Are occult fractures of the hip and pelvic ring mutually exclusive?

We have evaluated retrospectively the relationship of bony injuries seen on 106 consecutive MR scans in elderly patients of a mean age of 81.4 years (67 to 101) who were unable to bear weight after a low-energy injury. There were no visible fractures on plain radiographs of the hip but eight patients (7.5%) had fractures of the pubic ramus. In 43 patients (40.5%) MRI revealed a fracture of the femoral neck and in 26 (24.5%) there was a fracture of a pubic ramus. In 17 patients (16%) MRI showed an occult sacral fracture and all of these had a fracture of the pubic ramus. No patient with a fracture of the femoral neck had an associated fracture of the pelvic ring or vice versa. Occult fracture of the hip and of the pelvic ring appear to be mutually exclusive and if an acute fracture of the pubic ramus is diagnosed radiologically further investigations are not needed to rule out an occult fracture of the hip.     

Trends in Irish hip fracture surgery over a 7-year period and international registry comparison

BackgroundHip fractures are a significant cause of morbidity and mortality in elderly patients. Timely surgical fixation and early mobilisation are the cornerstone to successful outcomes. The Irish Hip Fracture Database (IHFD) was established in 2012 and publishes annual reports on hip fracture care. This paper describes the trends in surgical fixation in Ireland during a 7-year period (2013–2019), assesses for compliance with guidelines and compares the most recent published reports from ten international hip fracture registries.MethodsAll published IHFD reports were systematically reviewed and tabulated. Data corresponding to demographics, fracture type, surgical fixation and post-operative management was plotted and analysed. Ten international hip fracture registries were identified and reviewed. Data was extracted corresponding to the IHFD dataset.ResultsA total of 21,684 hip fractures were recorded during this period. The majority of patients were female (70.16%), >80 years old (58.26%), admitted from their own home (82.13%) and ASA grade 3 (53%). The majority of undisplaced and displaced intracapsular fractures were treated with hemiarthroplasty, 62% and 88% respectively. There has been a decline in the use of dynamic hip screw (DHS) for intertrochanteric fractures with intramedullary nails being favoured.ConclusionDespite greater awareness of hip fracture care through the IHFD and the introduction of Best Practice Tariffs (BPT), further improvements are needed. Ireland compares well to international standards but has low rates of compliance to NICE guidelines for surgical fixation.     

The value of megaprostheses in non-oncological fractures in elderly patients: A short-term results

IntroductionThe management of both hip and distal femur fractures as well as periprosthetic fractures can be challenging for orthopaedic surgeons. The use of megaprosthetic implants could provide substantial advantages in elderly population affected by complex fractures. The aim of the study was to evaluate the effectiveness of megaprosthetic implants for treating hip and distal femur fractures as well as periprosthetic fractures in elderly.Material and MethodsFrom January 1st 2015 to December 31st 2019, patients treated for proximal or distal femoral fractures with severe bone loss or failure of previous surgery were retrospectively reviewed. Patients were divided into two group based on diagnosis: proximal femur fractures (group A) and distal femur fractures (group B). Subsequently, patients underwent hip (group A) or knee (group B) megaprosthesis. Self-assessed questionnaires were administered to all patients pre and postoperatively. Primary outcome was the Activity Daily Living. Secondary outcomes were: Instrumental Activity Daily Living, Short Form-12, Oxford knee or hip score, complications. Charlson score, Harris classification for hip or Anderson Orthopaedic Research Institute score and complication were recorded. All patients underwent a radiological follow up to rule out implant loosening and mobilization. Pre and postoperative functional score comparisons in each group were undertaken. Significance was set p ≤ 0.05.ResultsTwelve patients were finally included in the study. There were 6 male and 6 females, the mean age was 72,9 years old (± 7,4); the mean BMI was 29,8 points (± 4.5). The mean follow-up was 2.9 years (± 1.4). No differences could be found between pre and postoperative evaluation in each group. No aseptic loosening, dislocation, mobilization or radiolucency were recorded during the follow-up. In group A, two surgical site infections (2/6 patients) and one pneumonia (1/6 patients) were recorded. In group B, two surgical site infections occurred (2/6 patients). All patients were treated by antimicrobial oral therapy with complete regression.ConclusionThe use of hip and knee megaprosthetic implants in traumatology is a safe and viable option in elderly patients.     

