Philadelphia College of Osteopathic Medicine

To evaluate whether preoperative intravenous tranexamic acid (TXA) reduces postoperative blood transfusion rates in geriatric patients undergoing operative treatment for hip fracture. Design: Prospective, double-blinded, randomized controlled trial terminated early after interim futility analysis. Single-center Level I trauma center. Patients aged ≥65 years who underwent operative treatment for femoral neck (AO/OTA 31-B), intertrochanteric region (AO/OTA 31-A), or subtrochanteric (AO/OTA 32-A/B/C) fractures between June 2019 and June 2022 were included. Procedures included arthroplasty (hemiarthroplasty or total hip arthroplasty), and internal fixation (ORIF) with intramedullary nailing or sliding hip screw fixation. Exclusion criteria were recent thromboembolic events, cancer, hypercoagulable disorders, or TXA allergy. The primary outcome was postoperative transfusion. Secondary outcomes included hospital length of stay (HLOS), 30-day readmission, and 90-day complications and mortality. Statistical comparisons were performed using odds ratios, chi-squared, and t-tests, with significance thresholds adjusted by O'Brien-Fleming criteria. 283 patients were analyzed (TXA: 146 (mean age 84 (range 65-100), 71.9% female; Placebo: 137 (mean age 83.1 (range 65-100), 77.2% female). Baseline characteristics, including BMI and procedure type, were comparable (all p> 0.05). 229 patients (80.9%) required no postoperative transfusion (TXA 81%; Placebo: 81%, p=0.97). No significant differences were observed in 30-day readmission (p = 0.729), 90-day complications (p = 0.183), HLOS (p = 0.783), or 90-day mortality (p = 0.655). Subgroup analysis revealed higher transfusion rates in ORIF versus arthroplasty (ORIF 25%, Arthroplasty 8%, p < 0.05), though no difference between TXA and placebo within subgroups (p=0.38). Preoperative TXA was not associated with reduced transfusion requirements in geriatric hip fracture surgery. No significant differences were observed in complications, mortality, or hospital stay. Surgical procedure may influence transfusion risk more than TXA use. Level I.

Introduction Lower extremity injuries are common in male professional soccer players, yet no known studies examine how these injuries impact return to play in these athletes. Objective To analyze whether lower extremity injuries affected the rate of return to play and performance in male Major League Soccer players. Materials/Methods Injury data from the 2018-2023 men’s professional soccer seasons for both Major League Soccer and International Leagues were collected from FBref, Transfermrkt, and the MLS Player Availability Report. Players were included if they experienced a lower extremity injury during the 2018-2023 soccer seasons. Injuries were included if they resulted in absence from a minimum of 14 days, including games or practices. Performance metrics were analyzed across three periods: short-term, defined as within the same year of injury; medium-term, up to one-year post-injury; and long-term, up to two years post-injury. Statistical analysis comparing performance metrics before and after the injury were conducted using Microsoft excel and Julius. Paired t-tests were used to asses statistical significance. Results Of the 1,522 total injuries from 2018-2023, 838 (55.1%) were considered lower extremity injuries. Among all positions, the knee was the most commonly injured structure (151.18%). The Center Back was the most commonly injured position (166 injuries, 19.8%). Conclusions Through the data, it was found that the knee was the most injured body part. Center Backs experienced both declines and improvements in performance metrics. Forwards demonstrated a decrease in goals per game and other offensive metrics following injury. These findings can help sports medicine professionals enhance patient recovery, prolong players’ career, and develop targeted injury prevention strategies by understanding the position specific impacts of lower extremity injuries on soccer performance.

ABSTRACTHeterotopic ossification (HO) following distal biceps tendon repair is an uncommon but potential complication. This may present pain, limited range of motion, or sensory changes due to nerve compression. This case study reports the case of a patient who developed significant functional limitation after primary distal biceps tendon repair complicated by heterotopic ossification. Radiographs confirmed extensive ossification surrounding the radial tuberosity. Plain radiographs were obtained to confirm the presence and maturity of the HO; a CT scan was performed to delineate the extent and proximity to the neurovascular bundle for operative planning. Surgical revision was performed using an Achillies tendon allograft to reconstruct the distal biceps tendon while excising the ossified tissue. Postoperatively, the patient experienced marked improvement in motion and resolution of pain. No recurrence was observed at follow‐up. This case emphasizes the importance of early recognition of heterotopic ossification after tendon repair and demonstrates that timely revision with an Achillies allograft can effectively restore elbow function and minimize recurrence.

Background and objectivesIron plays a critical role beyond erythropoiesis, yet the prognostic significance of iron deficiency (ID) independent of anemia remains poorly defined in the peritoneal dialysis (PD) population. This study aimed to evaluate the association between iron status, specifically transferrin saturation (TSAT), and mortality in PD patients, independent of hemoglobin levels.Design, setting, participants, and measurementsWe conducted a retrospective cohort study of 11,013 adults who initiated PD at a large US dialysis network between December 2004 and January 2011. Patients had at least 180 days on PD and baseline data on TSAT, ferritin, hemoglobin, albumin, and white blood cell count. The primary outcome was all-cause mortality. Broadly adjusted associations between iron parameters and mortality were assessed using Cox proportional hazards models and restricted cubic splines, with adjustments for demographic, clinical, treatment-related, and laboratory variables including hemoglobin and ESA use.ResultsIron deficiency, defined as TSAT ≤20%, was present in 10% of patients at PD initiation. The cohort was 54% male and 70% Caucasian, with a mean age of 55 years; 39% had diabetes. While 91% received erythropoiesis-stimulating agents, only 34% received IV iron. After comprehensive adjustment, TSAT ≤20% remained independently associated with increased mortality (adjusted HR: 1.26; 95% CI: 1.12-1.42). Spline analyses showed a sharp rise in mortality risk at TSAT levels below 25%. Ferritin was inconsistently associated with mortality risk. During follow-up, 2704 deaths occurred (24.6% of the cohort) over a median 440-day follow-up.ConclusionsIron deficiency is common in incident PD patients and is associated with increased mortality risk, independent of anemia. These findings challenge current anemia-centric treatment paradigms and suggest that iron status, particularly TSAT, should be routinely assessed in PD patients regardless of hemoglobin levels. A prospective, randomized trial is warranted to evaluate whether proactive iron management improves outcomes in this population.