Does the type of hip fracture affect functional recovery in elderly patients undergoing inpatient rehabilitation?

BackgroundHip fractures should not be considered as a single, homogeneous condition. Various determinants of functional recovery of patients with hip fracture have been proposed, such as age or type of fracture. The aim of this study was to determine if patients with an intertrochanteric fracture (ITF) had lower functional recovery characteristics with respect to those with a femoral neck fracture (FNF).MethodsA retrospective study was carried out on 531 elderly patients with hip fracture, surgically treated, admitted to a rehabilitation institute between December 1, 2014, and December 31, 2017. Patients underwent an individualized rehabilitation program for improving their physical function. The outcome measures of this study were the length of stay (LOS) in the rehabilitation institute, the Functional Independence Measure (FIM) gain, i.e. the difference in FIM score between discharge and admission, and the FIM efficiency, which represents the daily gain. Patients were also stratified by age categories and by different levels of functional independence, as evaluated with the FIM total score at baseline.ResultsAge (p<0.05), LOS (p<0.005) and rehabilitation outcomes (FIM score and efficiency; p<0.05) differed significantly between patients with FNF and ITF. In particular, patients with ITF were older and more dependent at baseline. Moreover, they showed a lower FIM efficiency with respect to patients with FNF (p<0.05), which obtained a similar improvement in FIM total score of about 26 points but were discharged on average 3 days before. With aging, FIM efficiency decreased, while LOS increased. Patients highly dependent at baseline (FIM total score <40) had the lowest FIM gain and efficiency and the longest LOS respect to the more independent patients. Moreover, in older (85+ years) and in higher dependent patients the differences in the outcome measures between ITF and FNF were reduced.ConclusionsThe type of hip fracture could affect the LOS and FIM efficiency of younger and more independent patients with hip fracture during inpatient rehabilitation. In particular, patients with ITF require a longer rehabilitation period to achieve a similar functional gain as those with FNF.     

Does anatomical type of proximal hip fracture affect rehabilitation outcomes among older adults?

Background and purposeNumerous studies have detailed the potential benefits of inpatient geriatric rehabilitation for older adults with hip fractures. However, data regarding effect of fracture type (femoral neck, intertrochanteric, or subtrochanteric) on rehabilitation outcomes are limited. This study assessed whether the anatomical type of proximal hip fracture affects rehabilitation outcomes among disabled older adults.MethodsA population-based study was conducted comparing all patients with a recent hip fracture who were admitted to a geriatric rehabilitation facility in Israel. Data were collected retrospectively from an electronic database during a 5-year period (2014–2019). The Functional Independence Measure (FIM) was used to assess physical and cognitive function at admission and discharge.ResultsThe analyses included 624 older adults with hip fractures. We found significant differences in motor FIM score at admission, as patients with femoral neck fracture performed better than patients with intertrochanteric and subtrochanteric fracture did. The disparity in motor FIM score remained consistent through discharge, with all groups achieving a median gain of 14 points. Within one month of rehabilitation, about a third of all patients achieved a higher functional level.ConclusionsPatients with femoral neck fracture have better motor ability than do those with intertrochanteric and subtrochanteric fractures, which were retained throughout the course of rehabilitation; yet, the level of improvement remained similar. Clinicians should be aware of such differences in functional ability when discussing goals of care with older adults with hip fractures and consider them when implementing individual rehabilitation programs .     

When does hip fracture surgery fail?

Introduction

Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surgery for any cause carries a higher morbidity, mortality, and healthcare-related cost. The aims of this study were to determine risk factors for surgical complications of hip fracture surgery, when they occurred and their effect on mortality.

Patients and methods

From a prospectively collected consecutive database of 795 hip fractures admitted between July 2007 and June 2008, all surgical and non-surgical complications were identified as well as re-operation for any cause and mortality in the 4 years since surgery.

Results

Fifty-five (6.9%) patients were found to have developed a surgical complication requiring further intervention. Risk factors included younger age, smoking and cannulated screw fixation. Cannulated screw fixation was associated with a 30.9% rate of re-operation. Post-operative medical complication occurred in 21.8%. It was associated with a 78.5% mortality at 4 years with a median time to mortality of 58 days (95% CI 0–120 days).