The influence of pre-operative antiplatelet and anticoagulant agents on the outcomes in elderly patients undergoing early surgery for hip fracture

BackgroundEarly surgery improves the prognosis of elderly patients with hip fractures. However, many patients take antiplatelet and anticoagulant therapies for comorbidities. This study compared perioperative outcomes and 1-year mortality rates with early surgery in elderly patients with hip fractures taking or not taking these agents preoperatively.MethodsAmong 418 patients undergoing surgery for hip fractures at our institution from 2014 to 2016, 266 patients over 65 years who had surgery within 48 hours of admission were enrolled. We excluded patients with high-energy injuries, multiple or pathological fractures, and patients undergoing osteosynthesis for femoral neck fractures. The study population was divided into those who underwent hemiarthroplasty for neck fractures and those who underwent osteosynthesis for trochanteric fractures. We also divided the population into patients receiving chronic anticoagulation therapy (medicated group: 19 hemiarthroplasty, 70 osteosynthesis) and patients not receiving anticoagulation therapy (non-medicated group: 47 hemiarthroplasty, 130 osteosynthesis). Comorbidities, intraoperative blood loss, estimated blood loss from admission to the first and seventh day after surgery, transfusions, length of stay, complications, and 1-year mortality rates were evaluated.ResultsDiabetes mellitus and cerebrovascular disorders were significantly more common in the medicated group for both surgery types. In the osteosynthesis group, estimated blood loss on the first day was 710 ml in the medicated group and 572 ml in the non-medicated group (P = 0.015). In the hemiarthroplasty group, corresponding values were 668 and 480 ml, respectively (P = 0.016). Estimated blood loss on the seventh day, complications, length of stay and 1-year mortality rate were not increased significantly.ConclusionsThe medicated group had an increase in estimated blood loss on the first day. However, there was no significant increase in transfusions, complications and 1-year mortality rates. Early surgery for elderly patients with hip fractures is recommended, even for those taking antiplatelet and anticoagulant agents.     

Outcomes of elderly patients with proximal femoral fractures according to positive criteria for surgical treatment

Proximal femoral fractures in elderly patients are a serious problem in the aging society. Recently, surgical indications have changed due to advancements in medical technology. The purpose of this study was to investigate the outcome of elderly patients with displaced proximal hip fractures according to our positive criteria for surgical treatment. Exclusion criteria included (1) terminal-stage malignancy; (2) a combination of an inability to walk, a severe mental disorder, and caregiver refusal of surgery; and (3) nonapproval of the anesthesiologist for surgery. The study group comprised 666 elderly patients. They were categorized into surgically and nonsurgically treated groups, and their treatment outcomes were retrospectively analyzed. The majority of patients were treated surgically (97.0% vs 3.0%). One-year survival rate was higher among surgically treated patients (82.2%-91.8%) than non-surgically treated patients (55%). The major cause of death in nonsurgically treated patients was deterioration of comorbidities (66.7%), whereas this was the cause of death in 18.9% of surgically treated patients. One-year survival rates were worse in both groups with a lower American Society of Anesthesiologists grade. The 1-year survival rate of our patients suggests that our surgical criteria offer a reasonable outcome in surgically and nonsurgically treated patients. American Society of Anesthesiologists grade and preexisting comorbidities were strongly correlated with patient outcome.     

