Search

Objectives: This study presents our experience in surgical treatment of extravertebral bone hydatidosis and aims to investigate the utility of specific immunoglobulin E (IgE) in diagnosis and prognosis of the disease. Patients and methods: Between January 1990 and December 2019, a total of 10 patients (6 males, 4 females; mean age: 47.2±14.7 years; range, 27 to 71 years) with non-vertebral bone hydatidosis surgically treated in our hospital were retrospectively included. Curettage or wide resection was performed in all cases, followed by medical antihelminthic therapy. Specific IgE p2 was studied in seven patients during and at final follow-up. Results: At the time of diagnosis, secondary infection of the cyst was observed as the initial symptom in two patients mimicking an abscess and, in both cases, more surgeries were required without final healing. In two cases, over five specific IgE presented a false negative at the time of diagnosis and it was not correlated with clinical evolution in three cases over seven. In six cases, diagnosis was obtained before surgery. In treatment, pelvic disease had the worst prognosis (none healed) and bacterial overinfection was a common complication after surgery. At the final follow-up, only two femoral cases (20%) were free of disease. Other four cases (three in iliac bone, one in proximal femur) needed several surgeries without healing. The other four patients showed no progression or refused a new surgical treatment. Conclusion: Location, bone defect, when it is possible to perform a radical surgery, and associated bacterial overinfection after surgery make cystic hydatidosis in bone an infection very difficult to treat definitively in humans. Negative specific IgE does not exclude bone hydatidosis.

Objectives: This study aims to assess the development of osteoarthritis (OA) in granzyme A- (gzmA) and B- (gzmB) and perforin- (perf) knockout mice. Materials and methods: A total of 75 male and female C57BL/6 (eight to nine-week-old) mice were allocated to: gzmA-deficient (gzmA-/-) (11 females, 8 males), gzmB-deficient (gzmB-/-) (9 females, 8 males), perf-deficient (perf-/-) (10 females, 9 males), and control group (10 females, 10 males). Osteoarthritis was induced in the right knee by instability of the meniscus medial ligament. Sham surgery was practiced in the left knee. Knee samples obtained eight weeks after surgery were stained (Safranin-O) and blindly scored in lateral and medial femur and tibia using the Osteoarthritis Research Society International scale (OARSI) (from Grade 0, cartilage intact to 6, deformation), (five stages from 0, no OA to 4, >50% surface involvement); OARSI score (grade x stage); and a semi-quantitative scale from Grade 0 (normal) to 6 (cartilage erosion >80%). Results: Significantly higher values in all scales in the right knees compared to the left knees in male and female mice were observed (p

Las fracturas de fémur suponen en torno al 13% del total en el ser humano y deben ser tratadas quirúrgicamente tratando de conseguir la estabilidad necesaria para la consolidación. Ante la falta de evidencias en los conocimientos existentes, los estudios biomecánicos son de máximo interés, permitiendo establecer los protocolos de tratamiento óptimos. En este estudio se compara la biomecánica de una fractura femoral distal tratada con placa lateral y calvo retrógrado.

Introduction Intramedullary nailing is generally accepted as the first choice for the treatment of diaphyseal fractures of femur and tibia, with a gradual incease in the use of unreamed nails. Different studies during last years show controversial outcomes. Some authors strongly favor unreamed nailing, but most of the authors conclude that reamed nailing have proved to be more successful. Material and methods This study simulates unreamed intramedullary nailing of four femoral and three tibial fracture types by means of Finite Element (FE) models, at early postoperative stages with a fraction of physiological loads, in order to determine whether sufficient stability is achieved, and if the extent of movements and strains at the fracture site may preclude proper consolidation. Results The behavior observed in the different fracture models is very diverse. In the new biomechanical situation, loads are only transmitted through the intramedullary nail. Mean relative displacement values of fractures in the femoral bone range from 0.30 mm to 0.82 mm, depending on the fracture type. Mean relative displacement values of the tibial fractures lie between 0.18 and 0.62 mm, depending on the type of fracture. Concerning mean strains, for femoral fractures the maximum strains ranged between 12.7% and 42.3%. For tibial fractures the maximum strains ranged between 10.9% and 40.8%. Conclusions The results showed that unreamed nailing provides a very limited mechanical stability, taking into account that analyzed fracture patterns correspond to simple fracture without comminution. Therefore, unreamed nailing is not a correct indication in femoral fractures and should be an exceptional indication in open tibial fractures produced by high-energy mechanism.

