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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (1): 172-177. doi: 10.19723/j.issn.1671-167X.2025.01.026

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Early efficacy of local tranexamic acid in reducing postoperative swelling in hallux valgus surgery

Ning SUN, Xuewen WANG, Yong WU*(), Shuang REN, Heng LI, Hui DU, Xiaofeng GONG   

  1. Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
  • Received:2023-05-18 Online:2025-02-18 Published:2025-01-25
  • Contact: Yong WU E-mail:yongwu11@126.com
  • Supported by:
    the Beijing Jishuitan Hospital Faculty Research Project(YGQ-202213)

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Abstract:

Objective: To evaluate the early efficacy of local application of tranexamic acid on the osteotomy surface during hallux valgus surgery in reducing postoperative occult blood loss and thus postoperative swelling. Methods: The data of 40 cases with hallux valgus osteotomy admitted to the Department of Foot and Ankle Surgery of Jishuitan Hospital from July 11, 2022 to October 8, 2022, including 5 males and 35 females were retrospectively analyzed. According to the inclusion and exclusion criteria, 32 cases were finally divided into 16 cases in the observation group (application of tranexamic acid) and 16 cases in the control group (no application of tranexamic acid). The observation group was paired with the control group one by one in accordance with the operation style, and the change in the anterior and posterior diameter of the first metatarsal head, the change in the circumferential diameter of the foot, the length of the first metatarsal midline and the length of the plumbline of the foot measured by postoperative CT were compared between the two groups before and after surgery, in order to evaluate the degree of swelling around the incision after the surgery. The first metatarsal midline and plumb line were measured by reference to the two auxiliary lines that intersect the soft tissue border in the sesamoid bone position to measure the rotation angle of the first metatarsal. A total of three clinicians completed the measurements of these two line segments and interobserver comparisons were performed. Results: By interobserver comparison, the consistency of the length of the midline of the first metatarsal and the plumbline measured by CT was high and could be considered a reliable measurement. After the paired t-test, there was no statistical difference in the amount of changes in the anteroposterior diameter of the first metatarsal before and after surgery between the observation and control groups (P>0.05), and the amount of changes in the circumferential diameter of the foot before and after surgery was smaller in the observation group than in the control group, which was statistically significant (P < 0.05); the length of the midline of the first metatarsal and the plumbline of the foot measured by CT after surgery was smaller in the observation group than in the control group, which was statistically significant (P < 0.05). Conclusion: Local application of tranexamic acid on the osteotomy surface during hallux valgus osteotomy can relieve postoperative swelling to some extent, which may be related to the fact that tranexamic acid reduces occult blood loss in the postoperative period.

Key words: Tranexamic acid, Hallux valgus, Topical administration, Swelling

CLC Number: 

  • R687.3

Table 1

Basic information about the included 32 patients"

Group n Age/years, ${\bar x}$±s Gender   Side BMI/(kg/m2), ${\bar x}$±s AOFAS forefoot score, ${\bar x}$±s
Male Female Left Right
Observation group 16 52.44±12.39 1 15   11 5 24.2±4.24 69.94±8.76
Control group 16 43.50±17.60 2 14 8 8 22.2±2.45 65.50±11.84
t   1.463     1.543 1.162
P   0.164 >0.999 0.180 0.144 0.263

Figure 1

Illustration of the measurement of the anterior-posterior diameter of the first metatarsal head (A) and the circumferential diameter of the foot (B)"

Figure 2

Illustration of the CT measurement of the midline of the first metatarsal and the plumbline of the foot A, to find the right coronal level in the horizontal and sagittal positions of the CT; B, to measure the midline of the first metatarsal (line α) and the plumbline of the foot (line β)."

Table 2

Consistent results of the CT measurements of the length of the first metatarsal midline and the plumbline after surgery"

Items First metatarsal midline/cm, ${\bar x}$±s Plumbline of the foot/cm, ${\bar x}$±s
Observer 1 4.15±0.60 4.22±0.66
Observer 2 4.14±0.57 4.21±0.63
Observer 3 4.19±0.56 4.24±0.64
ICC 0.988 0.987
95%CI 0.980-0.993 0.979-0.993
P < 0.001 < 0.001

Table 3

Comparison of preoperative, postoperative anteroposterior diameter of the first metatarsal head and the amount of change between the two groups"

Group Preoperative/cm, ${\bar x}$±s Postoperative/cm, ${\bar x}$±s Amount of change/cm, ${\bar x}$±s
Observation group 30.93±2.97 39.96±4.43 9.04±3.76
Control group 31.38±3.38 41.68±2.44 10.30±4.12
t 0.443 1.570 0.795
P 0.664 0.137 0.439

Table 4

Comparison of preoperative, postoperative circumference of the foot and amount of change between the two groups"

Group Preoperative/cm, ${\bar x}$±s Postoperative/cm, ${\bar x}$±s Amount of change/cm, ${\bar x}$±s
Observation group 22.40±1.06 22.39±1.13 -0.012±0.43
Control group 22.71±1.19 23.16±1.00 0.44±0.72
t 0.806 2.529 2.521
P 0.433 0.023 0.023

Table 5

Comparison of postoperative CT-measured first metatarsal midline and the plumbline between the two groups"

Group First metatarsal midline/cm, ${\bar x}$±s Plumbline of the foot/cm, ${\bar x}$±s
Observation group 4.23±0.47 4.30±0.51
Control group 4.61±0.34 4.74±0.40
t 2.686 2.994
P 0.017 0.009
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