Purpose: We set four objectives: compare compression plate with locking screw, assess bone graft usefulness, assess utility of resection and compression of fracture site, and determine prognostic factors.

Materials and methods: A multicentre study was carried out including Sant Pau, Valle de Hebròn and IMAS hospitals in Barcelona. 54 surgical cases treated from 1994 to 2003 were included for retrospective study. Three groups of factors were analysed: familial, factors associated with the initial trauma and those associated with the surgical procedure. We studied the statistical relation to consolidation, consolidation time and postoperative complications.

Results: The following factors significantly enhanced consolidation (p< 0.05): treatment with nail in atrophic pseudoarthrosis and plate in hypertrophic. Consolidation time was significantly shortened (p< 0.05) if fractures were initially simple (type A) and for those initially treated conservatively. Postoperative complications were reduced (p< 0.05) in fractures that were initially simple (type A).

Conclusions: There were no differences between the two implants studied in terms of consolidation, consolidation time and complications. However, cases of atrophic pseudoarthrosis had a better outcome with nails and the hypertrophic cases with plates. Bone grafts did not improve results. Compression of the fracture site was a determining factor in achieving consolidation; therefore, open intramedullary nailing should be performed to this end. Simple fractures and fractures initially receiving conservative treatment were good prognostic factors following pseudoarthrosis surgery.

Introduction and purpose: Methods are needed to store blood for scheduled surgery with high transfusion requirements. We evaluated the transfusion requirements in patients undergoing surgery for total hip replacement (THR) and the results of the autotransfusion programme.

Materials and methods: We assessed 211 patients who underwent primary or secondary THR between November 1999 and November 2004 and were included in the blood-storing programme. The variables analysed were: sex, age, operation, start of weight bearing, hospital stay, units extracted and transfused, basal hemoglobin and follow-up and use of allogeneic blood.

Results: 177 patients entered the programme, 14 on EPO and 13 with no blood-storing procedure. The mean age was 61.8. The male/female ratio was 1.5, and 109 patients (52%) were transfused. We found differences (p< 0.01) between non-transfused and transfused patients in relation to their basal Hb (14.4 vs 13.7), start of weight bearing (4.6 vs 9.6 days) and hospital stay (9.1 vs 10.3 days). Of the patients in the autotransfusion programme, 58% (103) required transfusion and used 54% of the units extracted. Seven percent (13) required allogeneic blood. Of 138 patients with primary THR, 80 were transfused – 83% women and 36% men (p< 0.001). Of the 39 revision THRs, 23 patients were transfused with no differences between the sexes. Overall, 31 units of allogeneic red cell concentrate were used, 192 autologous. 87 patients required 2 units, 15 patients 1 unit and one patient 3 units.

Conclusions: The autotransfusion programme for THR patients is adequate for storing allogeneic blood. Nevertheless, it should be included in this protocol via an individualised interdisciplinary programme.