Endoprosthesis. The best way to treat unstable intracapsular hip fractures in elderly patients.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
K H Stappaerts
Publications and source records attributed to K H Stappaerts.
Factors determining quadriceps recovery following femoral shaft fractures.
Explore the source record for details and available documents.
Adolescent↗
Early fixation failure in displaced femoral neck fractures.
A study of 76 displaced femoral neck fractures treated by reduction and Knowles pins or AO (ASIF) cancellous bone screws was carried out. Fixation failure within 3 months occurred in 17 cases (22%). Advanced age, inaccurate reduction, a poor mental state of the patient, the number of Knowles pins used, and the preinjury functional ability of the patient are significant risk factors for fixation failure. Neurological disease, the type of fracture according to Garden, delay before operation, and the method of fixation are not significantly related to fixation failure.
Adolescent↗
Pertrochanteric fractures in the elderly. Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminution?
During a ten year period (1978-1988) 565 patients, aged 70 years and over, suffering a fresh pertrochanteric fracture have been treated in the Department of Traumatology at the University Hospitals of Leuven, Belgium. According to the system of Evans and Jensen, 388 fractures were classified as unstable. Special attention was given to the 324 cases of type I C and I D fractures. The method of treating greatly changed during the period of study. All patients were followed up prospectively during one year. Our study showed that for these unstable fractures, fixation with an angled plate or Ender nails should be forsaken. The overall results of the dynamic hip screw treatment were good (reoperation rate 2%, good functional results in 64%), but as this treatment has a risk for serious collapse and pain in about 80% of all type I D fractures, one could suggest to treat these complex multifragment fractures primarily with an endoprosthesis. This treatment needs no longer to be considered as a severe intervention, as the danger of mechanical complications being very minimal (less than 1%).
Aged↗
Hip fractures in the elderly. Mortality, functional results and social readaptation.
Six-hundred and fourteen aged over 70 and presenting hip fractures have been studied prospectively. The results were compared with the literature. The overall mortality rate within three months was 24%. This mortality was significantly influenced by the general health condition of the patient at the time of the injury, his living conditions and the possibility of walking again after the operation (p less than 0.001). For 38% of the survivors, the fracture means a considerable loss of functional independence. The adjacent impairment was in close relationship with patient's age and fracture-type (p less than 0.05). Sixty per cent of the patients were able to return home. In predicting the probability of returning home, the functional status before injury and the possibility of walking at the moment of discharge were particularly important (p less than 0.001).
Aged↗
Home-going: prognostic factors concerning the major goal in treatment of elderly hip fracture-patients.
Two hundred and forty-one hip fracture patients over 70 years of age still living at home at the moment of the accident were followed prospectively until three months postoperatively. The patients were admitted to the department over a five year period (1978-1983). One hundred and forty-four patients returned home. In order to predict whether an elderly hip fracture patient will be able to return home within three months, the following prognostic factors will have to be taken into account: pre-operative functional status (p = 0.0001), ambulatory capacity at discharge (p = 0.0001), age (p = 0.001), presence of relatives at home to return to (p = 0.02) and general medical postoperative complications (p = 0.0006). In this respect it was noted that sex, fracture type or mechanical complication with possible operation do not significantly influence the home-going rate within three months after surgery (p greater than 0.05).
Activities of Daily Living↗
Polytrauma in patients of 65 and over. Injury patterns and outcome.
In a consecutive series of 416 patients with multiple injuries, 49 were aged 65 years or older (mean age 72.1). This group of "old" patients was compared with the remaining 367 "young" patients (mean age 31.3). In the old patients group, survivors and non-survivors were profiled. In general the injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' group (33.2 versus 42.1) (p less than 0.001), the mortality rate was significantly higher (18% versus 7.6%) (p less than 0.05). We found that in the elderly injured the ISS and preexisting diseases were not predictive of survival. However, brain injury with unconsciousness and the need for early intubation followed by long-term assisted ventilation were predictive of survival (p less than 0.001). Seventy-six per cent of the survivors were able to return home again within six months. As the final outcome in the elderly is no worse after polytrauma than after other important emergency procedures, an aggressive treatment including urgent operative fixation of major fractures is in our opinion justified.
Accidental Falls↗
[The use of Müller hip prostheses for post-traumatic injuries].
Between 1978 and 1984 373 Müller prostheses have been used in treating post traumatic lesions of the hip joint. Three groups of patients were concerned: elderly people with fresh fractures of the femoral neck; late sequels of femoral neck fractures; late sequels of acetabular fractures. The follow-up period ranged from 18 months to 8 years. Special attention was brought to late mechanical problems and the final functional status of the patients. We could conclude that: 1. Three years after surgery about 50% of the survivors were still in a good functional condition. After 5 years, this number decreased to 35%. 2. Total prosthesis with "banana formed" stem has to be abandoned. After five years signs of loosening were present in nearly all the cases. The functional results of the straight stem prostheses were significantly better. 3. Old people in good general condition with a fresh fracture of the femoral neck are better of with a total hip replacement than with a hemiarthroplasty. 4. Late sequels of acetabulum fractures present a more complex problem. Maybe a total hip arthroplasty is not always the best final solution.
Acetabulum↗
Internal fixation of femoral neck fractures. A follow-up study of 118 cases.
A retrospective study of 118 femoral neck fractures treated with multiple Knowles pins or with AO (ASIF) cancellous bone screws, and followed for at least 22 months, revealed nonunion in 1/33 undisplaced fractures and in 27/85 displaced fractures. Avascular necrosis was radiographically evident in respectively 2/32 and 19/58 united undisplaced and displaced fractures. Four factors were adversely associated with union: inaccurate reduction, mental confusion, age above 80 years and fixation with less than 6 Knowles pins. Late segmental collapse was not significantly related with any of the 9 analyzed factors. It was concluded that displaced femoral neck fractures in confused patients older than 80 years, or fractures one cannot adequately reduce, should be primarily treated with arthroplasty. Following accurate reduction, internal fixation with less than 6 Knowles pins cannot be recommended.
Adolescent↗
Multiple trauma in patients of 65 and over. Injury patterns. Factors influencing outcome. The importance of an aggressive care.
In a first study of 416 polytrauma patients, 49 were aged 65 years or older. These "old patients" (mean age 72.1) were compared with the remaining 367 "young patients" (mean age 31.3). In a second study concerning 126 polytrauma patients of 65 and over, the survivors and non survivors were profiled and compared. The typical injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' groups (33.2 versus 42.1 degrees) (p < 0.0001) the mortality rate was higher (18% versus 7.6%) (p < 0.05). In old trauma victims multiple system organ failure (MSOF) was responsible for the fatal outcome in 48% of the cases and in 71% of the deaths more than 7 days after trauma. Seventy eight percent of the surviving old patients still living at home pre-injury were able to go back to their normal surroundings. In the old patients groups there was no significant difference in age nor in ISS nor in pre-existing diseases between survivors and non-survivors. On the other hand the Glasgow Coma Scale (GCS) was of important prognostic value, as well as to survival as to functional recovery (p < 0.001). Also the need for early intubation and continued ventilation were predictive of survival (p < 0.001). Nevertheless this need for respiratory assistance was not an indication for withdrawing support as also 9% of the survivors required endotracheal intubation for 5 days or longer.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