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PubMed1996

[Postoperative stress on by dynamic hip screw or endoprostheses treated femoral neck and pertrochanteric femoral fractures in elderly patients].

Fractures of the neck and the pertrochanteric region of the femur in elderly patients are often treated with dynamic hip screw or endoprothesis. In the aftercare, specially in fractures that have been stabilised with a DHS, partial weight-bearing is recommended. Some other authors describe immediate full weight-bearing after osteosynthesis with the same implant. For elderly patients it is often difficult to apply partial weight-bearing on one limb only. Remobilisation as soon as possible is very important to these patients, to avoid postoperative complications. Therefore the allowance of full weight-bearing enables us to rehabilitate these old patients more appropriate. We have studied the rates of systemic and local complications in patients with different weight bearing on the operated hip with means of the data of the ASIF-documentation records. In patients who bear full weight on the operated limb immediately after operation, the rates of systemic complications are lower. The rates of local complications increased with the instability of the fracture. Both results are though not statistically significant.

Aged↗
PubMed1990

Performance of external fixation devices in femoral fractures; the ultimate challenge? A laboratory study with plastic rods.

Whether or not external fixation should be applied to the femur, and on what grounds, will depend upon a variety of factors. It is rarely considered to be the treatment of first choice. External fixation can, however, be indicated in certain circumstances. Looking for optimal rigidity in such cases we tested and compared the stability of 14 different femoral external fixators in an experimental model. It was found that the weight of the different frames varied from 400 to 2000 g. The comparative stability also varied widely. Movements of between 1 mm and 4 cm and rotations varying from almost 0 degrees to 16 degrees were measured at the (experimental) fracture site, based upon the geometry of an adult patient. In view of this finding primary bone-healing would not be expected to occur, since it demands more stability than external femoral fixation can offer. A relatively simple two-dimensional (unilateral) frame can be as rigid as a three-dimensional one, in response to all but transverse loading.

Adult↗
PubMed1994

[Femoral fractures close to the hip--an epidemiological study in the county of Southern Jutland].

During the period 1986-1991 a total of 3159 patients with diagnosis of either subcapital, intertrochanteric or subtrochanteric fracture were registered in the County of Southern Jutland in order to make a prognosis for the next twenty years. Contrary to other investigations an exponential increase in fractures was not seen, but only an increase related to the rising number of elderly people in the population.

Adult↗
PubMed1991

[Has the dynamic hip screw justifiably replaced Ender nailing in the management of hip para-articular femoral fractures of the A1-A3 and B2 type?].

The results obtained in 167 extracapsular fractures of the hip are presented. Ender's pins were used in 82 cases and the dynamic hip screw (DHS) in 85. Comparison of different aspects (handling, postoperative mobility, complication rate, mortality) shows that the second operating procedure named DHS is highly suitable for the treatment of fractures A1-A3 and B2 (Müller classification) and superior to the procedure with Ender's pins.

Aged↗
PubMed1992

Whole-body and site-specific bone remodelling in patients with previous femoral fractures: relationships between reduced physical activity, reduced bone mass and increased bone resorption.

1. A new tracer method is described for the non-invasive measurement of bone formation in the proximal femur. The method is based on our previously described whole-body method using 85Sr as the tracer (Reeve, J., Hesp, R. & Wootton, R. Calcif. Tissue Res. 1976; 22, 191-206). It allows correction to be made for long-term exchange processes within the skeleton. 2. The method has been applied in a study of regional and whole-body bone formation in 12 rehabilitated patients who had previously suffered a fracture of the proximal femur. Twelve healthy control subjects were studied, who were selected for their good health and continued physical activity. The aim was to explore the relationship between bone formation and physical activity. 3. Bone formation was similar in the two groups, both regionally and in the whole body. Based on analyses of four cadaver specimens, bone formation in the proximal femur was about one and two-thirds times that in the whole skeleton when related to mass of calcium in the region of interest. 4. Whole-body bone resorption, estimated from five measurements per subject of hydroxyproline excretion in relation to creatinine excretion, was significantly higher in the fracture patients (P < 0.01, Wilcoxon's test). 5. Estimates of current physical activity (and immediate pre-fracture physical activity) were made with a newly devised questionnaire. Historical levels of physical activity (at ages 15-45 years) were determined with Astrom's questionnaire. No bone formation index correlated with any index of physical activity. Urinary hydroxyproline excretion correlated inversely both with current physical activity and historical physical activity (for both regression coefficients P < 0.01). 6. The results are discussed in the light of our current understanding of the control of bone remodelling by the discrete basic multicellular units of bone. The opportunity to study regional bone resorption by the additional use of serial dual X-ray absorptiometry of the same region will in future allow the direct monitoring of the effects of therapeutic interventions which have been designed to prevent contralateral hip fracture.

Aged↗
PubMed1990

[A femur head preserving osteosynthesis procedure in para-articular femoral fracture of the hip in cardiopulmonary at-risk patients].