Effectiveness of anabolic steroids in improving outcomes for post-operative hip fracture patients: A randomized controlled trial

BackgroundPost-operative elderly hip fracture patients require significant rehabilitation. Nandrolone is an anabolic steroid used to promote muscle growth. This study aims to examine the effect of nandrolone in improving rehabilitation and quality of life in elderly female patients with hip fractures undergoing hemiarthroplasty.MethodsThis is a double-blinded prospective randomized-controlled-trial consisting of female patients above the age of 65 with an isolated neck of femur fracture planned for a hip hemiarthroplasty. Participants were randomized into two arms of the study – 50 mg intramuscular nandrolone vs normal saline placebo administered on post-operative day 0, and weeks 2, 6 and 12. The participants were followed up across a 1-year period following the surgery. Clinical outcomes such as time taken to achieve rehabilitation milestones, distance of ambulation and thigh muscle girth, and functional scoring with SF-36 questionnaire were recorded at intervals of 2, 6 and 12 weeks, 6 months and 1 year following the surgery.ResultsThere were a total of 23 subjects with 11 in the steroid group and 12 in the placebo group. There was no significant difference in demographics and injury patterns between both groups. There was no significant difference for time taken to achieve various rehabilitation milestones and distance of ambulation. SF-36 scores on discharge and at 1-year follow-up mark were comparable. There was no difference in the complication rate between both groups.ConclusionIntra-muscular Nandrolone after hip surgery in elderly female patients does not result in short to mid-term improved rehabilitation or functional outcomes. Nandrolone did not result in increased short-term complications after hip surgery.Level of evidenceI.     

Mortality related to and functional outcomes of upper cervical spine fractures in the elderly

BackgroundAlthough the mortality related to hip fracture and osteoporotic vertebral fracture have been reported, few studies have examined the mortality related to atlas and/or axis fractures. The aim of this study was to assess the association between mortality and atlas and/or axis fractures retrospectively and to elucidate the efficacy of surgical treatment.MethodsA total of 33 elderly patients who were treated for atlas and/or axis fractures at our institution between January 2012 and December 2018 were included in this study. These patients were divided into two groups: surgical treatment and conservative treatment. Fracture types, comorbidities, neurological status, treatment types, and walking ability at follow-up were reviewed. Mortality was assessed using medical records or via phone interviews.ResultsThe mean age at injury was 79.9 ± 8.0 years, and the mean follow-up period was 2.3 years. The overall mortality rates at 1 and 5 years were 21.4% and 48.4%, respectively. During the observation period, 12 (36%) patients died. Twenty-two patients were treated conservatively (14 were treated with a cervical collar, 8 were treated with a halo vest). Surgical procedures included occipital-cervical fixation, osteosynthesis of C2 fractures, C1–2 fixation, and C1–4 fixation using a posterior approach. Surgical treatment correlated with better survival rates. There was no significant difference between the two groups in terms of ambulatory ability and functional recovery.ConclusionUpper cervical spine fractures appear to have a worse prognosis compared to hip and osteoporotic vertebral fractures. This study indicates the efficacy of surgical treatment for upper cervical spine fractures in the elderly for improving survival prognosis.     

Evaluation of Clopidogrel Safety in Geriatric Patients with Hip Fracture: A Retrospective Study

ObjectiveTo evaluate the risk of bleeding in elderly patients undergoing early hip fracture surgery with/without clopidogrel administration.MethodsThis was a retrospective study, and patients over 65 years with fresh hip fracture were enrolled. For the patients taking clopidogrel, early surgical treatment was performed without 5–7 days waiting time. The patients were divided into groups according to their fracture type and the surgical method. Within each fracture/surgery group, the patients were further divided into subgroups according to whether they had clopidogrel administration. The patients'' age, gender, American Society of Anesthesiologists (ASA) score, hemoglobin level at admission, and the time from admission to surgery were compared in the different groups. The bleeding outcomes, such as intraoperative blood loss and blood transfusion status, as well as secondary outcomes, such as operation duration and length of hospital stay, were also compared in these groups.ResultsThere were no statistically significant differences in patients'' baseline characteristics and outcomes, including intraoperative blood loss, blood transfusion rate, operation duration and length of hospital stay, between the clopidogrel‐administrated patients and the control patients. However, the percentage of patients taking general anesthesia was significantly higher in clopidogrel group than that in control group (P = 0.01). Similar intraoperative blood loss was found in the subgroups of hemi‐hip replacement, internal fixation for intertrochanteric fracture of the femur (fracture type A1‐2, short pin), and internal fixation of femoral neck fracture with cannulated nails. For the internal fixation of femoral neck fracture with cannulated nails, the blood loss is significantly less in both subgroups than that with other two surgical methods. Moreover, the total hip arthroplasty, with the highest bleeding risk among all the surgical methods involved, was rarely chosen to treat geriatric hip fracture in this study.ConclusionThis study indicated that compared with patients without clopidogrel administration, elderly patients with hip fractures who receive clopidogrel as long‐term anti‐platelet therapy are relatively safe for surgery in less than 5–7 days after discontinuation of clopidogrel.     