Conclusions

Mechanical failure was the most common reason for cannulated screw re-operation. Hip hemiarthroplasty most commonly failed by infection. Inter-trochanteric and sub-trochanteric fracture fixation had very low failure rates. Post-operative medical complications, but not surgical complications, were associated with a higher mortality rate.     

Basicervical fracture – a rare type of hip fracture

Basicervical fracture is a controversial type of hip fracture, which can be regarded as either extracapsular or intracapsular. It is seldom mentioned in the authorized orthopaedic textbooks, and it lacks an exact definition in the most commonly used classifications. The aim of this study was to evaluate the rate of basicervical hip fractures and the methods of treating them in a prospective series of 1624 consecutive hip fractures. Standardized forms were used to collect information, including the classification of fracture types. Initially, 108 fractures were classified as basicervical, but a careful second-look check revealed that 51 were transcervical fractures, while 27 fractures had a trochanteric extension. Thus, 30 of the fractures fulfilled the criteria of basicervical fracture (rate 1.8%). The 14 fractures treated as extracapsular fractures (dynamic hip screw, DHS, or gamma nail) showed a better outcome than the 16 treated as intracapsular fractures (hemiarthroplasty or screw osteosynthesis). We conclude that basicervical fracture of the hip is a very uncommon entity, but it is worth considering and should be treated as a trochanteric fracture.     

Total hip arthroplasty after avascular necrosis of the femoral head: does etiology affect the results?

INTRODUCTION: The aim of the study was to evaluate the results of total hip arthroplasty (THA) due to avascular necrosis (AVN) of the femoral head and to establish whether the cause of AVN affects the results. MATERIAL AND METHODS: A group of 68 patients, 17-82 years of age (mean: 49.9 years) underwent 84 total hip arthroplasties due to AVN. The patients were divided into subgroups according to the etiology of AVN of the hip joint. The results of each group were evaluated by the Harris Hip score (HHS) at 3-18 years (mean: 6.2 years). The complication rate was also assessed. RESULTS: The mean preoperative HHS was 28.5+/-4.5 as opposed to a postoperative HHS of 86+/-10. The revision rate was 16.7%. Etiology does not affect the final outcome, but less favorable long-term results were found in the steroid-induced AVN patients. CONCLUSIONS: Despite the previously reported, less favorable results, THA is a good option for the younger population, even with AVN, especially in bilateral disease. Etiology did not affect the final outcome. However, patients with steroid-induced AVN should be informed that although their final functional results will equal those of other groups, the longevity of the implants is limited.     

Stability of extracapsular hip fracture: Does it affect rehabilitation outcome of post-acute patients?

BackgroundVarious factors have been shown to affect rehabilitation outcome of hip fractured patients. The degree of extracapsular fracture stability may also affect functional recovery. The aim of our study was to assess the relationship between extracapsular hip fracture stability and rehabilitation outcome in a post-acute setting.MethodsA retrospective cohort study of 144 hip fractured patients was carried out in a post-acute geriatric rehabilitation center from 1/2014 to 6/2015. The main outcome measures were the Functional Independence Measure (FIM) instrument, motor FIM (mFIM), Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). The associations between patients with stable vs. unstable and clinical, demographic and comorbidity variables, were assessed by the Mann-Whitney U and chi-square tests. A multiple linear regression model was used to estimate the association between fracture stability and LOS score after controlling for sociodemographic characteristics and chronic diseases.ResultsRehabilitation outcomes (FIM and mFIM score changes, mFIM MRFS) were found independent of extracapsular hip fracture stability. Patients with an unstable fracture presented with a significantly longer LOS compared with a stable fracture (p = .008). Multiple linear regression analysis showed that fracture stability was significantly associated with LOS after adjustment for confounding demographic, clinical and functional variables (p = .009).ConclusionPatients with unstable extracapsular hip fractures may require a prolonged rehabilitation period in order to achieve the same functional gain as patients with stable fractures.     

Does bone mineral density affect hip fracture severity?