A series of 224 patients with fractures near the hip joint underwent internal fixation with conservation of the femoral head. Between January 1983 and December 1987 the operations with conservation of the femoral head were performed with Ender pins and Böhler nails. From January 1988 to December 1988 dynamic hip screws (DHS) were used exclusively for conservation of the femoral head. The patients were divided into three risk groups by preoperative cardiac and pulmonary risk score. In a retrospective study we compared different osteosyntheses for lethality, complications and duration of stay in hospital. The lethality with DHS was lower in risk groups II and III. The complication rate was significantly lower (P less than 0.05) in the group with DHS. The duration of hospital stay was significantly shorter (P less than 0.001) in the group in which DHS were used.

Aged↗
PubMed1992

[The gamma-nail as a resilient alternative to the dynamic hip screw in unstable proximal femoral fractures in the elderly].

In a prospective randomised trial between September 1989 and June 1990 one hundred patients with per- and subtrochanteric fractures were consecutively treated by gamma-nail or DHS. The average age of both groups was about 80 years. The operation time for gamma-nailing was longer than for DHS implantation and also the postoperative blood loss was higher in the gamma-nail group. We found no difference of intraoperative blood loss, of perioperative lethality and in duration of hospital care. 90% of gamma-nail patients and 80% of DHS patients were successfully able to walk four days after operation with full weight bearing on the operated limb. Three patients in the DHS group with unstable fractures got cranial perforation of the cephalic screw mobilisation. Five patients of the gamma-nail group were reoperated, one case because of missed distal locking, one because of cranial perforation of the cephalic screw after varus dislocation of the proximal fragment. One patient suffered intraoperatively a proximal femur shaft fracture which was corrected during operation. In one case a wound hematoma was evacuated, an other patient needed secondary wound closure. Despite technical imperfection of implant and instruments, we conclude that the gamma-nail allows a very high percentage early and full weight bearing immediately after operation. So we consider that in the treatment of unstable pertrochanteric fractures of geriatric patients, the gamma-nail has proven to be more efficient than the DHS.

Aged↗
PubMed1983

Condylocephalic nailing of proximal femoral fractures.

The use of a closed nailing technique for elderly patients with intertrochanteric fractures has resulted in a substantially improved mortality. The incidence of fixation failures and degree of shortening are similar to that experienced with sliding screw and sliding nail plate systems. However, since rotational deformities may occur, the procedure is most beneficial for debilitated patients with intertrochanteric fractures, who represent substantial surgical risks. In general, subtrochanteric fractures occur in a younger group of patients. Since the proximal fragment is usually much larger and the quality of bone superior in this group of patients, the fixation failure rate was extremely low and significant loss of rotatory reduction did not occur. The body of experience gained in recent years with closed nailing techniques for femoral shaft and tibial fractures is directly applicable to the closed nailing of intertrochanteric and subtrochanteric fractures. Extremely comminuted fractures or long oblique fractures may shorten, and rotatory reduction and control must always be a concern. These difficulties must be weighed against the advantages of a negligible infection rate and extremely low nonunion and implant failure rates.

Bone Nails↗
PubMed2003

Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults.

BACKGROUND: Displaced intracapsular fractures may be treated by either reduction and internal fixation which preserves the femoral head, or by replacement of the femoral head with an arthroplasty. OBJECTIVES: To review all randomised trials that have compared internal fixation and arthroplasty. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002), MEDLINE (1966 to January 2002), EMBASE (1988 to 2002, Week 2), Current Contents (1993 to 2002, Week 4), PREMEDLINE (January 2002) and selected orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists where possible. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing internal fixation with arthroplasty for intracapsular hip fractures in adults. DATA COLLECTION AND ANALYSIS: Trial quality was assessed by use of a 10 item scale. Data from the majority of trials were independently extracted by three reviewers with the remaining extracted by two. Additional information was sought from trialists. After grouping into three broad categories, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed effects model. MAIN RESULTS: Thirteen trials involving 2091 patients were included. Internal fixation had a reduced length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection. Arthroplasty had a lower re-operation rate in comparison with fixation. No definite differences for hospital stay, mortality, degree of residual pain, regain of mobility or regain of same residential state were found. REVIEWER'S CONCLUSIONS: Internal fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and there is still a need for studies to define which patient groups are better served by the different treatment methods.

Adult↗
PubMed2005

[Expense analysis of the proximal femoral fractures treatment].

The aim of this paper was to provide estimated average costs of the hip fractures in the national scale by means of the analysis of the treatment expenses of 256 injured patients who were operated in the 1st Surgical Clinic of the General Teaching Hospital in Prague in 2002. Particular cost items as operation costs, price of the implant, hospitalization expenses by the categories and price of blood derivates were figured out. The follow-up treatment after hospital discharge like price per bed, expenses for general practicioner etc. was considered as well. Each patient was observed for the period of one year after the operation. As a result we came to the total sum of 120,000 Kc per one patient per year. The way to reduce hip fractures treatment cost does not certainly lead to deterioration of medical care quality but to proper treatment of osteoporosis which is the principal cause of these injuries.

Aged, 80 and over↗
PubMed2006

Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures.