Symptomatic venous thromboembolism following a hip fracture

Background and purpose Venous thromboembolism (VTE) remains a substantial cause of morbidity and mortality following hip fracture. Previous work has not identified any risk factors associated with the type of hip fracture. We report the incidence of and risk factors for development of symptomatic VTE in patients following a hip fracture.

Patients and methods In this prospective study, we collected information on 5,300 consecutive patients who were admitted to a single unit with a hip fracture—in terms of their pre-admission status, details of any operation performed, and details of complications in the form of symptomatic venous thromboembolism. All patients received thromboprophylaxis with heparin.

Results The incidence of symptomatic VTE was 2.2% (95% CI: 1.8–2.6). 85% of these events occurred within 5 weeks of the fracture. The statistically significant risk factors for symptomatic VTE were better preoperative mobility, living in one's own home, high mental test score, high preoperative hemoglobin, inter-trochanteric fractures, and fixation with a dynamic hip screw. In multivariate analysis adjusting for sex and age, type of residence on admission, type of fracture, and hemoglobin values on admission remained independently significant.

Interpretation We found that the rate of symptomatic VTE using thromboprophylaxis with heparin was low but that there were a number of groups that were at a significantly higher risk of developing VTE. The patients who are particularly at risk appear to be those with a subtrochanteric or intertrochanteric hip fracture; here, the incidence of symptomatic VTE was twice that of intracapsular hip fractures.     

Timing of surgery for hip fractures in the elderly: A retrospective cohort study

IntroductionAlthough early surgery for elderly patients with hip fracture is recommended in existing clinical guidelines, the results of previous studies are inconsistent. The aim of this study was to compare postoperative outcomes of early and delayed surgery for elderly patients with hip fracture.Materials and MethodsIn this retrospective study using a national inpatient database in Japan, patients aged 65 years or older who underwent surgery for hip fracture between July 2010 and March 2014 were included. Early surgery was defined as surgery on the day or the next day of admission. Assessed outcomes included death within 30 days and hospital-acquired pneumonia.ResultsIn this cohort, 47,073 (22.5%) patients underwent surgery for hip fractures within two days of admission (early surgery group) and 161,805 (77.5%) underwent surgery for hip fractures thereafter (delayed surgery group). Early surgery was significantly associated with lower odds for hospital-acquired pneumonia (odds ratio, 0.42; 95% confidence interval, 0.25–0.69) and pressure ulcers (odds ratio, 0.56, 95%CI: 0.33–0.96, p = 0.035), but was not associated with 30-day mortality (odds ratio, 0.96; 95% confidence interval, 0.49–1.86) or pulmonary embolism (odds ratio, 1.62, 95%CI: 0.58–4.52, p = 0.357).ConclusionsThese results support current guidelines, which recommend early surgery for elderly hip fractures patients.     

Imaging of occult hip fractures: CT or MRI?

ObjectivesPatients presenting with hip pain but normal plain radiographs may ultimately be shown on further investigation to have suffered an occult hip fracture (OHF). This diagnosis can be made with CT or MRI. Traditionally MRI has been considered a superior modality. We performed a retrospective review of all patients presenting to our service with a suspected OHF over a four-year period, investigated with either CT or MRI.DesignRetrospective review.SettingUrban trauma centre.PatientsPatients with suspected hip fractures and negative radiographs.InterventionCT or MRI.Main outcome measuresDetection rate; delay in request for further imaging; delay to theatre; re-presentations with missed fractures.ResultsA total of 179 patients were investigated, with a mean age of 82 ± 13 years. The ultimate diagnosis was of an OHF in 71 cases and pelvic or acetabular fracture in 34. The average time from presentation plain radiograph to further imaging was 2.0 ± 2.7 days, but was significantly shorter for CT. No patient re-presented with unidentified fractures or other localised hip pathology within a 12-month period.ConclusionsModern imaging technology does not appear to miss clinically significant fractures. As CT is usually more accessible than MRI, the results of our study should encourage surgeons to consider CT as a first line investigation for occult hip fractures. We advocate a high index of suspicion and early imaging referral for elderly patients presenting with non-specific hip pain following a fall.Level 3 Evidence.     

