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Hip hemiarthroplasty is the commonest operation performed for a displaced intracapsular hip fracture in the UK. A variety of implants including fixed offset prostheses are utilised. There has been no study investigating the relationship between restoration of femoral offset and long term pain and function. This study aims to evaluate long-term pain and functional outcomes of a fixed offset hemiarthroplasty...
To determine the optimum choice of implant for a patient with a the different types of trochanteric hip fracture.1000 patients with a trochanteric hip fracture were randomised to internal fixation of the fracture with either a Sliding Hip Screw or an intramedullary nail. Fractures were subdivided into two part fractures, comminuted fractures and fractures at the level of the lesser trochanter (reversed/oblique...
There are no specific guidelines for treating Parkinson’s disease patients who present with a hip fracture. Here we present a large cohort of patients with Parkinson’s disease who suffered hip fractures. Our aim was to assess for differences between a Parkinson’s disease population and a non-Parkinson’s disease population with hip fractures and make recommendations on management guidelines.We performed...
This study compares the outcome of intracapsular hip fracture fixation using the Targon Femoral Neck (TFN) locking plate system with the standard fixation using cannulated cancellous screws (CCS).Analyses of a prospectively collected data of all patients treated for intracapsular hip fractures using the TFN system and CCS at our department over a period of 28 years. Baseline characteristics and specific...
The degree of femoral neck collapse that occurred after 519 patients with an intracapsular hip fracture treated by internal fixation with a Targon FN implant was measured. Mean femoral neck collapse was 8.0mm and this was increased for displaced fractures in comparison to undisplaced fractures (9.5mm versus 5.9mm, p<0.0001) and for those patients that subsequently developed fracture healing complications...
When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications,...
A review of the literature was undertaken to determine which amenable factors could be identified that would potentially improve the morbidity or mortality after hip fracture. Only two factors were identified that have been reported to be associated with a reduction in mortality, these were early surgery and experience of the surgeon. Other factors identified that may potentially reduce morbidity...
The aim of this study was to evaluate the medium to long term follow up results for the Exeter Trauma Stem (ETS) in the treatment of displaced femoral neck fractures. We retrospectively evaluated 604 consecutive cemented ETS hemiarthroplasties performed at our institution between 2007 and 2012. The range of follow up was 2–7 years with a mean follow-up of 4.1 years for the surviving patients. The...
Uncertainty remains regarding the optimum method of anaesthesia for hip fracture surgery. We randomised 322 patients with a hip fracture to receive either general anaesthesia or regional (spinal) anaesthesia. Surviving patients were followed up to 1 year from injury. There was no notable difference in the outcomes of hospital stay, need for blood transfusion or post-operative complications between...
Continued debate exists about the merits of the different surgical approaches for arthroplasty of the hip. For hemiarthroplasty to the hip the two most commonly used approaches are lateral and posterior. 216 patients with an intracapsular hip fracture being treated with a cemented hemiarthroplasty were randomised to surgery using either a lateral or posterior approach. Surviving patients were followed...
Debate exists as to what should be the transfusion threshold for patients with anaemia after hip fracture surgery.A total of 200 patients aged 60 years and above with a haemoglobin level of between 8.0 and 9.5gdl −1 after hip fracture surgery were randomised to receive a transfusion to raise the haemoglobin to at least 10.0gdl −1 or not to have a transfusion unless definite symptoms...
A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current...
Numerous different designs of hemiarthroplasty are available but few have been compared within the context of a randomised controlled trial. Two-hundred patients presenting with a displaced intracapsular fracture of the hip were randomised to receive either a cemented Thompson hemiarthroplasty or a cemented smooth tapered stem hemiarthroplasty (Exeter Trauma Stem). All operations were undertaken or...
This study investigated the relationship between different components of the full blood count, such as haemoglobin (Hb), total white cell count, total lymphocyte count on admission and total neutrophil count as possible surrogate markers of conditions that lead to increased mortality in hip-fracture patients. A total of 791 patients were studied with 81.2% being females. The 1-year mortality was 26...
A hip fracture is the commonest reason for an elderly person to be admitted to an orthopaedic ward. The injury is generally caused by a fall or trip from a standing height. Most patients are elderly and female with many having associated comorbidity. The essence of treatment is early effective surgery to either fix the fracture or replace the fracture bone with an arthroplasty. After surgery early...
It is unclear which length of thread may be most advantageous for the internal fixation of an intracapsular fracture with cancellous screws. We have compared the 16mm versus the 32mm threads on cancellous screws within a randomised trial for 432 patients. All fractures were fixed with three screws and patients followed-up for a minimum of one year from injury.The characteristics of the patients in...
In a prospective randomised trial, 455 patients presenting to one hospital with a displaced intracapsular fracture were randomised to either closed reduction and internal fixation with three cancellous screws or replacement with an uncemented hemiarthroplasty. Follow-up of surviving patients was for between 9 and 15 years to determine the long-term outcome for the two treatment methods. 93% of patients...
The results of treatment for 83 patients treated with a new implant designed specifically for the internal fixation of intracapsular hip fractures are reported. Nonunion occurred in one out of the 37 undisplaced fractures (3%) and seven out of the 46 displaced fractures (15%). In addition, four patients developed avascular necrosis (5%), one developed a fracture around the distal screws and another...
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