The incidence of bone fracture has become a major clinical problem on a worldwide scale. In the past two decades there has been an increase in the use of computational tools to analyse the bone fracture problem. In several works, various study cases have been analysed to compare human and animal bone fracture healing. Unfortunately, there are not many publications about computational advances in this field and the existing approaches to the problem are usually similar. In this context, the objective of this work is the application of a diffusion problem in the model of the bone fragments resulting from fracture, working together with a mesh-growing algorithm that allows free growth of the callus depending on the established conditions, without a pre-meshed domain. The diffusion problem concerns the different biological magnitudes controlling the callus growth, among which Mesenchymal Stem Cells and chondrocytes concentrations were chosen, together with Tumour Necrosis Factor α and Bone Morphogenetic Protein as the factors influencing the velocity in the callus formation. A Finite Element approach was used to solve the corresponding diffusion problems, obtaining the concentration values along the entire domain and allowing detecting the zones in which biological magnitudes reach the necessary thresholds for callus growth. The callus growth is guided by a geometrical algorithm which performs an additional mesh generation process (self-added mesh) at each step of the iterative procedure until complete callus formation. The proposed approach was applied to different types of diaphyseal femoral fractures treated by means of intramedullary nailing. Axisymmetric models based on triangular quadratic elements were used, obtaining results in good agreement with clinical evidence of these kinds of fractures. The algorithm proposed has the advantage of a natural callus growth, without the existence of a previous mesh that may affect the conditions and direction of growth. The approach is intended for the initial phase of callus growth. Future work will address the implementation of the corresponding formulations for tissue transformation and bone remodelling in order to achieve complete fracture healing.

The objective is to establish the duration of our interventions, intermediate times and surgical performance. This will create a virtual waiting list to apply a mathematical programme that performs programming with maximum performance. Material and methods Retrospective review of 49 surgical sessions obtaining the delay in start time, intermediate time and surgical performance. Retrospective review of 4045 interventions performed in the last 3 years to obtain the average duration of each type of surgery. Creation of a virtual waiting list of 700 patients in order to perform virtual programming through the MIQCP-P until achieving optimal performance. Results Our surgical performance with manual programming was 75.9%, ending 22.4% later than 3 pm. The performance in the days without suspensions was 78.4%. The delay at start time was 9.7 min. The optimum performance was 77.5% with a confidence of finishing before 15 h of 80.6%. The waiting list has been scheduled in 254 sessions. Discussion Our manual surgical performance without suspensions (78.4%) was superior to the optimal (77.5%), generating days finished later than 3 pm and suspensions. The possibilities for improvement are to achieve punctuality at the start time and adjust the schedule to the ideal performance. The virtual programming has allowed us to obtain our ideal performance and to establish the number of operating rooms necessary to solve the waiting list created. Conclusions The data obtained in virtual mathematical programming are reliable enough to implement this model with guarantees.

Supracondylar femoral fractures account for a noticeable percentage of the femoral shaft fractures, affecting two etiological groups: high energy trauma in young men, with good bone quality, and older women with osteoporotic femur. Surgical treatment of those kind of fractures remains controversial, with different surgical options such as plate and sliding barrel locking condylar plate, less invasive stabilization system (LISS) or intramedullary nailing, which has emerged as a new fixation choice in the treatment of that type of fractures. The present work performs a comparative study about the biomechanical behavior of anterograde and retrograde nailing in supracondylar femoral fractures type A, in order to determine the best choice of nailing and locking configuration. A three-dimensional finite element model of the femur was developed, modeling femoral supracondylar fracture and different nailing configurations, both for anterograde and retrograde nails. The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. The obtained results show a better biomechanical behavior for anterograde nails, providing a better stability from the point of view of global movements, lower stresses in screws, and less stress concentration in cortical bone. So, for the analyzed fractures and osteosyntheses types, anterograde nailing has demonstrated to be a better surgical option, being an excellent indication in supracondylar fractures of femur, with clear benefits compared to retrograde nailing, providing a better stabilization which enables for a more satisfactory fracture healing.

