TECHNICAL SECTION
Bone wax following proximal femoral osteotomy in total hip replacement R Middleton, S McDonnell, A Taylor Nuffield Orthopaedic Centre, UK CORRESPONDENCE TO Robert Middleton, E: [email protected]
Figure 4 Gentle retraction with the left-handed instrument allows manipulation of the Hartmann’s pouch medially and laterally
Any means of reducing blood loss during total hip replacement is beneficial. Following femoral neck osteotomy, the cut femoral end is usually left. This is a potential source of significant low pressure ooze, which can account for a sizeable proportion of intraoperative blood loss and may also obscure the surgical field. Cheap and easily available bone wax, first described in 1892, can be smeared across the cut trabecular surface following femoral osteotomy (Fig 1). The wax is later removed on broaching the femur. This simple and cost effective method can limit bone bleeding intraoperatively and can help maintain a clear surgical field.
DISCUSSION
For the experienced laparoscopic surgeon, this tip makes manoeuvrability of the thickened, impacted Hartmann’s pouch simpler. We have used it in the acute and elective setting to great effect. The tape provides gentle traction and can be resited easily if there are any concerns about placement as dissection continues.
Figure 1 Bone wax applied to femoral osteotomy demonstrating complete haemostasis from cut surface
164
Ann R Coll Surg Engl 2014; 96: 163–171
Bone wax following proximal femoral osteotomy in total hip replacement R Middleton, S McDonnell, A Taylor Nuffield Orthopaedic Centre, UK CORRESPONDENCE TO Robert Middleton, E: [email protected]
Figure 4 Gentle retraction with the left-handed instrument allows manipulation of the Hartmann’s pouch medially and laterally
Any means of reducing blood loss during total hip replacement is beneficial. Following femoral neck osteotomy, the cut femoral end is usually left. This is a potential source of significant low pressure ooze, which can account for a sizeable proportion of intraoperative blood loss and may also obscure the surgical field. Cheap and easily available bone wax, first described in 1892, can be smeared across the cut trabecular surface following femoral osteotomy (Fig 1). The wax is later removed on broaching the femur. This simple and cost effective method can limit bone bleeding intraoperatively and can help maintain a clear surgical field.
DISCUSSION
For the experienced laparoscopic surgeon, this tip makes manoeuvrability of the thickened, impacted Hartmann’s pouch simpler. We have used it in the acute and elective setting to great effect. The tape provides gentle traction and can be resited easily if there are any concerns about placement as dissection continues.
Figure 1 Bone wax applied to femoral osteotomy demonstrating complete haemostasis from cut surface
164
Ann R Coll Surg Engl 2014; 96: 163–171