加长柄人工股骨头置换治疗高龄不稳定型股骨转子间骨折

目的评价应用加长柄股骨头置换治疗高龄骨质疏松不稳定型转子间骨折的临床疗效。方法对85例高龄不稳定型股骨转子间骨折采用加长柄人工股骨头置换术,根据Harris髋关节评分评价临床疗效。结果患者均获得随访,时间9~18个月。患者髋关节功能均恢复良好,术后3~6个月基本恢复生活能力。术后随访均未出现下肢深静脉血栓、关节脱位、人工假体松动、下沉或断裂、假体周围骨折等并发症。术后9个月根据髋关节Harris评分优良率达90.83%。结论加长柄人工股骨头置换是治疗高龄不稳定型转子间骨折安全、有效的方法,但远期疗效尚需进一步随访观察。     

Displaced acetabular fractures in the elderly: Results after open reduction and internal fixation

BackgroundThe optimal management of elderly patients with displaced acetabular fractures remains controversial. This paper aims to summarize the clinical results of open reduction and internal fixation (ORIF) and the possible factors influencing them.MethodsRadiographic and clinical data on 52 elderly patients with displaced acetabular fractures that were treated by ORIF between May 2000 and May 2008 were retrospectively analysed. Data, such as fracture type (Letournel's classification system), quality of reduction, clinical outcomes (Harris hip score and modified Merle d’Aubigne-Postel score), and radiological outcomes (Matta score), were evaluated.ResultsGood to excellent clinical and radiological outcomes were recorded in 43 (82.7%) and 37 patients (71.2%), respectively. Acetabular fractures without radiographic features, such as quadrilateral plate fracture, Gull sign, posterior dislocation of hip, posterior wall marginal impaction, comminuted posterior wall fracture, and femoral head injury, can still achieve good to excellent outcomes. However, patients with the abovementioned radiographic features tend to achieve fair or poor outcomes. When an acetabular fracture with the aforementioned features, except for femoral head injury, can achieve and maintain anatomic reduction until complete fracture healing, the difference between fractures with and without the radiographic features is no longer significant. The results indicate that the outcomes are more affected by reduction rather than radiographic features.ConclusionORIF may be suggested for displaced acetabular fractures in the elderly. Good to excellent outcomes and a high degree of patient satisfaction can be achieved in majority of the patients. We recommend ORIF as the preferred treatment for displaced acetabular fractures without the abovementioned radiographic features.Level of evidenceTherapeutic level IV.     

股骨近端防旋髓内钉治疗老年股骨转子间不稳定性骨折

目的评价股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)在老年股骨转子间不稳定性骨折治疗中的效果。方法采用PFNA治疗老年股骨转子间不稳定性骨折23例。按照Harris评分标准评价术后髋关节功能。结果 23例均获得随访,随访时间6.0~24.0个月,平均(7.9±2.1)个月。所有病例骨折均愈合,愈合时间6.0~12.0个月,平均(7.3±2.2)个月,其中21例患者已完全负重行走。参照Harris评分标准评定髋关节功能:优13例,良8例,可2例,优良率91.3%。结论 PFNA治疗老年股骨转子间不稳定性骨折操作简单,手术时间短,内固定可靠,是一种理想的治疗方法。     

Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients

OBJECTIVES: To identify whether differences exist in the outcomes between patients undergoing hemodialysis and elderly nonhemodialysis patients with a femoral neck fracture. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/INTERVENTIONS: A total of 71 femoral neck fractures in 62 patients undergoing hemodialysis treated nonoperatively or operatively. MAIN OUTCOME MEASUREMENTS: Clinical outcomes were analyzed to identify factors that may be correlated with life expectancy and functional prognosis. RESULTS: The overall survival rates in this study at 1-year and 5-years postfracture were found to be 89.8% and 51.5%, respectively. There were significant correlations among the survival rate, patients' age, type of treatment, prefracture ambulation status, and prefracture activities of daily living status. However, using multivariate analysis, the only significant predictor of life expectancy was prefracture ambulation status. As for functional prognosis, the rates of total ambulation recovery and total activities of daily living recovery at 1-year postfracture were 50.0% and 71.2%, respectively. Both patients' age and age at the onset of hemodialysis may contribute considerably to functional prognosis in patients undergoing hemodialysis after femoral neck fracture. CONCLUSIONS: The present study suggests that the clinical outcomes of patients with femoral neck fractures who undergo hemodialysis are considerably superior to those of previous studies. In addition, when those fractures are treated surgically with specific management in patients undergoing hemodialysis, it may be possible to expect a life expectancy and functional prognosis similar to elderly nonhemodialysis patients with hip fractures.     

Characteristics and outcomes of hip fractures in lower limb amputees

IntroductionLower limb amputees, regardless of age are at an increased risk of developing fragility fractures of the neck of femur. The characteristics and outcomes of the fractures of the neck of femur in lower limb amputees have not been studied in detail.MethodsWe undertook a retrospective review of a prospectively collected single centre and single surgeon database between March 1996 and January 2017, using a standard proforma to identify patients who required surgical intervention for fracture neck of femur and had sustained a previous lower limb amputation and compared them with a cohort of standard hip fracture patients.ResultsTwenty-seven patients, sustaining 28 fractures of the neck of femurs were identified of which 16 were females with mean age of 78 years (50-89). Nineteen fractures were sustained on the ipsilateral side of the amputation. Results showed that seventy percent of amputees returned to their previous level of mobility and prior residence. Mortality in this group is higher as compared to a standard hip fracture patient but pain and mobility were comparable in both groups.DiscussionThe incidence of both hip fractures and amputations in increasing worldwide but no study has compared outcomes of hip fractures in amputees and compared them to a standard hip fracture patient. Amputees exhibit reduced bone density both at the hip and stump end which increases risk for osteoporosis and fragility fractures in the hip. The management of our patients followed orthopaedic principles, well established surgical interventions and rehabilitation.ConclusionThis study reveals that hip fractures in amputees can have comparable results to a standard hip fracture cohort if preoperative optimisation, planning and postoperative rehabilitation is carried out.     

Mortality in patients sustaining a periprosthetic fracture following a previous extracapsular hip fracture fixation

BackgroundMortality rates following hip fractures are decreasing. As these outcomes improve, it increases the potential for further falls and the potential to sustain a periprosthetic fracture. The aim of this study was to analyse the 1 year mortality of periprosthetic fractures around an implant used to treat an extracapsular hip fracture. Secondary outcomes included 30 day mortality, complications and risk factors associated with mortality.MethodsA retrospective case note and radiographic review of all patients who presented to a single institution with a periprosthetic femoral fracture around an implant previously used to treat an extracapsular hip fracture between 1st January and 2008 and 31st May 2015.Results29 patients with a mean age of 75.8. 6 males and 23 females. 20 (69.0%) patients had capacity to consent for surgery. Pre-operatively 34.5% mobilised independently without any walking aids. 79.3% lived at home. 62.1% had a Charlson co-morbidity score of 0 or 1, 27.6% a score of 2 or 3, 6.9% a score of 4 and 5, and 3.4% a score of more than 5.3.4% was ASA grade 1, 13.8% ASA2, 65.5% ASA 3 and 17.2% were ASA 4. The previous implant a dynamic hip screw in 75.9% dynamic hip screws and an intramedullary nail in 24.1%. There were 4 (13.8%) in-patient deaths. The 30 day mortality 17.2% (5 patients) was and the 1 year mortality was 44.8% (13 patients). There were 0 complications that required return to surgery during admission. 1 patient with a revision intramedullary nail had dynamisation performed due to delayed union 7 months following surgery. 1 patient required removal of metalwork 2 years following surgery for infection. When comparing risk factors for mortality, there were no significant risk factors found in this study for 30 day and 1 year mortality.ConclusionsThis paper suggests that periprosthetic fractures sustained after the surgical treatment of extra capsular neck of femur fractures have higher mortality rates than hip fractures. These patients should be given the same priority as these patients in there management.     