The operation room (OR) is one of the most expensive material resources in hospitals. Additionally, the demand for surgical service is increasing due to the aging population, while the number of surgical interventions performed is stagnated because of budget reasons. In this context, the importance of improving the efficiency of the surgical service is accentuated. The main objective of this work is to propose and to evaluate a Decision Support System (DSS) for helping medical staff in the automatic scheduling of elective patients, improving the efficiency of medical teams&rsquo, work. First, the scheduling criteria are fixed and then the scheduling problem of elective patients is approached by a mathematical programming model. A heuristic algorithm is proposed and included in the DSS. Moreover, other different features are implemented in a software tool with a friendly user interface, called CIPLAN. Considering realistic data, a simulation comparison of the scheduling obtained using the approach presented in this paper and other similar approaches in the bibliography is shown and analyzed. On the other hand, a case study considering real data provided by the Orthopedic Surgical Department (OSD) of the &ldquo, Lozano Blesa&rdquo, hospital in Zaragoza (HCU) is proposed. The simulation results show that the approach presented here obtains similar occupation rates and similar confidence levels of not exceeding the available time than approaches in the bibliography. However, from the point of view of respecting the order of the patients in the waiting list, the approach in this paper obtains scheduling much more ordered. In the case of the Orthopedic Surgical Department of the &ldquo, hospital in Zaragoza, the occupation rate may be increased by 2.83%, which represents a saving of 110,000 euros per year. Moreover, medical doctors (who use this tool) consider CIPLAN as an intuitive, rapid and efficient software solution that can make easier the corresponding task.

Femoral shaft fractures present high morbidity and important complications and consequences, being spiral fractures the most complicated from a biomechanical point of view, being unstable and without possibility of getting a good contact between nail and femoral endosteum. Femoral diaphyseal fractures are treated, usually, by means of intramedullary nailing. So, it is necessary to know the osteosynthesis stability and which locking screws combination is optimal. This work studies the use of reamed locked intramedullary nails in spiral femoral fractures located along zones 2 and 4 of wiss, depending on the spire length, corresponding to 32-A spiral type in AO/OTA classification, which represent a percentage of 23% within the total of diaphyseal fractures. A three-dimensional finite element model of the femur was developed, modeling a spiral fracture with different spiral lengths and gaps. A femoral nail was used, considering two transversal screws both at the proximal and the distal parts. The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. Reamed intramedullary blocked nails provide appropriate stability of femoral spiral fractures, considering global mobility of femoral head with respect to femoral condyles, relative displacements between fragments at fracture site, stresses at nail and locking screws, and stresses at cortical bone. The obtained results show that the use of blocked reamed nails in spiral femoral fractures can be considered as an appropriate surgical technique, providing sufficient stability in order to obtain an adequate fracture healing.

Resumen Objetivo Estudiar las causas de produccion y resultados en los pacientes tratados con fractura interprotesica femoral. Material y metodos Revision retrospectiva de 7 pacientes tratados entre 2010 y 2013. Las artroplastias de rodilla tenian al menos 5 anos desde su implantacion y las de cadera menos de un ano siendo cementadas bipolares en 6 pacientes y total no cementada en un paciente, implantadas todas por una fractura desplazada del cuello femoral. Han sido tratadas mediante osteosintesis con placa de estabilidad angular abarcando todo el segmento femoral interprotesico. Excepto un paciente, los demas han sido revisados 12 meses como minimo. Resultados Han sido 6 mujeres y un hombre con edad media de 84,7 anos. La fractura, siempre por baja energia, se ha producido entre 2 y 8 meses tras la de cadera sin encontrarse movilizados los implantes, estando localizadas 4 de ellas a nivel diafisario y 3 a nivel supracondileo, sin relacion con el tipo de implante de rodilla. Se ha producido la consolidacion en todos los pacientes a los 4,5 meses de media sin reintervencion en ninguno de ellos y sin mortalidad en el tiempo que han sido controlados. Todos los pacientes deambulaban en carga en el momento de producirse la fractura y todos ellos han conseguido volver a deambular en carga, habiendo perdido como media 20° de flexion de rodilla en los casos de fractura supracondilea. Conclusiones Los factores mas importantes en nuestros pacientes con respecto a la produccion de la fractura han sido la alteracion de la capacidad de deambulacion tras la artroplastia de cadera y la fragilidad osea. La placa de estabilidad angular concede buenos resultados en el tratamiento de las fracturas interprotesicas femorales.

