Authors (including presenting author) :
Tam JPH (1), Yung C (1), Fang C (1)
Affiliation :
(1) Department of Orthopaedics & Traumatology, Queen Mary Hospital
Keyword 1: :
patella fracture
Keyword 3: :
intra-articular cocktail
Introduction :
Patella fracture commonly occurs after a fall on a flexed knee, treatment can be conservative or surgical with open reduction and internal fixation (ORIF). Patients often experience significant pain around the knee post-operatively, limiting their walking ability and hinders their rehabilitation . As a result, total hospital stay will be prolonged, leading to hospital stay related morbidity and additional healthcare economic burden.
Objectives :
This study investigated the effect of a single dose intra-operative intra-articular cocktail injection in Patella ORIF, assessing the degree pain relief and functional recovery among groups that received intra-articular cocktail injection compared with those who did not receive any intra-articular injection.
Methodology :
A single centre, prospective, double-blinded randomised control trial. Patients with acute traumatic patella fracture requiring surgery and whom fulfilled the inclusion criteria are randomized to no injection (control) vs intra-operative intra-articular cocktail injection (intervention). The “cocktail” contains Ketoralac, Ropivacaine, Adrenaline and Stacort, the total volume was around 50 milliliters. It was administered under aseptic condition before wound closure. Primary outcome measures include pre-operative, post-operative visual analog pain score (VAS), range of active knee flexion, quality of recovery score, frequency and type of analgesics consumed during the early post-operative 2 weeks period. Secondary outcomes include total hospital stay, Lysholm knee score and Knee Injury and Osteoarthritis Outcome Score (KOOS). Subjects and assessors were both blinded to the treatment randomization. We hpothesise the “cocktail” can reduce pain score, improve range of motion, improve quality of recovery, reduce analgesics usage and reduce total length of hospital stay.
Result & Outcome :
54 subjects are recruited (27 control, 27 intervention). Operations were performed by surgeons with varying experience. Fixation methods were decided according to the fracture pattern and surgeon preference. There were no immediate post-operative complications. Intervention group demonstrated a 3.7 reduction in VAS compared with 2.1 in the control group (p< 0.05) from pre-operative to discharge day. There was no statistically significant improvement in range of motion when compared to the control group. At 2 weeks follow up, the mean Lysholm Knee Score was 73.1 (IA group) vs 54.2 (control group), KOOS was 77.2 (IA group) vs 61.1 (control group). IA group consumed less and lower level of analgesics in the post-operative 2 weeks period. There was also a slight positive health-economic effect as IA group required 0.8 day shorter hospital-stay compared to control group (p< 0.05). IA cocktail is a promising route of analgesics delivery in patella ORIF, with targeted pain relief at the operative site, reducing analgesics consumption and its related complications. This is the first RCT assessing the use of intra-articular cocktail injection for patella fracture fixation surgery. The results demonstrated intra-Operative intra-Articular Cocktail Injection is an effective mode of analgesics delivery. IA cocktail contributed to a statistically significant reduction in pain score, improved functional recovery and reduced total hospital stay. Future studies should focus on the different combination of drugs with a longer follow up on patient rehabilitation and fracture healing.
