Ipsilateral proximal and shaft femoral fractures: Results of two treatment strategies.

INTRODUCTION: Ipsilateral proximal and shaft femoral fractures typically occur in young adults after high-energy trauma. No consensus exists regarding the optimal internal fixation device or surgical strategy for these complex fractures. Our main objective is to identify differences on outcomes and complications between patients treated with one or combined implants. MATERIAL AND METHOD: This is a single-center retrospective cohort study in patients with associated fractures of the proximal (31 AO) and shaft femur (32 AO). We divided the patients into two groups according to the use of single (Group I) or combined implants (Group II). Demographic, clinical, radiological, surgical data and development of complications were collected. RESULTS: We identified 28 patients (19 men and 9 women) with an average age of 43 years. We used an anterograde femoral nail in group I (17 patients) and a retrograde femoral nail or a plate associated with hip lag screws or sliding hip screw in Group II (11 patients). Patients were followed up for 26.28 (9.12-62.88) months. Osteonecrosis of the femoral head, osteoarthritis, infection or nonunion was found in 9 patients (32%). No significant differences (p 0.70) were found in complications between two groups or between definitive surgical fixation before or after the first 24h. CONCLUSIONS: No differences in the development of complications or timing of definitive fixation were found between the use of one or combined implants in ipsilateral proximal femur and shaft fractures. Regardless of the implant chosen, an appropriate osteosynthesis technique is crucial, even so high complication rates are expected. LEVEL OF EVIDENCE: IV. Grade of Recommendation: C.

[Erythrocyte morphometry in alcoholism]. / Morfometría eritrocitaria en el alcoholismo.

The aim of this study is to evaluate the erythrocyte morphology (area, perimeter, shape) and its correlation with high alcohol intake and the conventional blood test (MCV, GOT/GPT, and activated PTT). 60 persons were studied (20 non-drinkers, 20 chronic alcoholics and 20 with hepatic cirrhosis). The erythrocyte area and perimeter was significantly higher, in patients other than the group of non-drinkers. This is directly related to the alcohol intake and liver damage. We believe, that the study of the morphology of the erythrocyte is of interest as a "biological marker" related to the grade of alcoholism.

[Effect of chronic hypobaric hypoxia on water distribution in the rat]. / Efecto de la hipoxia hipobárica crónica sobre la distribución del agua en la rata.

Rats of both sexes chronically submitted to a simulated sltitude of 4700 m (440 mm Hg) in a hypopressure chamber show a different behavior in relation to total body water. The aim of the present work was to analyze the behavior of body fluids in these conditions in order to precise whether or not the observed change in total body water is accompanied by a difference in its distribution. Male, female and castrated female rats, submitted to 440 mm Hg during nine months and their respective controls maintained at ambient pressure, were used. At the end of that period, and previous insertion of a carotid cannula, total water, extracellular fluid and blood volume were determinated by isotopic dilution techniques (Fig. 1), using tritiated water, radiosulfate and 131I human serum albumin, respectively. Blood samples were obtained without interruption of the hypopressure. Immediately after the experiments, the animals were sacrificed and total body fat was determined. Results, expressed in percentage of lean body mass (Table 1), showed that in intact female rats the increase in total body water would be due to an increase in interstitial water volume and that there was a significant decrease in plasma water volume. On the other hand, in castrated females, exposure to hypoxia produced dehydration, by a decrease in intraellular water, without significant changes in plasma water volume. The results in males showed a tendency in the same direction, but the differences were not statistically significant. The difference found in water distribution can be adscribed to an effect of estrogens, which may be direct or mediated by other endocrine factors.