Mesenchymal stem cells (MSCs) are being investigated for the treatment of equine joint diseases because of their regenerative potential. Recently, the focus mainly has addressed to their immunomodulatory capacities. Inflammation plays a central role in joint pathologies, since the release of proinflammatory mediators to the synovial fluid (SF) leads to the activation of enzymatic degradation of the cartilage. MSCs can modulate the local immune environment through direct or paracrine interaction with immune cells, suppressing their proliferation and re-addressing their functions. Proinflammatory molecules can induce MSC immunoregulatory potential, but they could also increase the expression of immunogenic molecules. Studying the effect of inflammatory environment on MSC immunomodulation and immunogenicity profiles is mandatory to improve cellular therapies. The aim of this study was to analyse the response of equine bone marrow MSCs (eBM-MSCs) to three inflammatory conditions. Equine BM-MSCs from three animals were exposed to: (a) 20% allogeneic inflammatory SF (SF); (b) 50 ng/ml of TNFα and IFNγ (CK50) and (c) 20 ng/ml of TNFα and IFNγ (CK20). After 72 h of exposure, expression of immunogenic and immunomodulation-related molecules, including cell-to-cell contact and paracrine signalling molecules, were analysed by RT-qPCR and flow cytometry. The gene expression of adhesion molecules was upregulated whereas MSC migration-related genes were downregulated by all inflammatory conditions tested. CK culture conditions significantly upregulated the expression of COX-2, iNOS, IDO and IL-6. MHC-I gene expression was upregulated by all conditions, whereas MHC-II was upregulated only after CK priming. The expression of CD40 did not significantly change, whereas the ligand, CD40L, was downregulated in CK conditions. Flow cytometry showed an increase in the percentage of positive cells and mean fluorescence intensity (MFI) of the MHC-I and MHC-II molecules at CK50 conditions, supporting the gene expression results. These outcomes reinforce the change of the immunophenotype of the eBM-MSCs according to the surrounding conditions. Inflammatory synovial environment did not lead to significant changes, so the environment found by eBM-MSCs when they are intraarticular administered may not be enough to activate their immunomodulatory potential. CK priming at tested doses enhances the immunoregulatory profile of eBM-MSCs, which may promote a therapeutic benefit. Even if CK priming induced an upregulation of MHC expression, costimulatory molecule expression however was not upregulated, suggesting that immunogenicity might not be increased. This study provides a better understanding about the behaviour of eBM-MSCs inside the inflamed joint and constitutes a first step to improve MSC-based therapies for equine joint diseases.

Femoral shaft fractures are among the most prevalent fracture type, representing around 13% of total skeleton fractures. In addition, they are associated with high morbidity and mortality; consequently, they are among the most severe injuries of the skeleton. The most appropriate treatment depends on the type of fracture and location level. Intramedullary (IM) nailing is a common technique that is universally accepted to treat femoral diaphyseal fractures (zones 2 to 5 according to Wiss’ classification). Nevertheless, the treatment of fractures located in the distal third remains a controversial issue. Even if IM treatment is indicated, there are many types of nail geometries and materials, combinations of screws for stabilization, etc. Finite element analysis can be used for determining the most appropriate system. This can help surgeons to choose the best osteosynthesis in each case.

Medical doctors working in hospitals should spend their working time taking care of the patients. However, in the Spanish hospitals, they also play the role of decision makers being involved, for example, in scheduling surgeries in operation rooms. Although some doctors might be doing this for a long time, which give them experience in such decisions, the efficiency of the operation room can be improved with the help of some technical solutions that are the result of advance research in planning and scheduling surgeries. Such technical solutions can also decrease the overtime hours and reduce the under/over utilization of some operating rooms. This paper’s focus is to create such a solution that will help medical doctors to spend less time in managing tasks and have a better occupancy rate within the available capacity of the operation room. It will also decrease the stress level and allow the medical doctors to offer more of their time to healthcare. The contributions of this paper are: (i) a new heuristic algorithm for scheduling operations that do not require the use of any optimization tool, (ii) an in-built managing system for patients and operation rooms in the Operating Theater, and (iii) simulation results using real data in the proposed software tool. The created interface is intuitive and developed with direct feedback from doctors allowing different access level, for a better security of the medical data.

Intramedullary nailing (IM) is a technique universally accepted to treat femoral diaphyseal fractures. The treatment of fractures located in the distal third remains a controversial issue though. A finite element model of the femur has been developed, analyzing distal fractures with several gap sizes combined with different interlocking combinations of distal screws with one oblique screw proximally to stabilize the intramedullary nail. The mechanical strength of the nail against bending and compression efforts was also studied. Beside the FE simulations, a clinical follow-up of 15 patients, 6 males and 9 females, with mean age of 53.2 years was carried out. Localizations of fractures were 10 in the right femur and 5 in the left femur, respectively. A fairly good correspondence agreement between clinical results and the simulated fractures in terms of gap size was found. Non-comminuted fractures had a mean consolidation time of 20.5 weeks (4.8 months), a tendency corresponding well to the mobility obtained in the FE simulations; Comminuted fractures on the other hand exhibited a higher mean consolidation period of 22.2 weeks (5.2 months) secondary to the excessive mobility at fracture site obtained by means of FE simulations. The best stability at fracture site was found for the system with three distal screws and the system with two distal screws placed medial lateral. The highest leverage of distal screws was obtained maximizing the distance between them and choosing the coronal plane for their orientation. The results obtained with both nail materials (stainless steel and titanium alloy) show a higher mobility when using titanium nails. Steel nails provide stiffer osteosyntheses than the titanium nails. In conclusion, the best screw combination in terms of stability to produce fracture healing and the least difficulties during treatment is the one which had one oblique proximal screw with two distal lateral screw implanted in the coronal plane.

