fibrin and Femoral-Neck-Fractures

The effect of a low-dosage regimen of ancrod in the prevention of postoperative deep vein thrombosis was assessed in 24 patients having surgical repair of fractured neck femur and compared with 25 control patients who did not receive therapy. The objective of the therapy was to lower the preoperative fibrinogen level and produce a low concentration of fibrin degradation products yet avoid the haemorrhagic complications of total defibrination. Ancrod therapy proved feasible to carry out, was not associated with haemorrhagic complications, and produced sustained, predictable reductions in fibrinogen concentration. There were seven thromboembolic complications in the control patients compared to one such complication in the ancrod-treated patients. Five deaths occurred in the control group and one in the treated group. Though the incidence of deep vein thrombosis was not apparently affected by ancrod it appeared on venography that the thrombi in the treated patients were less extensive than those in the control patients. Finally, some discrepancies in the diagnosis of deep vein thrombosis by the three techniques of clinical examination, (125)I-fibrinogen scanning, and ascending venography were identified.

Topics: Aged; Anticoagulants; Clinical Trials as Topic; Female; Femoral Neck Fractures; Fibrin; Fibrinogen; Hemagglutination Inhibition Tests; Humans; Injections, Intravenous; Iodine Radioisotopes; Peptide Hydrolases; Phlebography; Postoperative Complications; Radionuclide Imaging; Thromboembolism; Thrombophlebitis; Venoms

Fat embolization following major trauma is reported to be a quite common event, while the clinical fat embolism syndrome (FES) seems to be a much rarer event. Fat embolism occurs in 2 up to 23% of patients with isolated femoral shaft fractures. This complication appears to be related not only to the fracture, but also to the timing of stabilization. Sometimes it may be impossible to perform histochemical reactions on frozen sections to detect fat emboli thus confirming diagnosis or suspicion of FES. The finding of fibrinogen and platelets around the apparently empty spaces in the blood vessels has been proposed as an evidence for vital reaction due to either a vital cellular reaction or a flotation mechanism, thus supporting an intravital fat embolism. We report a fatal case due to fat embolism syndrome in a young man hospitalized for a right femoral neck fracture, treated with orthopaedic surgery and subjected to an intra-surgery transesophageal echocardiography that revealed embolization of numerous highly echogenic bodies. Four hours after the onset of clinical symptoms the man died from respiratory failure. The autopsy confirmed the clinical diagnosis of fat embolism syndrome. The histological examination revealed a large amount of fat globules in cerebral and pulmonary arteries and in glomerular capillaries, as well as fibrin and platelet deposition confirmed by the positive results by Sudan III staining for lipids and immunohistochemistry with anti-CD61 and anti-fibrinogen antibodies. The quantitative classification of fat embolism was grade 3 of Sevitt's classification or grade 4 of Fineschi's quantification, according to the current quantitative microscopic methods used for grading fat embolism in pulmonary tissue.

Topics: Adult; Antibodies; Blood Platelets; Capillaries; Echocardiography, Transesophageal; Embolism, Fat; Femoral Neck Fractures; Fibrin; Fibrinogen; Forensic Pathology; Humans; Immunohistochemistry; Integrin beta3; Lung; Male; Microscopy, Confocal; Pulmonary Artery; Respiratory Insufficiency; Syndrome

Topics: Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Male; Risk

Topics: Aged; Angiography; Antigens; Female; Femoral Neck Fractures; Fibrin; Fibrinogen; Fibrinolysis; Heart Failure; Humans; Iodine Radioisotopes; Male; Neoplasm Metastasis; Postoperative Complications; Pulmonary Embolism; Radionuclide Imaging; Sepsis; Thrombophlebitis

Topics: Acrylates; Arthroplasty; Bone Diseases; Callosities; Cell Movement; Edema; Female; Femoral Neck Fractures; Femur Neck; Fibrin; Humans; Joint Prosthesis; Male; Middle Aged; Ossification, Heterotopic; Plastics