safety in patients with acetabular and pelvic fractures undergoing ORIF. Methods: We systematically searched Cochrane, PubMed, and EMBASE databases until August 30, 2023. Our evaluation of TXA focused on 6 domains: estimated blood loss (EBL), blood transfusion units, transfusion rates, thromboembolic events, other complications, and surgery duration. Data from these studies were analyzed using RevMan Manager 5.4. Results: This study included 4 randomized controlled trials with 179 patients with acetabular and pelvic fractures treated with TXA. The analysis showed that TXA did not significantly reduce EBL, packed red blood cell transfusion units, blood transfusion rates, or surgery duration. There was no significant difference in thromboembolic events or other postoperative complications, like surgical wound issues, pneumonia, heterotopic ossification, and sciatic nerve injuries, between the TXA and control groups. Conclusion: TXA did not demonstrate a significant benefit in reducing perioperative bleeding or complications in patients treated with ORIF for acetabular and pelvic fractures. The utilization of TXA in such clinical scenarios remains a topic necessitating further rigorous investigation to delineate its role in this clinical setting.

Background: Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs. Method: The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants. Results: A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P < 0.001; I² = 0%), fracture healing time (WMD = -1.54; 95% CI, -2.38 to -0.70; P < 0.001; I² = 92%), length of femoral neck shortening (WMD = -2.01; 95% CI, -3.11 to -0.91; P < 0.001; I² = 0%), femoral head necrosis (OR = 0.27; 95% CI, 0.08 to 0.83; P = 0.02; I² = 0%), implant failure/cutout (OR = 0.28; 95% CI, 0.10 to 0.82; P = 0.02; I² = 0%), and Visual Analog Scale Score (WMD = -1.27; 95% CI, -2.51 to -0.04; P = 0.04; I² = 91%). And the Harris Score was significantly higher in the FNS group than in the CS group (WMD = 4.15; 95% CI, 1.00 to 7.30; P = 0.01; I² = 89%). Conclusions: Based on this meta-analysis, FNS shows better clinical efficacy and safety in treating FNFs compared to CS. However, due to the limited quality and number of included studies and the high heterogeneity of the meta-analysis; large samples and multicenter RCTs are needed to confirm this conclusion in the future. Level of evidence: II, Systematic review and Meta-analysis. Trial registration: PROSPERO CRD42021283646.