Back to 2025 Abstracts
THAW A Prospective Randomized Control Trial Comparing Hand Edema Post Operatively in Patients given TXA vs placebo before Dupuytren's Excision and Distal Radius Fixation: A pilot study
Alexandra Munn, MD, MSc, FRCSC
1; Joy MacDermid, BScPT, MSc, PhD
2; Kendrick Au, MD, MSc, FRCSC
1; Douglas C. Ross, MD, MEd, FRCSC
3; Ruby Grewal, MD, MSc
41Western University, London, ON, Canada; 2Hand and Upper Limb Center, University of Western Ontario, Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada; 3Plastic Surgery/ Hand and Upper limb Centre, Division of Plastic Surgery, Roth|McFarlane Hand & Upper Limb Centre/Co-Director, The Peripheral Nerve Clinic, Western University, London, ON, Canada; 4Hand and Upper Limb Center, Western University, London, ON, Canada
Hypothesis Edema is a common but potentially devastating sequalae after hand surgery. At this time, treatment strategies are targeted towards reducing edema once it has developed. Tranexamic acid (TXA) is an antifibrinolytic agent that has been proven to reduce edema and blood loss and is now routinely used in trauma and arthroplasty surgery. The purpose of this trial is to evaluate the efficacy of TXA in reducing post-operative edema in hand surgery.
Methods This was a prospective, randomized, placebo-controlled, double-blinded pilot study designed to test intravenous TXA effect on swelling after Dupuytren's limited fasciectomy surgery or open reduction and internal fixation (ORIF) of distal radius fractures. Patients 18 years old undergoing either a limited fasciectomy or distal radius ORIF using a volar approach were included. Patients were randomized to TXA or placebo. The first dose was administered preoperatively before entering the operative room and the second dose was administered post operatively. Patient demographics were collected for comparison between treatment groups. The primary outcome measure was the of the change in hand volume over time using volume displacement method and figure- of- eight measurements. Secondary outcomes include patient rated hand and wrist evaluation (PRWHE), Numeric Rating Scale (NRS) for postoperative pain, and tip-to-palmer crease distance measurements.
Results Seventy three patients consented to this pilot study. Twenty nine patients with distal radius fractures met inclusion criteria with mean age of patients in this cohort was 59 years and 22 patients were female. Thirty eight patients with Dupuytrens disease undergoing partial fasciectomy met inclusion criteria and mean age of the group was 64.8 and 12 were female. The mean figure of eight and mean water displacement measurements trended to smaller measurements at time points further from surgery for both Dupuytren's disease and distal radius ORIF. The group receiving TXA had values that were consistently improved compared to the control group but did not achieve statistical significance at any time point (Figure 1.).
Conclusions This pilot study provided insight into hand edema trends after two common hand surgeries. We found that TXA improved hand swelling measurements as compared to control groups at every time point after surgery. A larger multicentre randomized clinical trial comparing tranexamic acid with placebo in postoperative hand and wrist edema is feasible based on our trial.
Back to 2025 Abstracts