Single screw type of lag screw results higher reoperation rate in the osteosynthesis of basicervical hip fracture

BackgroundBasicervical hip fractures are relatively rare with greater biomechanical instability compared to the other types of hip fractures. Several studies have reported ambivalent surgical outcomes of basicervical hip fractures. The purpose of this multicenter study was to analyze surgical outcomes of basicervical hip fractures according to the fixation type of proximal femur and lag screw type.MethodsAmong 3220 hip fractures, 145 were classified as basicervical hip fractures. Of those, 106 patients treated with osteosynthesis were included to analyze the surgical complications according to fixation type of proximal femur: sliding hip screw(SHS) and cephalomedullary nail (CMN) groups. Surgical complications including the excessive displacement of fracture and the occurrence of reoperation were evaluated at the final follow up. We further evaluated surgical complications according to lag screw type with subgroup analysis in CMN group: single screw type, blade type and two integrated screw type.ResultsTen patients (9.4%) sustained surgical complications (5 excessive displacements and 5 reoperations). For fixation type of proximal femur, SHS group showed higher tendency of excessive displacement despite no statistical difference between the two groups (p = 0.060). For lag screw type with subgroup analysis in CMN group, single screw type showed statistically high rates of reoperation compared to the other types of lag screw (p = 0.022).ConclusionBasicervical hip fractures treated with osteosynthesis resulted to high rates of surgical complications in this study. However, they could be drastically reduced if CMN with blade type or two integrated screw type were used in the osteosynthesis of basicervical hip fractures.     

Objective sound wave amplitude measurement generated by a tuning fork. An analysis of its use as a diagnostic tool in suspected femoral neck fractures

IntroductionHip injuries are becoming a more common problem as the elderly population increases and their management represents a significant proportion of health care costs. Diagnosis of a fracture based on clinical assessment and plain films is not always conclusive and further investigations for such occult fractures, such as magnetic resonance imaging (MRI), are sometimes required which are expensive and may be difficult to access. Disruption to the conduction of a sound wave travelling through a fractured bone is a concept that has been used to diagnose fractures.Patients and methodsIn our study we used a tuning fork with frequency of 128 Hz to objectively measure the reduction in sound amplitude in fractured and non-fractured hips. We looked at the feasibility of using this test as a diagnostic tool for neck of femur fractures.ResultsA total of 20 patients was included in the study, using MRI scan as the standard for comparison of diagnostic findings. Informed consent was obtained from the patients. There was a significant difference in the amplitude reduction of the sound waves when comparing normal to fractured hips. This was 0.9 in normal hips, compared to 0.31 and 0.18 in intra-capsular and extra-capsular fractures, respectively. Our test was 80% accurate at diagnosing neck of femur fractures.ConclusionIn conclusion this test may be used as a diagnostic test or screening tool in the assessment of occult hip fractures.     

Bilateral spontaneous inter-trochanteric fractures of proximal femurs

INTRODUCTIONBilateral spontaneous inter-trochanteric fractures of the proximal femur are rare. We report an unusual case of bilateral intertrochanteric fractures of the proximal femur in a 92 year old lady.PRESENTATION OF CASEA 92 year old lady presented to us with one week history of pain in both hips and poor mobilisation. There was no history of mechanical fall. The initial plain films of the hips did not show any fractures and the diagnosis was made by MRI scans. She underwent bilateral fixation of the fractures with dynamic hip screws. After a period of rehabilitation she returned to the pre injury mobilisation status.DISCUSSIONBilateral spontaneous intertrochanteric fractures of the hip due to osteoporosis are not that common. These rare fractures are usually associated with major trauma, renal disease, osteoporosis, osteomalacia, long term corticosteroid treatment and epilepsy.CONCLUSIONEarly diagnosis with high index of suspicion and appropriate investigations are mandatory in the management of these fractures.