The association between hip fracture and reduced bone mineral density is well documented, with reduced bone mineral density predisposing to fracture. However, it is unknown whether an association exists between the magnitude of bone density lost and the severity of the hip fracture sustained. One hundred forty-two patients (96 women, 46 men) with a mean age of 74 years (range, 49-92 years) who sustained a hip fracture following a simple ground-level fall and were treated for this injury were reviewed. All patients had undergone dual-energy x-ray absorptiometry bone scanning of the contralateral hip and lumbar spine. Fractures were classified as intra- or extracapsular or subtrochanteric and then subclassified by degree of severity as simple (stable) or multifragmentary (unstable) fracture patterns.Although a low hip bone mineral density (T- or Z score <2.5) was associated with an increased risk of extracapsular fracture (P=.025) compared with other fracture types, no association existed between bone mineral density and the severity of the resultant hip fracture. Although an association exists between bone mineral density and the risk of fragility fractures, the results of the current study suggest that the severity of hip fractures does not follow this correlation. Therefore, no assumption can be made about bone mineral density of the proximal femur based on the severity of the fracture observed on plain radiographs.     

Restoration of hip architecture with bipolar hemiarthroplasty in the elderly: does it affect early functional outcome?

Introduction

Reconstruction of the anatomic architecture correlates with functional outcome in patients receiving elective total hip arthroplasty. In theory similar rules should apply for bipolar hemiarthroplasty in femoral neck fractures. The influence of anatomic restoration after bipolar hemiarthroplasty on short-term clinical and functional outcome is explored in this study.

Patients and methods

Patients receiving bipolar hemiarthroplasty for intracapsular femoral neck fractures between 2010 and 2012 were included into a retrospective cohort study. Radiologic and functional outcome parameters were recorded during the acute care phase and geriatric rehabilitation. Postoperative mobilization data were recorded and co-morbidities documented for each case. Outcome parameters were obtained during geriatric rehabilitation: Barthel index, Tinetti score, Timed up and go test, Mini-Mental State Examination. The FO-ratio (ratio of femoral offset to the body weight lever arm), HC-ratio (ratio of the height of the hip center to the pelvic height) and the BWLA ratio (ratio of the body weight lever arm to the pelvic height) were obtained from postoperative radiographs.

Results

A total of 193 patients with a median age of 84 (IQR = 78–94, 72 % female) were analyzed. The in-hospital mortality rate was 5.7 %. There was a high proportion of patients with prior co-morbidities (96 % with at least one co-morbidity). During rehabilitation the Barthel index improved significantly (p < 0.001) from 40 to 55. The median Tinetti score on rehabilitation discharge was 15.5 (IQR = 10–19.5). The patients significantly improved in the timed up and go test from a median of 22 to 19 s. A significant difference (p < 0.001) was found comparing the FO ratios of the operated vs. non-operated side. None of the radiographic measures, representing the reconstructed anatomic hip geometry, significantly influenced the clinical and geriatric outcome.

Conclusions

Applying the short-term functional outcome scores used in this study, optimized anatomic restoration in hemiarthroplasty may not be a major influencing factor in a cohort of elder, multi-morbid patients.     

Tibial fractures treated with circular fixation: does the use of olive wires at the fracture site improve healing?

Clinical experience and published studies suggest that oblique fractures of the tibia are associated with delayed healing and non-union. Experimental studies have attributed this to increased shear at the fracture site. We have adopted the practice of using supplementary olive wires to reduce shear when using circular fixation for these fractures. A complete cohort of 54 oblique tibial fractures treated with the Sheffield Ring Fixator (Orthofix, Verona) was reviewed to elucidate the effect of using additional olive wires on fracture healing/treatment times. Fifty patients were studied in the final analysis. With low-energy injuries, the use of olive wires reduced treatment times significantly (no olives: 37 weeks, olives: 22 weeks, P<0.05), although this was not seen with higher energy injuries (no olives: 44 weeks, olives: 39 weeks, P=NS). There was no evidence of additional complications related to their use. We recommend the use of additional olive wires in the circular fixation of these difficult fractures.     

Does hip strength analysis explain the lower incidence of hip fracture in the People's Republic of China?