A biomechanical investigation on eight pairs of human cadaver proximal femurs was performed to evaluate the impact of a new augmentation method on the internal fixation of osteoporotic proximal femur fractures. The study focused on enhancing implant purchase to reduce the incidence of implant cut-out in osteoporotic bone. In a left-right comparison, a conventional hip screw fixation (control) was compared to the new cement augmentation method. After bone bed preparation through high pressure irrigation to remove fat, blood, and bone debris, the bones were augmented with low viscosity polymethylmethacrylate (PMMA) cement. Step-wise fatigue testing was performed by cyclically loading the femoral heads in a physiological manner, beginning at 1,500 N and increasing 500 N every 5,000 cycles to 4,000 N, and continuously monitoring head displacement. Failure was defined as >5.0 mm head displacement. The head displacement at 2,000 N was significantly smaller (p=0.018) for the augmented group as compared to the conventionally treated bones (0.09+/-0.01 mm vs. 0.90+/-0.32 mm; mean+/-SEM). The displacement rate at the second load step was significantly higher (p=0.018) for the conventionally treated bones as compared to the augmented ones. All of the nonaugmented specimens failed during testing, where 50% of the augmented specimens did not fail. The promising results of these experiments suggest that this new standardized irrigation/augmentation method enhances the implant anchorage and offers a potential solution to the problem of implant cut-out in osteoporotic metaphyseal bone.

Biomechanical Phenomena↗
PubMed1997

Subtrochanteric femoral fractures in children. Alignment after 90 degrees-90 degrees traction and cast application.

Fifteen children younger than 10 years of age with subtrochanteric fractures treated by a uniform method were evaluated. These patients had been treated with femoral skeletal traction, with the hip and knee flexed to 90 degrees until radiographic callus appeared, then with a hip spica cast. True neck to shaft and anteversion angles were calculated bilaterally using a biplanar method. Leg lengths were measured radiographically and clinically. Mean age at injury was 4.5 years, and mean followup was 6.5 years. Overgrowth averaged 10 mm after fracture. Anteversion at final followup differed only by a mean of 2 degrees from the contralateral side (range, -3 degrees to +4 degrees), and the mean neck shaft angle differed by only 1 degree. Remodeling of coronal angulation was 50% or more in all cases.

Adolescent↗
PubMed1990

[Decreasing risk by individualized timing of surgery of para-articular femoral fractures of the hip in the elderly].

While there is no doubt about the importance of early operation of fractures of the proximal femur in the very old the exact timing of the operation is still in discussion. Routine emergency operation is opposed to a carefully planned individual timing of surgery. The advantages of a medical and anesthesiological pretreatment could be clearly demonstrated in an own series of 107 patients older than 85 treated for fracture of the proximal femur in the last three years. Hospital mortality was lowered from 18.9 to 9.1%. At the same time the rate of severe complications and the length of hospital stay were reduced significantly.

Aged↗
PubMed1979

Treatment of subcapital femoral fractures by primary total hip replacement.

Primary total hip replacement for displaced subcapital fractures may be performed with an acceptable mortality. The majority of a series of patients who were reviewed after operation experienced few symptoms and 87 per cent were able to walk independently. These results compared favourably with other forms of management, and deterioration was seldom observed.

Aged↗
PubMed1999

[Economic aspects of treatment of proximal femoral fractures in the Czech Republic].

BACKGROUND: The number of publications evaluating economic and social aspects of the treatment of proximal femur fractures increased steadily in the last 20 years in the foreign literature. Due to the absence of similar studies in the domestic literature the authors decided to investigate this issue in the Czech Republic and to present outcomes. The aim of the presented study is to inform about the costs of treatment of patients with proximal femur fractures in an orthopaedic department and estimate the costs of such treatment on a nationwide scale. METHODS AND RESULTS: A detailed follow up of 244 patients treated for a proximal femur fracture was carried out at the Orthopaedic Clinic of the 3rd Medical Faculty and Faculty Hospital, Královské Vinohrady in 1997, including economic aspects and the fate of patients after their discharge from the hospital in the course of one year after their injury or surgery. The average cost of primary treatment of a patient in this group amounted to 38,000 Kc, on a nation-wide scale this sum totalled 29,000. The obtained results were compared with national data acquired from the Institute of Health Care Informations and Statistics and from the General Health Insurance Company. The monitored group accounted for 2% of the national group of patients with this diagnosis. CONCLUSIONS: Exact data on the costs of primary treatment of patients with a proximal femur fracture were obtained only in the monitored group of our patients, in 1997 these costs amounted to 9,389,848 CZK. The costs in the whole Czech Republic may be only estimated at approximately 450 million CZK.

Adult↗
PubMed1995

[Rehabilitation after trochanteric femoral fractures].

Hip fractures constitute an increasing problem due to the associated lengthy hospitalization, pressure on orthopaedic units and the frequently serious consequences for the health and social function of the patients. The outcome of rehabilitation following hip fractures depends on several prefracture risk factors with only limited possibilities for intervention. Modern surgical techniques permit early mobilisation and possible changes in surgical procedures will probably not essentially influence the outcome of rehabilitation. Foreign experiences, however, suggest that early transfer to a specialized unit for rehabilitative aftercare involves more effective rehabilitation with reduced consumption of resources.

Aftercare↗