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This case report describes a rare posterior dislocation of the hip with fractures of the ipsilateral femoral neck and greater trochanter, without fracture of the femoral head, in a young adult male following a railway accident. This patient was managed within 6h of injury by open reconstruction. This unusual injury has not been reported previously. Cases of posterior fracture dislocation of the hip...
In this retrospective study, we looked at the difference in 1 year mortality between two groups of patients who were operated for fracture of the hip. Patients and methods: In cohort 1, 72% of the patients underwent surgery on the same day of admission, 15% of the patients were operated on the next day, the remaining 13% of the patients waited more than 1 day for surgery. The mean waiting time was...
Post-operative fractures around the tip of the femoral component of a hip prosthesis are inherently unstable and have been reported to be associated with high nonunion rate if treated conservatively. A group of 27 of these fractures were treated with dynamic compression plates between 1994 and 2000. The fractures followed primary total hip arthroplasty in 10 cases, revision surgery in five cases and...
Adequate pre-operative analgesia for elderly patients with femoral neck fractures is difficult to assess and is often an overseen aspect of their care. We aimed to assess the efficacy of fascia iliaca blocks inserted via plexus blockade catheters in the pre-operative period. Our simple technique allowed the block to be administered safely without the need for a nerve stimulator. We assessed the effectiveness...
We describe a distinct variant of an impacted intracapsular hip fracture that is difficult to classify within any of the current fracture classification systems. Instead of impaction occurring laterally, as generally occurs with a Garden grade I fracture, there is medial impaction. We have termed this a varus impacted fracture. Nineteen such fractures were identified. The majority of these patients...
Dislocation of a Thompson hemiarthroplasty of the hip is a serious complication with a high mortality rate. Previous papers have focused on surgical techniques to try and prevent dislocation. There is little in the literature on how to manage a patient after a dislocation.Patients with a dislocated Thompson hemiarthroplasty over a 5-year period from 1997 to March 2002 were analysed. Attempts were...
To explore potential predictors of functional outcome one year after the injury in elderly women who sustained a displaced intracapsular hip fracture and who were treated with internal fixation, hemiarthroplasty, or total hip arthroplasty.Eighty-four women aged ≥50 years were enrolled on a consecutive basis in this one-year prospective cohort study reflecting standard day-to-day clinical practice...
To assess the relationship between pre-operative serum urea and electrolyte concentrations and mortality in patients with hip fractures requiring surgery.A prospective observational study of 2963 consecutive patients admitted to a single trauma unit with a hip fracture, treated operatively.The 30-day mortality for patients with low and normal urea concentrations was 6.9%. The 30-day mortality for...
We compared the mechanical behaviour of osteosynthesis with the percutaneous compression plate (PCCP) compared with the standard osteosynthesis sliding hip screw (SHS) in intracapsular hip fractures. We created 10 stable and 10 unstable intracapsular hip fractures in 20 synthetic femurs. Each fracture was fixed with either the SHS or PCCP. In six pairs of cadaver femurs, we created unstable intracapsular...
The Tip Apex Distance (TAD) is defined as the sum of the distance, in millimetres, from the tip of the lag screw to the apex of the femoral head, as measured on an antero-posterior radiograph and lateral radiograph, after correction has been made for magnification. The relationship between the degree of rotation of the hip joint and its implication on measuring TAD during fixation of a proximal femoral...
To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF).Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped...
A retrograde femoral nail was designed to slide over the tip of the femoral stem. Eighteen patients (4 ♂, 14 ♀) were treated with this retrograde nail between 1995 and 2003. The mean age was 81.4 years (range 61–96) with a mean follow-up of 21 months (range 4–61 months). Eight patients suffered from severe comorbidity. Mean surgical time was 91min. Fourteen patients regained their preoperative functional...
The nonagenarian population is increasing yet there is little known about their survival and mortality rates following hip fractures. The aim was to review and evaluate all the nonagenarians who underwent surgery for intra- or extracapsular hip fracture at the Trauma Unit of the Department of Surgery at the Academic Medical Center (AMC) in Amsterdam in the past 20 years. In this retrospective study,...
During the first three decades of the 21st century the combination of increasing life expectancy and falling birth rates will result in substantial demographic changes within the population of the United Kingdom. A large increase in the elderly population is likely to have significant effects on the number of patients who sustain a hip fracture.To predict future changes in hip fracture burden in Scotland...
Femoral intramedullary nailing is currently one of the most frequent surgical treatments for extracapsular hip-fracture fixation. Cutting-out of the lag screw is the main complication of this technique, but only few studies have approached the cutting-out focussed on femoral nailing. The aim of this study was to confirm in patients treated with intramedullary nailing not only with regard to previous...
Several authors have identified on admission haemoglobin level as the most useful predictor of transfusion risk in patients with a hip fracture. A low postoperative haemoglobin unexplained by perioperative blood loss is not uncommon in these patients. The drop in haemoglobin after re-hydration prior to surgery should depend not only on the degree of dehydration but also on the amount of blood lost...
Internal fixation is one of the main options for treating displaced intracapsular hip fractures. However, controversy remains over which osteosynthesis is the best choice. Using a simulated displaced intracapsular hip fracture model, we compared the mechanical stability of three types of osteosynthesis: the sliding hip screw (SHS), three cannulated screws and the Targon ® FN. We also assessed...
The purpose of this study is to determine the biomechanical stability of a novel prototype femoral neck locking plate (FNLP) for treatment of Pauwels type C femoral neck fractures compared with other current fixation methods.Forty femur sawbones were divided into groups and a vertical femoral neck fracture was made. Each group was repaired with one of the following: (CS) three parallel cancellous...
To compare clinical and radiological outcome between acetabular fractures with marginal impaction that were treated with either cancellous bone graft (CBG) or tricalcium phosphate cement (TPC) as bone void filler.Retrospective study.Forty-three patients with acetabular fractures with marginal impaction.Eighteen patients received cancellous bone graft and 25 patients received tricalcium phosphate cement...
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