Background: To determine patients clinical and haematological characteristics that could affect the use of blood and infection incidence with hip fractures (HF) treated with a dynamic hip screw (DHS).

Patients and Methods: A retrospective study of all the HF patients during 5 years (January1995- December1999) who were treated with a dynamic hip screw (DHS ïf’, Synthes-Stratec, Oberdof, Switzerland) at one unique university hospital. No patient was excluded. Age, gender, elapsed time, anaesthesia risk (ASA clasification), type of HF (internationalAO classification), transfusion procedure and the total used; haemoglobin (Hb) at days 0 (incoming to urgency service) and first postoperative (POD ï€1) were examined. We also analyzed the infection incidence (CDC criteria), place and severity. The statistical univariate analysis included Student’s t-test for numeric variables and Pearson’s chi-squared test for string variables. There was considered to be a statistically significant difference (SSD) when p< 0.05. A multivariate stepwise logistic regression model was used.

Results: Three hundred and one patients with HF were studied. 125 A1 and 176 A2, according to the AO classification. Male/female ratio: 76/225 (25.2%/74.8%); age 78.97 years old (range: 23–104); ASA: I 53 (17.6%); II 97 (32.2%); III 138 (45.8%) and IV 13 (4.3%). Hb Values on the day of admission: 128.7 g/L (range: 81.7–176.7) and POD ï€1: 101 g/L (range: 54.7–150.7). 186 (61.8%) patients were transfused with an average 1.42 red cell concentrate (range: 0–6). 89 (29.6%) had an infection diagnosis: 79 (26.2%) urinary tract infection (UTI), 7 (2.3%) pneumonia and 8 (2.7%) superficial wound. 18 (6%) died in the first month.

At univariant study of transfusion act, the transfused patients were older (p< 0.001), suffered more infections (p:0.019), more UTI (p:0.003), had lower Hb day 0 (p< 0.001) and POD ï€1(p< 0.001). When analyze the infection, the patients were older (p< 0.001), had higher ASA (p:0.019), lower Hb at day0 (p< 0.026), longer stay (p< 0.001), were more transfused (p:0.019), and received more transfusions (p:0.004). The logistic regression analysis identified only the type of HF, the age and the Hb level (p< 0.05) as independent predictors of transfusion.

Comments: In patients with HF the Hb is the most important predictor of blood transfusion, and it is associated with a higher rate of post surgical infection and longer hospital stays. These complications may be explained by the possible inmunomodulation effect of allogenic blood transfusion.

Aims: The purpose of our study was to evaluate the results of using a longitudinal oblong revision (LOR) cup in the management of types III and IV acetabular defects. Methods: Thirty-þve longitudinal oblong revision (LOR) cups were used to reconstruct 29 type III and 6 type IV acetabular defects. Defects were þlled with morcellized allografts in all cases. Structural allografts were used in 2 cases. All patients were followed up for 2 to 6 years (mean, 3.3 years). Results: At latest follow-up, 32 cups were stable (91.4%) and 3 had migrated (8.6%). Two of these cups failed one year after surgery and one four years postoperatively. We found a signiþcant relation between an incomplete cup contact with the acetabular rim and the subsequent failure (p=0.042). The postoperative abduction angle was signiþcantly increased in the group of unstable cups (p=0.032). Pain, limp, use of walking aids, functional level and limb-length discrepancy signiþcantly improved postoperatively (p< 0.0001). Conclusions: For patients with type III and IV acetabular defects, this implant provided encouraging clinical results and showed satisfactory stability at early to midterm follow-up.

Introduction and Objectives: This study examines the need for transfusion in trauma surgery for subcapital fractures of the femur (SFF) in a tertiary hospital and analyzes possible predictive factors.

Materials and Methods: A prospective study was done using patients requiring surgical treatment for SFF in the year 1998. Patients younger than 65 years, those with hemopathies, and patients undergoing anticoagulant therapy were excluded from the study. The following variables were analysed: age, sex, haemogram at time of admission (haemoglobin [Hb], haematocrit [Hct], mean corpuscular volume [MCV], mean corpuscular haemoglobin [MCH], anisocytosis [area under the curve or AUC]; preoperative and postoperative Hb and Hct (preoperative values only if surgery did not take place within 48 hours of admission); time to surgical intervention, transfusions, and use of blood derivatives.

Results: The study included 75 patients operated on for SFF. These included 18 with B1 fractures, 8 with B2, and 49 with B3 based on AO classification. There were 12 males and 63 females, and average age was 81 years (standard deviation [SD]=8). Average values upon admission were as follows: Hb 128 (SD=23) g/l, Hct 39% (SD=6%), MCH 30.3 pg, MCV 91.4 fL, and AUC 14.3%. Average time to surgical intervention was 5 days (SD=2.8). Types of surgical intervention included 23 screws (31%) and 52 partial hip prostheses (69%). Preoperative average haemogram values were Hb 119 (SD=12) g/l and Hct 36% (SD=4%). Forty-one patients (55%) received transfusions of concentrated red cells. Of these, 8 (11%) were preoperative, 8 (11%) were perioperative, and 31 (41%) were in the immediate postoperative period. Gender, age, MCV, MCH, and time to surgery were not found to be related to the need for transfusion. On the other hand, correlations were found between Hb at time of admission, postoperative Hb, anisocytosis, type of fracture, and type of surgical intervention. The only variable independently-related to the need for transfusion was Hb at time of admission.

Discussion and Conclusions: In spite of the urgent nature of these cases, the results of this study suggest a need for further studies designed to improve the haematologic parameters for these elderly patients upon admission, such as the adoption of less aggressive measures and the establishment of a blood storage system for high-risk patients, with the aim of reducing the need for transfusions and the inherent risks of allogeneic blood transfusions.