Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician.

BACKGROUND: Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment. METHODS: A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded. RESULTS: Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03). CONCLUSION: The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.

[Adjuvant treatment of diabetic foot]. / Trattamenti adiuvanti del piede diabetico.

A diabetic infected foot with erythema and fluctuation can suspect that the infection has passed the fascial compartmental, a condition that requires surgical drainage. Elective amputation may be considered for patients who have recurrent ulcers, irreversible loss of function or injuries that require long-term treatment in the hospital. If the diabetic infected foot appears ischemic it requires a treatment of revascularization. The outcome of revascularization is related with the extension of the damaged artery. The debridement removes the bacterial colonies, promotes granulation tissue and its reepithelialization, also facilitates the collection of samples for microbiological analyses. This procedure can be performed with the classic sharp instruments or with advanced autolytic dressings, maggots or ultrasonic equipment. The use of hyperbaric oxygen therapy in the treatment of infected diabetic foot is controversial because studies in this area are few and methodologically questionable. The same conclusion was reached also for the use of growth factors and skin substitutes.

[Streptococcus gordonii extensive multiple subcutanoeus abscesses]. / Ascessi sottocutanei multipli di vasta estensione da Streptococcus gordonii.

We describe extensive multiple subcutaneous abscesses involving the peri-scapular region, the right posterior and lateral peri-trochanteric area and ipsilateral thigh occurring in a 66-years-old woman. Streptococcus gordonii was identified as the unique pathogen. Despite this microrganism is generally considered not pathogenic, it has been previously described as responsible for two cases of peritonitis and one case of endocarditis. The patient has been treated with immediate surgical incision and drainage and was cured after two months of antibiotic therapy, medications and hyperbaric oxygen therapy.