To explore whether there are ethnic differences in calculated hip strength that might explain the low incidence of hip fracture in China, we used Lunar DPX 'beta' version of hip strength analysis (HAS) and hip axis length (HAL) programs to compare hip geometry, calculated strength and densitometric values from Chinese subjects in Shenyang to those of Caucasian subjects in Oslo and Leuven participating in the European Prospective Osteoporosis Study (EPOS). Subjects were 210 Chinese and 403 Caucasian men and women aged 53-77 years. Parameters investigated included bone mineral density (BMD), bone mineral content (BMC), bone area (BA), cross-sectional moment of inertia (CSMI) and section modulus (both indicating strength and rigidity of the femoral neck), HAL, neck length (NL), neck diameter, tensile stress (Tstress) and compressive stress (Cstress) (indicating the stress in the femoral neck at its weakest cross section arising from walking or a standard fall, respectively), safety factor (SF, indicating the resistance to fracture for forces generated during walking) and fall index (FI, indicating the resistance to fracture from force generated during a fall in the greater trochanter). The Chinese men and women were significantly shorter and lighter than their Caucasian counterparts (P<0.01) and had significantly lower BMD, BMC and BA of the femoral neck (P<0.01). After adjusting for BA, weight and height, there was no significant ethnic difference in either gender in BMC. CSMI and section modulus were significantly lower, and HAL, NL and neck diameter were significantly shorter in the Chinese men and women (P<0.01). These differences all remained after adjusting for weight and height. There were no significant differences in Tstress, Cstress, SF and FI between ethnic groups in either gender. Most of the parameters of calculated hip strength in the Chinese subjects were similar to or poorer than those in the Caucasian subjects. There was no evidence to indicate that Shenyang Chinese have superior BMD or BMC or better calculated hip strength. The short HAL and NL of the population, however, could be an independent factor contributing to the low incidence of hip fracture.     

Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?

BACKGROUND: Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Our hypothesis was that arthroscopic repair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. METHODS: Sixty-five consecutive shoulders with a chronic full-thickness supraspinatus tear were repaired arthroscopically in sixty-five patients with use of a tension-band suture technique. Patients ranged in age from twenty-nine to seventy-nine years. The average duration of follow-up was twenty-nine months. Fifty-one patients (fifty-one shoulders) had a computed tomographic arthrogram, and fourteen had a magnetic resonance imaging scan, performed between six months and three years after surgery. All patients were assessed with regard to function and the strength of the shoulder elevation. RESULTS: The rotator cuff was completely healed and watertight in forty-six (71%) of the sixty-five patients and was partially healed in three. Although the supraspinatus tendon did not heal to the tuberosity in sixteen shoulders, the size of the persistent defect was smaller than the initial tear in fifteen. Sixty-two of the sixty-five patients were satisfied with the result. The Constant score improved from an average (and standard deviation) of 51.6 +/- 10.6 points preoperatively to 83.8 +/- 10.3 points at the time of the last follow-up evaluation (p < 0.001), and the average University of California at Los Angeles score improved from 11.5 +/- 1.1 to 32.3 +/- 1.3 (p < 0.001). The average strength of the shoulder elevation was significantly better (p = 0.001) when the tendon had healed (7.3 +/- 2.9 kg) than when it had not (4.7 +/- 1.9 kg). Factors that were negatively associated with tendon healing were increasing age and associated delamination of the subscapularis or infraspinatus tendon. Only ten (43%) of twenty-three patients over the age of sixty-five years had completely healed tendons (p < 0.001). CONCLUSIONS: Arthroscopic repair of an isolated supraspinatus detachment commonly leads to complete tendon healing. The absence of healing of the repaired rotator cuff is associated with inferior strength. Patients over the age of sixty-five years (p = 0.001) and patients with associated delamination of the subscapularis and/or the infraspinatus (p = 0.02) have significantly lower rates of healing.     

Faciohypoglossal anastomosis: does the morphology of the facial nerve affect the functional result?

We report the results of a histological study of facial nerve specimens obtained at the time of faciohypoglossal anastomosis. We examined sections from 24 patients using light and electron microscopy in order to determine the extent of the degenerative process with time and its relationship to the functional results of the anastomosis. We graded the histological features associated with degeneration, regeneration, and fibrosis on an ordered nominal scale from 0 to 3 and correlated them with duration of facial palsy and postoperative facial function. There was no histological evidence of increasing collagenosis or fibrosis with duration of facial palsy, and endoneural fibrosis was a very infrequent finding. There was no evidence that the relative numbers of endoneural fibrocytes or the degree of collagenosis had any bearing on the functional result. The presence of large numbers of endoneural tubes, containing nonmyelinated axons, showed a positive correlation with the postoperative facial function, whereas the presence of active axon degeneration showed a negative correlation.     

