Trends in hospital admissions for fractures of the hip and femur in England, 1989-1990 to 1997-1998.
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BACKGROUND: Fractures of the hip are a major public health issue. Suggestions of a recent stabilization of age-specific admission rates would have implications for health service planning, thus we investigated this using hospital data. METHOD: Hospital episode statistics for England, 1989-1990 to 1997-1998, were examined for admissions and deaths for fractures of the hip and femur in NHS hospitals in patients aged 45 years and over. RESULTS: Age-standardized admission rates increased by 32 per cent between 1989-1990 and 1997-1998 in men, and by 30 per cent in women. The increase in admission rates was almost entirely confined to the period 1989-1990 to 1991-1992, with very little change after this. The proportion of admissions ending in death during the study period decreased in both men (-35 per cent) and women (-40 per cent) but this change was largely confined to the early years of the study. The number of admissions from hip and femoral fractures in people aged 65 years and over is projected to increase from about 57,300 in 1997-1998 to 69,500 by 2021-2022. CONCLUSIONS: Age-specific rates of admission appear to be stabilizing, which is in contrast to previous trends. The lack of any decrease in hospital admission and mortality rates over the last 5 years is of concern. The management of osteoporosis-induced fractures in hospitals, the prevention and treatment of osteoporosis in primary care and the prevention of falls should be seen as priorities for the NHS to help reduce the burden of disease from osteoporosis in the elderly. (+info)
Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses.
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In a prospective, controlled study, we measured the effect on cardiac output of the introduction of methylmethacrylate during hemiarthroplasty for displaced fractures of the femoral neck. We treated 20 elderly patients who were similar in age, height, weight and preoperative left ventricular function with either cemented or uncemented hemiarthroplasty. Using a transoesophageal Doppler probe, we measured cardiac output before incision and at six stages of the procedure: during the surgical approach, reaming and lavage of the femoral canal, the introduction of cement, the insertion of the prosthesis, and in reduction and closure. We found that before the cement was introduced, there was no difference in stroke volume or cardiac output (p > 0.25). Cementation produced a transient but significant reduction in cardiac output of 33% (p < 0.01) and a reduction in stroke volume of 44% (p < 0.02). The introduction of cement did not affect the heart rate or mean arterial pressure. There was no significant difference in cardiac function on insertion of the prosthesis. Standard non-invasive haemodynamic monitoring did not detect the cardiovascular changes which may account for the sudden deaths that sometimes occur during cemented hemiarthroplasty. The fall in stroke volume and cardiac output may be caused by embolism occurring during cementation, but there was no similar fall during reaming or insertion of the prosthesis. (+info)
Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987-99.
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We studied the rates of revision for 53,698 primary total hip replacements (THRs) in nine different groups of disease. Factors which have previously been shown to be associated with increased risk of revision, such as male gender, young age, or certain types of uncemented prosthesis, showed important differences between the diagnostic groups. Without adjustment for these factors we observed an increased risk of revision in patients with paediatric hip diseases and in a small heterogeneous 'other' group, compared with patients with primary osteoarthritis. Most differences were reduced or disappeared when an adjustment for the prognostic factors was made. After adjustment, an increased relative risk (RR) of revision compared with primary osteoarthritis was seen in hips with complications after fracture of the femoral neck (RR = 1.3, p = 0.0005), in hips with congenital dislocation (RR = 1.3, p = 0.03), and in the heterogenous 'other' group. The analyses were also undertaken in a more homogenous subgroup of 16,217 patients which had a Charnley prosthesis implanted with high-viscosity cement. The only difference in this group was an increased risk for revision in patients who had undergone THR for complications after fracture of the femoral neck (RR = 1.5, p = 0.0005). THR for diagnoses seen mainly among young patients had a good prognosis, but they had more often received inferior uncemented implants. If a cemented Charnley prosthesis is used, the type of disease leading to THR seems in most cases to have only a minor influence on the survival of the prosthesis. (+info)
Is physical activity protective against hip fracture in frail older people?
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BACKGROUND: there is limited evidence of a protective effect of physical activity in preventing hip fractures among older people living in institutions and in those aged 80 or over. OBJECTIVE: to examine the relationship between physical activity and risk of hip fracture in frail older people. DESIGN: a case-control study. SETTING: Auckland, New Zealand. SUBJECTS: a random sample of individuals hospitalized with a fracture of the femoral neck (n=911) and 910 randomly selected age- and sex-matched individuals from the lists of a random sample of general practitioners. METHODS: we sought information on physical activity and other potential risk factors for hip fracture from cases and controls, using a standardized interviewer-administered questionnaire. We conducted multivariate analyses, separately for those living in private homes and residential institutions. RESULTS: increasing hours of physical activity per week protected against the risk of hip fracture among individuals living in private homes, including those who are over 80. However, among individuals living in institutions, physical activity levels were extremely low (<15% participated in >/=2 h per week) and there was limited evidence of a protective effect. CONCLUSIONS: efforts to prevent hip fractures in individuals living in care homes and institutions should focus on passive interventions which are known to be effective. (+info)
Scattered radiation during fixation of hip fractures. Is distance alone enough protection?
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We measured the scattered radiation received by theatre staff, using high-sensitivity electronic personal dosimeters, during fixation of extracapsular fractures of the neck of the femur by dynamic hip screw. The dose received was correlated with that received by the patient, and the distance from the source of radiation. A scintillation detector and a water-filled model were used to define a map of the dose rate of scattered radiation in a standard operating theatre during surgery. Beyond two metres from the source of radiation, the scattered dose received was consistently low, while within the operating distance that received by staff was significant for both lateral and posteroanterior (PA) projections. The routine use of lead aprons outside the 2 m zone may be unnecessary. Within that zone it is recommended that lead aprons be worn and that thyroid shields are available for the surgeon and nursing assistants. (+info)
Heterotopic ossification following internal fixation or arthroplasty for displaced femoral neck fractures: a prospective randomized study.
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One hundred hips in 99 patients of 75 years or older, with a displaced femoral neck fracture, were studied for heterotopic ossification (HO). The patients were randomized to either internal fixation or total hip arthroplasty (THA). In the THA group HO was found in 32 of 45 hips compared with 1 of 39 in the internal fixation group (P < 0.0012). The frequency of HO after THA corresponds well with findings in other studies on patients receiving THA for osteoarthrosis. In cervical fractures the surgical procedure of total hip replacement seems to be a prerequisite for HO, indicating that the procedure itself is more important than the patient's age and the diagnosis. Severe symptoms due to HO were found in only one patient. HO following THA for a femoral neck fracture is of little clinical importance and prophylaxis is unnecessary. (+info)
Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults.
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Twenty cases of neglected (more than 1 month old) displaced femoral neck fractures in young adults were treated with a valgus intertrochanteric osteotomy. A fracture union rate of 85% (17 cases) was achieved. Two of the healed cases developed avascular necrosis. After 30 months 15 patients (75%) had achieved good to excellent results. We believe that intertrochanteric osteotomy provides good alternative management for neglected femoral neck fractures. (+info)
Transepiphyseal fracture of the femoral neck with dislocation of the femoral head and fracture of the posterior column of the acetabulum in a child.
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We describe a 15-year-old boy with a posterior dislocation of the hip, fracture of the posterior column of the acetabulum and separation of the femoral capital epiphysis. To our knowledge no previous case in a child has been reported. Such high-energy injuries are extremely rare, and a poor outcome is expected. We advocate early referral to a specialised tertiary centre, and the use of a modification of Delbet's classification to reflect the complexity and displacement which may occur with this injury. (+info)