Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año / Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality

Revisar el tratamiento perioperatorio de los pacientes con fracturas de cadera y tratamiento concomitante con antiagregantes plaquetarios, así como analizar las diferencias de mortalidad al año, y el sangrado perioperatorio según la pauta de cirugía precoz (< 48 h) vs. demorada (> 5 días). Paralelamente, determinar al ingreso y en el preoperatorio inmediato la agregabilidad plaquetaria en todos los pacientes incluidos en el estudio. Pacientes y método. Sobre 175 pacientes mayores de 65 años con fractura de cadera de baja energía se aleatorizaron 3 grupos: antiagregados con cirugía precoz, antiagregados con cirugía demorada, y no antiagregados con cirugía precoz; se recogieron prospectivamente los mismos datos clínicos y analíticos para todos ellos. La agregabilidad plaquetaria se determinó mediante un sistema informatizado semicuantitativo basado en la agregometría por impedancia en sangre completa. Resultados. El sangrado, los requerimientos transfusionales y los resultados analíticos no mostraron diferencias estadísticamente significativas entre los grupos. Un 59,8% de los pacientes que no referían tomar antiagregantes se encontraban analíticamente antiagregados al ingreso, mientras que un 13,5% de los que tomaban antiagregantes no se encontraban correctamente antiagregados. El análisis multivariante mostró mayor mortalidad a 12 meses para las variables del índice de Barthel bajo previo a la fractura (OR: 0,9-0,9) y número de transfusiones (OR: 1,1-1,5). La estancia media fue de 4,1 días mayor en el grupo demorado. Conclusión. La pauta de cirugía precoz para los pacientes en tratamiento antiagregante tiene resultados clínicos parecidos a la demorada, pero mejora la eficiencia hospitalaria al reducir la estancia media. La antiagregación farmacológica referida por el paciente resultó poco concordante con la determinación de la agregabilidad(AU)

Objective. A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study. Patients and methods. A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Results. Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. Conclusion. Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation(AU)

[Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality]. / Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año.

OBJECTIVE: A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study PATIENTS AND METHODS: A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. RESULTS: Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. CONCLUSION: Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.

Innervation of biceps brachii and brachialis: Anatomical and surgical approach.

This study describes the anatomy of the musculocutaneous nerve (MCN) in the middle and lower thirds of the arm, with special reference to the motor branches to the biceps and brachialis muscles, given their importance in certain clinical, particularly surgical, procedures. In each dissection (46 upper limbs) we recorded the course of the MCN and its variations, and the number, type of distribution pattern and length of the motor branches to the biceps brachii and brachialis muscles. We also recorded the position at which those branches arose from the MCN trunk. We found three branching patterns for biceps brachii: 1) one branch (60.5%); 2) two branches, one for each biceps head (27.9%); and 3) two branches, one for the two biceps heads and one for the common belly (11.6%). The mean distance between the acromion and the motor branches to biceps brachii was 133.8 mm, 45.3% of the acromion-lateral epicondyle distance. The mean length of those branches was 31.2 mm. We found two branching patterns for brachialis: 1) one branch (72.1%); and 2) two branches (27.9%). These motor nerves to brachialis arose from the MCN at a mean distance of 185.3 mm, 61.5% of the acromion-lateral epicondyle distance, and their average length was 33.0 mm. The data were expressed as the percentage of the distance between the acromion and the lateral epicondyle of the humerus, to make their clinical use easy and to avoid errors caused by anthropometric differences.

Contribution of femoral and proximal sciatic nerve branches to the sensory innervation of hindlimb digits in the rat.

The present study was performed to investigate the possibility of "aberrant" innervation of the tips of the hindlimb digits in the rat, i.e., from other sources than the femoral and the main sciatic branches (tibial, peroneal, sural). Cutaneous injections of fluorescent tracers in the digits were combined with either selective nerve transections to restrict afferent routes followed by detection of labeled neurons in dorsal root ganglia (DRGs), or by a delayed application of a second tracer to afferent nerves under study to detect double labeled neurons in DRGs. The results show that the tips of the digits were represented in DRGs L3-6. The femoral nerve afferents from digits 1 and 2 projected primarily to DRG L3 and to a smaller extent to DRG L4. A small number of neurons from primarily medial digits 1 and 2, but also from lateral digits 3-5, were found to project to DRGs L4 and L5 via a proximal branch that leaves the sciatic nerve near the sciatic notch and runs distally in the posterior part of the thigh, here called the musculocutaneous nerve of the hindlimb. We also have some evidence indicating innervation of the tips of the digits from the posterior cutaneous nerve of the thigh. Aberrant innervation such as that described here might contribute to remaining and perhaps abnormal sensibility after nerve injury and is of interest for the interpretation of results in experimental studies of collateral and regenerative sprouting after such injury.