Repair of giant abdominal hernias: does the type of prosthesis matter?

Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (> or = 20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non-Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized chi2 test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (+/- 16.3), males out-numbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study (n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non-Gore-Tex subgroup comparison results were as follows: GT (n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG (n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance.     

Obesity in total hip arthroplasty—does it really matter?: A meta-analysis

Background and purpose

Discussion persists as to whether obesity negatively influences the outcome of hip arthroplasty. We performed a meta-analysis with the primary research question of whether obesity has a negative effect on short- and long-term outcome of total hip arthroplasty.

Methods

We searched the literature and included studies comparing the outcome of hip arthroplasty in different weight groups. The methodology of the studies included was scored according to the Cochrane guidelines. We extracted and pooled the data. For continuous data, we calculated a weighted mean difference and for dichotomous variables we calculated a weighted odds ratio (OR). Heterogeneity was calculated using I₂ statistics.

Results

15 studies were eligible for data extraction. In obese patients, dislocation of the hip (OR = 0.54, 95% CI: 0.38–0.75) (10 studies, n = 8,634), aseptic loosening (OR = 0.64, CI: 0.43–0.96) (6 studies, n = 5,137), infection (OR = 0.3, CI: 0.19–0.49) (10 studies, n = 7,500), and venous thromboembolism (OR = 0.56, CI: 0.32–0.98) (7 studies, n = 3,716) occurred more often. Concerning septic loosening and intraoperative fractures, no statistically significant differences were found, possibly due to low power. Subjective outcome measurements did not allow pooling because of high heterogeneity (I₂ = 68%).

Interpretation

Obesity appears to have a negative influence on the outcome of total hip replacement.Obesity has reached epidemic proportions in the USA, and the rest of the well-developed world is expected to follow. Since obesity is a well-documented risk factor for the development of osteoarthritis (Sturmer et al. 2000, Flugsrud et al. 2006), an increased need for joint arthroplasty in obese people can be expected. Surgery on obese patients can lead to longer duration of the operative procedures themselves, with higher complication rates and longer hospital stays, and some authors have even suggested refusal of elective surgery in obese patients (Fehring et al. 2007).A controversy that has flared up during the last decennium is whether obesity might also influence the functional results and survival of total hip arthroplasty (THA), with studies showing either different or similar outcome compared to normal-weight patients. For both outcomes, different explanations have been postulated. McClung et al. (2000), for example, found that a higher BMI was associated with lower activity, resulting in less polyethylene wear in these patients, since wear is a function of use and not time. On the other hand, higher forces acting on the prosthesis in obese patients may lead to early loosening.Generally, a person with a BMI between 25 and 30 is categorized as overweight, and someone with a BMI of greater than 30 is obese. In this meta-analysis, we evaluated the results of all published trials comparing outcome and survival of primary THA between different BMI groups (BMI of < 30 and of > 30). Our main research question was whether obesity has a negative effect on the short- and long-term outcome of total hip arthroplasty.     

Pretransplantation overweight and obesity: does it really affect kidney transplantation outcomes?

Objective

The objective of this study was to compare kidney transplant outcomes among pretransplantation overweight and obese patients with those with normal weight.

Methods

We performed a retrospective analysis of a sample of 448 kidney transplantations performed between 1984 and 2008 in our institution. We compared of initial graft function, postoperative length of stay, surgical complications, acute and chronic rejection rates, creatinine serum levels, and patient and graft survival, between normal weight, overweight, and obesity groups.

Results

Overweight was detected on 28.3% of the patients, and obesity on 5.8%. A male predominance was noted among the normal and overweight groups, and the opposite in the obesity group: namely, male:female ratios of 2.17:1, 3.37:1, and 0.37:1, respectively. Mean age was lower in the normal weight group (41.51 years) versus 48.36 and 46.08 years in the overweight and obesity groups, respectively. Compared with the normal weight group, recipient creatinine serum levels between 1 and 6 months were higher among the obese group, but not the overweight one. Both overweight and obese groups showed significantly higher incidences of delayed graft function (26.8% and 26.9%, respectively) versus 16.9% in the normal weight group (P = .028) and longer surgery times, ie, greater than 3 hours in 22.8% and 42.3%, respectively, versus 20.7% of the normal weight patients. Surgical complication rates were higher in both non-normal weight groups (17.3% and 26.9% vs 15.9% in the normal weight group), especially lymphocele formation and wound dehiscence (P = .031 and P < .0005, respectively). However, no differences were detected concerning postoperative length of stay, graft loss, acute or chronic rejection, and graft or patient survival.

