The value of a prognostic scoring system in the rehabilitation of elderly patients with proximal femoral fractures

Aim: To evaluate a prognostic scoring system for elderly patients with hip fractures, which can, on admission, predict on the basis of pre‐injury prognostic factors the possible length of stay in hospital, progress of rehabilitation, level of self‐caring and rehousing needs at discharge. Methods: A prognostic scoring system, developed on the basis of pre‐injury level of independence in activities of daily living (ADL) (Katz), medical comorbidities and Pfeiffer's mental scoring system was used (Svensson O et al. J Bone Joint Surg 1996; B78: 115–8). The study was conducted on a cohort of 63 patients prospectively recruited from consecutive admissions. Results: Ninety percent of the patients (without comorbidities and mental score >7; group 3/3) who were independently mobile pre‐injury remained independently mobile at discharge (CI 95% 0.79–0.97). Pre‐injury score was found to be significantly related to the level of ADL at 2 weeks after operation and at discharge from hospital (CI 95% 0.69–0.9). There was a pattern in duration of hospital stay in different groups (score 3/3 = 22 days, 2/3 = 31 days and 1/3 = 33 days). A pattern of community placement and housing after discharge was noticed in relation to the pre‐injury score. Conclusion: 3/3 score groups are most likely to achieve independence with mobility and ADL on the acute orthopaedic ward and to be discharged directly to their pre‐injury homes. They also were the least likely group to need rehabilitation in a dedicated orthogeriatric rehabilitation unit. 2/3 score groups are most likely to benefit from rehabilitation in a dedicated orthogeriatric rehabilitation unit. 1/3 and 0/3 score groups are least likely to benefit from rehabilitation in a dedicated orthogeriatric unit, in terms of achieving independence with mobility and ADL. They were also the most likely group to need long‐term high dependency residential care. Early liaison with social and community services is essential for effective and timely planning of discharge.     

Bilateral posterior fracture dislocation of the shoulders following seizure

Bilateral posterior fracture dislocation is a rare injury known to be associated with seizures. Convulsion was found to be the cause of fracture dislocation in 78% of the cases reported. The mechanism of injury was described by Shaw in 1971. The management depends largely on the severity of the injury. In many cases reported, the fracture was a large compression defect in the anteromedial aspect of the articular surface of the humeral head. It has been suggested that for defects that involve less than 20% of the articular surface closed reduction can be attempted. Rush nail or percutaneous K wires can be used to maintain reduction. Open reduction is necessary for defects that are involving 20-40% of the surface. The aim in these cases is to reconstruct the proximal humerus if possible by the use of internal fixation. If reconstruction is not feasible, a modified McLaughlin procedure can be used to prevent chronic instability of the shoulder. This procedure involves re-implanting the subscapularis tendon into the defect. Reconstructing fractures that involve more than 40% of the articular surface or 4-part fracture is not usually successful. These fractures are associated with a high the risk of avascular necrosis. Hemi-arthroplasty or total shoulder replacement is generally regarded as better option as they offer rapid recovery and eliminate the possibility of multiple procedures if fixation fails.     

Re-operations following Austin Moore hemiarthroplasty: a district hospital experience

The Austin Moore prosthesis is commonly used for displaced femoral neck fractures. In this study the rate of re-operation following Austin Moore hemiarthroplasty was studied. Ten out of 88 cases (11.36%) were re-operated on within the first year following the original operations. The indications for re-operation were infection (4.5%), dislocation (3.4%) and loose prosthesis (3.4%). The rate of infection found in this study was higher than other published series and could be attributed to the lack of laminar flow ventilation system and the use of cotton drapes and surgical gowns while performing these operations. We recommend that Austin Moore hemiarthroplasty should be carried out in theatres equipped with a laminar flow ventilation system and to use waterproof gowns and drapes to limit the number of deep infections and therefore lower the re-operation rate.     

The impact of the Navrongo Project on contraceptive knowledge and use,reproductive preferences,and fertility

The Navrongo Community Health and Family Planning Project is a quasi-experimental study designed to test the hypothesis that introducing health and family planning services in a traditional African societal setting will introduce reproductive change. This article presents the impact of the initial three years of project exposure on contraceptive knowledge, awareness of supply sources, reproductive preferences, contraceptive use, and fertility. Findings show that knowledge of methods and supply sources increased as a result of exposure to project activities and that deployment of nurses to communities was associated with the emergence of preferences to limit childbearing. Fertility impact is evident in all treatment cells, most prominently in areas where nurse-outreach activities are combined with strategies for involving traditional leaders and male volunteers in promoting the program. In this combined cell, the initial three years of project exposure reduced the total fertility rate by one birth, comprising a 15 percent fertility decline relative to fertility levels in comparison communities.     

Management of Gartland's type III supracondylar fractures of the humerus in children: the role audit and practice guidelines

In 1995, we audited the outcome following Gartland's type III supracondylar fractures of the humerus in children. Closed reduction under anaesthesia (MUA) and cast immobilisation was the treatment of choice, with the treatment changed whenever displacement occurred. The result of the audit showed that 86% of cases were treated with this method. The rate of re-operation was 45.6%. Cubitus varus deformity developed in 50% of cases. Guidelines were introduced in order to abandon the use of MUA and cast immobilisation for type III fractures. The guidelines recommended treating these fractures with rigid fixation using Kirchner (K) wires. A re-audit was conducted in the year 2000 to study the impact of introducing the guidelines. The rate of compliance was 64%. The re-audit showed a significant drop in the rate of re-operations from 45.6 to 17.7% (P = 0.0043), and a significant drop in the incidence of cubitus varus from 50 to 6.6% ( P < 0.0001). The results of the re-audit suggest that practice guidelines can have a major impact on clinical practice.     

Profile of the navrongo health and demographic surveillance system

Located in the Kassena-Nankana districts of northern Ghana, the Navrongo health and demographic surveillance system (NHDSS) was established in 1992 by the Navrongo health research centre (NHRC). The NHRC is one of three research centres of the Ghana health service. The activities and potential of the NHDSS for collaborative research are described. The NHDSS monitors health and demographic dynamics of the two Kassena-Nankana districts of northern Ghana and facilitates evaluation of the morbidity and mortality impact of health and social interventions. The total population currently under surveillance is 152 000 residing in 32 000 households. Events monitored routinely include pregnancies, births, morbidity, deaths, migration, marriages and vaccination coverage. Data updates are done every 4 months by trained fieldworkers. The NHRC also undertakes biomedical and socio-economic studies. Additional features of the NHDSS include the community key informant system where trained volunteers routinely report key events, such as births and deaths as they occur in their locality and the verbal autopsy (VA) system for determining the probable causes of deaths that occur at the community level. Data from the NHDSS are shared with funders and collaborators and partners in the INDEPTH Network. The Director of the NHDSS is the contact person for potential collaboration with the NHDSS and the use of its data.