Jorge Cuenca

Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study.

BACKGROUND:  Patients undergoing pertrochanteric hip fracture (PHF) repair surgery often receive perioperative allogeneic blood transfusions (ABTs) to avoid the deleterious effects of anemia. Nevertheless, concerns about adverse effects of ABTs have prompted the review of transfusion practice and the search for a safer treatment of perioperative anemia.

Perioperative intravenous iron, with or without erythropoietin, plus restrictive transfusion protocol reduce the need for allogeneic blood after knee replacement surgery

BACKGROUND:  Unilateral total knee replacement (TKR) results in a substantial blood loss and 30 to 50 percent of patients receive allogeneic blood transfusion (ABT). Therefore, the effectiveness of a restrictive transfusion trigger (hemoglobin [Hb] level < 8 g/dL) plus stimulation of erythropoiesis was evaluated, with or without blood salvage, for reducing ABT in TKR patients.

Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study

Background and Objectives  Patients undergoing surgery for hip fracture (HF) often receive perioperative allogeneic blood transfusions (ABT) to avoid anaemia. However, concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia.

Very‐short‐term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients

Postoperative nosocomial infection (PNI) is a severe complication in surgical patients. Known risk factors of PNI such as allogeneic blood transfusions (ABTs), anemia, and iron deficiency are manageable with perioperative intravenous (IV) iron therapy. To address potential concerns about IV iron and the risk of PNI, we studied a large series of orthopedic surgical patients for possible relations between IV iron, ABT, and PNI.

Efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in patients undergoing surgery for hip fracture repair. An observational cohort study

Background  Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl.

Allograft reconstruction of segmental defects of the humeral head associated with posterior dislocations of the shoulder

Six men underwent operative management of defects of the humeral head involving at least 40% of the articular surface, following posterior dislocation of the humeral head. The cause of dislocation was a grand mal seizure in three and a fall in three cases. In five cases the dislocation was reduced under general anaesthesia, and in all the posterior dislocation recurred early. Time between dislocation and surgery ranged from 7 to 8 weeks. The defect in the head, revealed by CT, was filled with an allogeneic segment of humeral head contoured to restore the spherical shape. All the patients returned to their occupation 4 months later. The mean duration of follow-up was 62.6 (60-68) months. At discharge, four of the men had no complaints of pain, instability, clicking or catching; two had pain, clicking, catching and stiffness. Radiographs and CT revealed no failures of fixation or of incorporation of the allograft. In four cases the contour and volume of the graft were maintained, but in the two with a bad clinical result, flattening and collapse of the graft and osteoarthrosis were observed. If the procedure fails, prosthetic reconstruction should be simple because the skeletal anatomy has not been distorted.

Knee arthrodesis with the Wichita fusion nail.

We reviewed 32 patients who all had knee arthrodesis performed after failed knee replacement. The minimum clinical follow-up was 1 year. The arthrodesis was performed by means of the Wichita fusion nail in 11, by external fixation in 15 cases, by plating in three and by intramedullary nailing in three. The mean patient age was 68.6 years. When the Wichita nail was used, fusion was achieved in ten out of 11 cases after a mean period of 4.5 (3–7) months. Of the remaining 21 patients, fusion was only achieved in 11 cases after a mean period of 6.5 (4.5–10) months.RésuméNous avons examiné 32 malades, avec un suivi minimum d’un an, après arthrodèse du genou pour échec de remplacement prothétique. L’arthrodèse a été exécutée au moyen d’un clou de Wichita dans 11 cas, par fixation externe dans 15 cas, par plaque vissée dans trois cas en plaquant et par enclouage centromédullaire dans trois cas en. L’âge moyen des patients était 68.6 années. Quand le clou Wichita a été utilisé la fusion a été réalisée dans 10 cas sur 11 après une période moyenne de 4.5 (3–7) mois. Chez les 21 autres malades, la fusion a été réalisée 11 fois, après une période moyenne de 6.5 (4.5–10) mois.

Late lower extremity fractures in patients with paraplegia

We report the result of the treatment of 26 lower limb fractures in patients with established paraplegia. We treated one fracture of the femoral neck, one intertrochanteric, two subtrochanteric, two of the femoral shaft, seven of the supracondylar region, six of the proximal tibia, one of the tibial shaft, and six pilon fractures. Nine fractures were treated non-operatively, and the remaining fractures were treated operatively. Union was achieved in all the patients, but we think that open reduction and internal fixation may improve the level of independence and mobility of these patients during fracture healing.

Predeposit autologous donation in spinal surgery: a multicentre study

BackgroundAllogeneic blood transfusions (ABT) are often necessary in elective spine surgery because of perioperative blood loss. Preoperative autologous blood donation (PABD) has emerged as the principal means to avoid or reduce the need for ABT. Consequently, a multicentre study was conducted to determine the yield and efficacy of PABD in spine surgery and the possible role of recombinant human erythropoietin (EPO) in facilitating PABD.MethodsWe retrospectively reviewed the hospital charts and blood bank records from all consecutive spine surgery patients who were referred for PABD. Data were obtained from two A-category hospital blood banks and one general hospital. Although we collected data from 1994, the analytic study period was from the last quarter of 1995 to December 2003. Fifty-four (7%) out of 763 patients referred for PABD were rejected, and medical records were available for 680 patients who were grouped into spinal fusion (556; 82%) and scoliosis surgery (124;18%). EPO was administered to 120 patients (17.6%). From 1999 to 2003, PABD steadily increased from 60 to 209 patients per year.ResultsOverall, 92% of the patients were able to complete PABD, 71% were transfused, and almost 80% avoided ABT. PABD was more effective in fusions (86%) than in scoliosis (47%). Blood wastage was 38%, ranging from 18% for scoliosis to 42% for fusions. EPO allowed the results in the anaemic patients to be improved.ConclusionsTherefore, despite the limitations of this retrospective study, we feel that PABD is an excellent alternative to ABT in spine surgery. However, the effectiveness of PABD may be enhanced if associated with other blood-saving techniques.

Good results with unreamed nail and bone grafting for humeral nonunion A retrospective study of 21 patients

21 patients with humeral shaft nonunions were treated by retrograde nailing with the unreamed humeral nail. In all cases, we reamed the fracture site and performed a bone graft. Union of the fracture occurred in every case. The mean healing time was 4.2 (4-6) months. The range of motion of the shoulder and elbow was excellent in 14 patients, that of the shoulder moderate in 6 and poor in 1, and that of the elbow moderate in 7. The functional results were excellent in 13 patients, good in 5 and fair in 3. Given the good functional results in this series, retrograde locked nailing and bone grafting appears to be a good method for treating humeral shaft nonunions.