Reduction of postoperative bleeding following operative treatment of proximal humerus fractures using a collagen sponge

Sylvia Doleschal, Thomas Schmickal, Alexander Schuh
DOI: 10.4236/health.2010.212211                

Abstract

Aim of the present study is to investigate the efficacy and safety of TachoSil® to reduce afterbleeding and hematoma following operative treatment of proximal humerus fractures. In a prospective randomized study we included a consecutive series of 40 patients with a proximal humeral fracture in this study. All fractures were stabilized surgically with a fixed-angle “Philos plate” from May 2008 through May 2009. All patients were divided in two groups: Group I with plate osteosynthesis without TachoSil, Group II with plate osteosynthesis with TachoSil. For statistical analysis Chi2- Test and U- Test were used. There were 4 perioperative complica- tions in group II and one complication in group I (Chi2-Test: p=0.233). In group II one hardware failure occurred due to osteoporosis requiring revision and reosteosynthesis. Another patient suffered from paralysis of the radial nerve which healed uneventfully. One superficial postopera-tive infection and one superficial hematoma re-quired revision surgery, too. In this group no subfascial hematoma developed. One subfascial hematoma which required no revision occurred in group I. Blood transfusion was required 2 times in group I and 3 times in group II (Chi2-Test: p = 0.549). In sum in group II there was a sig-nificant lower blood loss for the subfascial drain, the region where TachoSil was applied. No ad-verse affects related to TachoSil could be de-tected. TachoSil was found to be safe and effective for reduction of postoperative bleeding following operative treatment of proximal hume-rus fractures. Further studies with larger sample size are required to confirm the efficacy of TachoSil® in orthopedic surgery.

Keywords

Hematoma; TachoSil; Proximal Humerus Fracture; Plate Osteosynthesis; Reduction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	P. Helwig, C. Bahrs, B. Epple, J. Oehm, C. Eingartner and K. Weise. “Does fixed-angle plate osteosynthesis solve the problems of a fractured proximal humerus? A prospective series of 87 patients”. Acta Orthop. Vol. 80, 2009, pp. 92 - 6.
[2]	J.B. Erhardt, G. Roderer, K. Grob, T.N. Forster, K. Stoffel and M.S. Kuster. “Early results in the treatment of proximal humeral fractures with a polyaxial locking plate”. Arch Orthop Trauma Surg. Vol. 129, 2009, pp. 1367 - 1374.
[3]	A.M. Foruria, M.T. Carrascal, C. Revilla, L. Munuera and J. Sanchez-Sotelo.” Proximal humerus fracture rotational stability after fixation using a locking plate or a fixed-angle locked nail: The role of implant stiffness”. Clin Biomech (Bristol, Avon). Vol. 25, 2010, pp. 307 - 311.
[4]	D.M. Friess and A. Attia. “Locking plate fixation for proximal humerus fractures: a omparison with other fixation techniques”. Orthopedics. Vol. 31, 2008, pii: orthosupersite.com/view.asp?rID=34698.
[5]	G. R?derer, M. AbouElsoud, F. Gebhard, L. Claes, A.J. Aschoff and L. Kinzl. “Biomechanical investigation of fixed-angle plate osteosynthesis of the proximal humerus”. Unfallchirurg. Vol. 113, 2010, pp. 133 -138.
[6]	N. Südkamp, J. Bayer, P. Hepp, C. Voigt, H. Oestern, M. K??b, C. Luo, M. Plecko, K. Wendt, W. K?stler and G. Konrad. “Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study”. J Bone Joint Surg Am. Vol. 91,2009, pp. 1320 - 1328.
[7]	B.D. Solberg, C.N. Moon, D.P. Franco and G.D. Paiement.”Surgical treatment of three and four-part proximal humeral fractures”. J Bone Joint Surg Am., Vol. 91, 2009, pp. 1689 - 1697.
[8]	U. Anegg, R. Rychlik and F. Smolle-Jüttner. “Do the benefits of shorter hospital stay associated with the use of fleece-bound sealing outweigh the cost of the materials?” Interact Cardiovasc Thorac Surg., Vol.2, 2008, pp. 292 - 296.
[9]	G. Bajardi, F. Pecoraro and D. Mirabella. “Efficacy of TachoSil patches in controlling Dacron suture-hole bleeding after abdominal aortic aneurysm open repair.” J Cardiothorac Surg. Vol. 4, 2009, pp. 60.
[10]	A. Frilling, G.A. Stavrou, H.J. Mischinger, B. de Hemptinne, M. Rokkjaer, J. Klempnauer, A. Th?rne, B. Gloor, S. Beckebaum, M.F. Ghaffar and C.E. Broelsch. “Effectiveness of a new carrier-bound fibrin sealant versus argon beamer as haemostatic agent during liver resection: a randomised prospective trial”. Langenbecks Arch Surg. Vol. 390, 2005, pp. 114 - 120.
[11]	S. Haas. “The use of a surgical patch coated with human coagulation factors in surgical routine: a multicenter postauthorization surveillance”. Clin Appl Thromb Hemost. Vol. 12, 2006, pp. 445 - 450.
[12]	A. Rickenbacher, S. Breitenstein, M. Lesurtel and A. Frilling. “Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery--a systematic review”. Expert Opin Biol Ther., Vol. 9, 2009, pp. 897 - 907.
[13]	S. Siemer, S. Lahme, S. Altziebler, S. Machtens, W. Strohmaier, H.W. Wechsel, P. Goebell, N. Schmeller, R. Oberneder, J.U. Stolzenburg, H. Becker, W. Lüftenegger, V. Tetens V and H. Van Poppel.”Efficacy and safety of TachoSil as haemostatic treatment versus standard suturing in kidney tumour resection: a randomised prospective study”. Eur Urol. Vol. 52, 2007, pp. 1156 - 1163.
[14]	C.S. Neer.”Displaced proximal humeral fractures. I. Classification and evaluation”. J Bone Joint Surg Am., Vol. 52, 1970, pp. 1077 - 1089.