In this paper, the scheduling problem of elective patients in the Orthopedic Department of the “Lozano Blesa” Hospital in Zaragoza is considered. This problem takes into account two contradictory objectives: obtain a given occupation rate of the Operation Room (OR) and respect as much as possible the preference order of the patients in the waiting list. Three different mathematical models are discussed: 1) Quadratic Assignment Problem (QAP); 2) a Mixed Integer Linear Programing (MILP) model; and 3) Generalized Assignment Problem (GAP). These models solve combinatorial problems with a high computational cost; for this reason, heuristic methods have been used to solve large instances. In particular, 1) a meta-heuristic Genetic Algorithm (GA) for the QAP; 2) a heuristic Steepest Descent Multiplier Adjustment Method (SDMAM) for the GAP; and 3) a heuristic iterative method for MILP. Finally, the models and the heuristics are compared according to the occupation rate and the preference order criteria.

HEAT (Healthcare Efficiency and Effectiveness Analysis Tool) is a software application developed to support designing and analysis processes of the clinical pathways. It was developed in collaboration with the Hospital “Lozano Blesa” in Zaragoza, and is composed by two different tools. The first one, called HEAT-Scenario Designer, can be used to: (a) design new clinical scenarios, (b) check the correct use of resources and (c) check the correct communication strategies between several clinical pathways. To model clinical pathways, HEAT uses a domain specific modeling language (DSML), called Healthcare System Specification (HSS), being defined as an Unified Modeling Language (UML) profile. This language lets the medical personnel to describe the system without any knowledge of UML or other mathematical theory. Then, the tool can be used to transform the clinical pathways to Stochastic Well-formed Nets (SWN), a formal model that can be used latter for analysis by using available packages. The second tool of HEAT, called HEAT-Patients Monitor can be used to monitor the flow of patients that follow the modeled clinical pathways inside the hospital, providing to the medical doctors useful information about the behavior of the clinical pathways.

Mesenchymal stem cells (MSCs) are gaining relevance for treating equine joint injuries because of their ability to limit inflammation and stimulate regeneration. Because inflammation activates MSC immunoregulatory function, proinflammatory priming could improve MSC efficacy. However, inflammatory molecules present in synovial fluid or added to the culture medium might have deleterious effects on MSCs. Therefore, this study was conducted to investigate the effects of inflammatory synovial fluid and proinflammatory cytokines priming on viability and plasticity of equine MSCs. Equine bone marrow derived MSCs (eBM-MSCs) from three animals were cultured for 72 h in media supplemented with: 20% inflammatory synovial fluid (SF); 50 ng/mL IFN-γ and TNF-α (CK50); and 20 ng/mL IFN-γ and TNF-α (CK20). Proliferation assay and expression of proliferation and apoptosis-related genes showed that SF exposed-eBM-MSCs maintained their viability, whereas the viability of CK primed-eBM-MSCs was significantly impaired. Tri-lineage differentiation assay revealed that exposure to inflammatory synovial fluid did not alter eBM-MSCs differentiation potential; however, eBM-MSCs primed with cytokines did not display osteogenic, adipogenic or chondrogenic phenotype. The inflammatory synovial environment is well tolerated by eBM-MSCs, whereas cytokine priming negatively affects the viability and differentiation abilities of eBM-MSCs, which might limit their in vivo efficacy.