Conclusion

Pretransplantation overweight and obesity did not seem to significantly affect kidney transplantation in the medium and long terms. The early posttransplantation period can however be disturbed by an increased incidence of surgical complications and reversible degradation of some graft functional parameters.     

Is the implantation of titanium stems in hip prostheses really obsolete?

AIM: Due to several bad results of studies, titanium is no longer used as an implant material in cemented total hip arthroplasty. This study attempts figure out by means of a meta-analysis if the material titanium itself was responsible for the bad results of some studies or if specific implant characteristics contributed to implant failure, independent of titanium. METHOD: Studies between 1960 and July 2002 were analysed concerning failure rates of cemented titanium total hip arthroplasties regarding their specific implant characteristics. RESULTS: Specific implant characteristics such as roughness of the surface and geometrical features led to significantly different failure rates. Stems of titanium with a dull surface and a wide proximal geometry could achieve such good results as those of the cobalt-chromium stems published in the study results of Malchau. CONCLUSION: Titanium is justified as a cementable material in total hip arthroplasty. By respecting specific implant characteristics, very good failure rates can be achieved. The high failure rates, published in several studies, are based upon implant characteristics which are not suitable for cementing techniques and not upon the implant material titanium itself.     

Initial diagnostic approach of the irritable hip in childhood: is ultrasound really useful?

The acutely painful hip is a common complaint in childhood and has numerous significant causes. This prospective study explored the use of ultrasound as an adjunct to medical history and clinical examination in children with an irritable hip attending a department of orthopaedic emergencies over the course of 8 months. One hundred thirty four children met the inclusion criteria. A provisional diagnosis was made after history, clinical examination and ultrasound scan and this initial diagnosis was compared with the final diagnosis after a 3-year follow-up. The nature and number of further investigations required to reach the final diagnosis were reviewed. The use of ultrasound reduced the number of early radiographs by 84% and in conjunction with history and clinical findings had a diagnostic accuracy of 92%.     

Short reconstruction nail for intertrochanteric fracture: does it really fit Asian feature?

Background  

The Trigen short reconstruction trochanteric antegrade nail (TAN) is considered most suitable for the small skeletons of Asian patients. We have evaluated the results of TAN for intertrochanteric fractures in Asian patients.     

How does the type of thoracotomy affect the patient quality of life? A short form-36 health survey study

Purpose

We evaluated whether the quality of life was affected in patients who had undergone various types of thoracotomy using the Short Form-36 Health Survey.

Methods

The patients who had undergone thoracotomy for diagnosis or treatment between January and September 2011 in the Thoracic Surgery Department were investigated to determine the effect of the type of thoracotomy on the quality of life using the Short Form-36 Health Survey. The patients were classified into three groups. In Group I, the latissimus dorsi and the serratus anterior had both been preserved, and there was no muscle dissection, in Group II the latissimus dorsi muscle had been dissected and only the serratus anterior muscle has been preserved, and in Group III both muscles had been dissected, and the standard posterolateral muscle dissection had been performed.

Results

A total of 101 patients comprising 64 males (63.37 %) and 37 females (36.63 %), with a median age of 38 years, were included in this study. There were significant differences in all quality of life subscales between Groups I and III and between Groups II and III. The patients in Group I had the highest scores, while the patients in Group III had the lowest scores. There were no significant differences in five of the eight Short Form-36 subscales and one of the two summary scores values between Group I and Group II in females.

Conclusions

We investigated the effect of the type of thoracotomy on the patient quality of life using the Short Form-36 Health Survey, and found that the standard posterolateral thoracotomy had a marked adverse effect on the quality of life compared to muscle-sparing thoracotomy. We also found that it is possible to use thoracotomy with serratus preservation rather than muscle-sparing thoracotomy in cases with benign diseases where a large field of view is required, such as for decortication and pulmonary hydatid cysts, without any significant decrease in the quality of life, especially in females.