Biomedical subjects
Publications and source records attributed to G A Pryor.
The effectiveness of providing additional community resources to enable early discharge following hip fracture surgery has been prospectively evaluated in a consecutive series of 645 patients. For those discharged under the scheme, the average hospital stay was 9.3 days, and this resulted in a substantial saving of hospital bed days.
The Moore and Thompson hemiarthroplasties are still commonly used for the displaced subcapital fracture in the elderly. The cemented Thompson has been claimed to be superior to the uncemented Moore prosthesis. However, the use of cement is associated with greater risks and the uncemented Moore appears to give good results in approximately two-thirds of patients. The technical adequacy of uncemented hemiarthroplasty has rarely been considered in assessing the outcome. This study indicates that, on the basis of four radiological criteria, incorrect insertion of the prosthesis leads to a high chance of a poor clinical result at 6 months. Good results are more likely when the postoperative radiograph shows the prosthesis to have been inserted accurately. This is possible in most cases, except where the femur is grossly osteoporotic with a wide intramedullary canal. Uncemented hemiarthroplasty can produce satisfactory results but, like uncemented total joint replacement, is a more demanding procedure.
The rehabilitation of elderly patients after hip fractures is important: we report a prospective study which compares supported home rehabilitation with management in hospital in two similar groups of patients. Our results show that early discharge from hospital and home rehabilitation produces substantial savings in bed days, and also provides quicker and more effective recovery.
True domiciliary health care services are not fully developed yet in Britain. The limited reports from this country and more extensive ones from abroad, indicate the potential of such schemes. The Peterborough Hospital at Home scheme (HAH) has been operating for 10 years and provides a valuable model for the development of a home care service. It has proved of particular value in a variety of patient groups. Terminally ill patients, those discharged early after operation, the elderly and children; all have derived benefits from home care. However, for a service to function efficiently, it must be of sufficient size, be fully integrated and organisationally responsive to changing needs and professional roles.
The management of 200 consecutive patients with hip fracture by a joint hospital and community team in Peterborough has shown that over half the patients could be discharged considerably earlier than is usual. The patients are cared for at home by the hospital-at-home nursing service and generally need much less nursing care than patients treated conventionally. In the first 10 months of the scheme 733 inpatient bed-days were saved and the average hospital stay of patients discharged home was reduced from 22.0 to 14.6 days.
Supracondylar fractures of the femur are often difficult to manage, especially in the elderly whose osteoporotic bone renders internal fixation tenuous. The Zickel supracondylar device provides a dynamic, medullary fracture fixation secure enough to allow unsupported early mobilization even in the elderly. The device can be inserted through small incisions, minimizing surgical injury. Interlocking screws prevent shortening and rotation and allow its use even in comminuted fractures. In 16 patients with non-pathological fractures, follow-up was possible on 14. There were 7 excellent, 5 satisfactory and 2 unsatisfactory results. There were no failures. Follow-up ranged from 6 months to 2 years. The device also proved effective in four patients with pathological fractures, the closed insertion allowing the benefit of early radiotherapy. This small but varied series shows the value of the Zickel supracondylar device in this difficult fracture.
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