Mesenchymal stem cells (MSCs) have a great potential for treating equine musculoskeletal injuries. Although their mechanisms of action are not completely known, their immunomodulatory properties appear to be key in their functions. The expression of immunoregulatory molecules by MSCs is regulated by proinflammatory cytokines; so inflammatory priming of MSCs might improve their therapeutic potential. However, inflammatory environment could also increase MSC immunogenicity and decrease MSC viability and differentiation capacity. The aim of this study was to assess the effect of cytokine priming on equine bone marrow-derived MSC (eBM-MSC) immunoregulation, immunogenicity, viability, and differentiation potential, to enhance MSC immunoregulatory properties, without impairing their immune-evasive status, viability, and plasticity. Equine BM-MSCs (n = 4) were exposed to 5 ng/mL of TNFα and IFNγ for 12 h (CK5-priming). Subsequently, expression of genes coding for immunomodulatory, immunogenic, and apoptosis-related molecules was analyzed by real-time quantitative polymerase chain reaction. Chromatin integrity and proliferation assays were assessed to evaluate cell viability. Trilineage differentiation was evaluated by specific staining and gene expression. Cells were reseeded in a basal medium for additional 7 days post-CK5 to elucidate if priming-induced changes were maintained along the time. CK5-priming led to an upregulation of immunoregulatory genes IDO, iNOS, IL-6, COX-2, and VCAM-1. MHC-II and CD40 were also upregulated, but no change in other costimulatory molecules was observed. These changes were not maintained 7 days after CK5-priming. Viability and differentiation potential were maintained after CK5-priming. These findings suggest that CK5-priming of eBM-MSCs could improve their in vivo effectiveness without affecting other eBM-MSC properties.

This paper considers the operation scheduling and planning of elective patients in the Orthopedic Department of the “Lozano Blesa” Hospital in Zaragoza. We assume an ordered list of patients that should be planned for surgery in two available rooms, each room being possible to be used for a specific duration per day. Based on the average durations of surgeries that have been computed by considering historical information, we propose a Mixed Integer Linear Programming (MILP) problem to obtain a specific utilization rate per room. We have developed a Decision Support System (DSS) base on MILP that helps doctors in their daily planning. The results are tested on some real data from the hospital and some simulation results are provided.

Highlights • The propofol sedation should be complemented with skeletal muscle relaxants in the cardioversion therapy to avoid hip fracture in select patients with osteoporosis. • Hip fracture in osteoporotic bones should be considered after muscle violent contraction that causes hip pain and functional impotence., Introduction Trochanteric hip fractures in elderly patients with osteoporosis are commonly caused by low energy trauma. The cardioversion therapy is an extremely rare cause of this type of fracture. Presentation of case We report the case of a woman with hip fracture after cardioversion. Discussion We discuss the production mechanism of this injury and the importance of the care of the osteoporotic bone under these therapies. Conclusion The propofol sedation should be complemented with skeletal muscle relaxants in the cardioversion therapy to avoid hip fracture in select patients with osteoporosis.

This paper presents a modeling methodology for clinical guidelines used in hospitals. The clinical guidelines are assumed to be given in a graphical form in a structure obtained by combining few elements. It is shown how the clinical guidelines represented with this syntax can be automatically converted into a mathematical model represented as Petri nets. The main advantage of the new model is the inclusion of resources and patient flow in the same model which makes possible its use in analysis and verification of the guidelines. Moreover, if different clinical guidelines in a hospital or department in a hospital are considered, the models can be used for resource optimization and performance evaluation. The clinical guideline of hip fracture from the ”Lozano Blesa” University hospital in Zaragoza is taken as an example.

To determine whether administration of intravenous iron in a patient diagnosed with hip fracture reduces the need for blood transfusion.A retrospective observational case-control study was performed comparing a control group of 63 patients diagnosed with hip fracture with another group of 57 patients treated with parenteral iron. Demographic, clinical condition/clinical record and hematometric differences of the case-control patients were described. We analyzed the morbidity (post-surgical infection) and mortality rate. SPSS(®) was used for statistical studies.Being statistically significant, after the administration of intravenous iron sucrose, the need of blood transfusion was reduced in the case group, as well as the quantity of concentrates required (1.37 vs 0.6). In the case group, there was a statistically significant decreasing trend in hospital mortality rate (case group: 0.8%/control group: 8.3%). It was not been proven the relation between the decrease in nosocomial infection and the administration of intravenous ironThe administration of intravenous iron sucrose in patients diagnosed with hip fracture before surgery could be effective blood saving measure in this type of trauma surgery. Furthermore, its use has been reliable without causing any side effects.

This paper considers the operation scheduling and planning of elective patients in the Orthopedic Department of the “Lozano Blesa” Hospital in Zaragoza. We assume an ordered list of patients that should be planned for surgery. We propose a mixed linear integer programming problem to obtain a utilization rate of 80% per room. The results are tested on some real data from the hospital and some simulation results are provided.