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Martyn J Parker

Publications and source records attributed to Martyn J Parker.

At least 19 recordsLinked to original sources
PubMed2007

Incidence of fracture-healing complications after femoral neck fractures.

What is the relationship between the age or gender of the patient and the incidence of fracture-healing complications after internal fixation of intracapsular fractures? We aimed to determine the association between the age of the patient and fracture nonunion and also to establish if the gender of the patient had any influence on the occurrence of fracture nonunion. We prospectively studied 1133 patients with intracapsular fractures of the femoral neck treated by internal fixation. The overall incidence of nonunion was 19.3%. Fracture nonunion was less common for undisplaced fractures than for displaced fractures (48 of 565 [8.5%] versus 171 of 568 [30.1%]) and in men than in women (35 of 271 [12.9%] versus 184 of 862 [21.3%]). The incidence of nonunion progressively increased with age from one of 17 (5.9%) in patients younger than 40 years to 84 of 337 (24.9%) in patients in their 70s. For patients in their 80s, the incidence of nonunion began to decrease, but if patients who died within 1 year after injury were excluded, the incidence continued to increase. Our study showed an increased risk for intracapsular hip fractures developing nonunion with older age and in females.

Adolescent↗
PubMed2006

Urinary catheterisation and deep wound infection after hip fracture surgery.

We have studied the incidence of deep wound infection after hip fracture surgery and its relationship to urinary catheterisation. Infection after hemiarthroplasty occurred in 16/949 cases and 10/1,143 sliding hip screw fixations. No cases of deep sepsis were seen for the 203 patients treated with an intramedullary nail or the 816 patients treated with parallel screws. The use of urinary catheterisation was compared with a control group of patients. In the sepsis group, 12/18 patients had been catheterised peri-operatively or within 24 h, as opposed to 18/36 patients in the control group; the difference between these two groups was not statistically significant (P=0.38). There was a statistically significant increase in the proportion of patients who had more than two urinary catheterisations (6/18 versus 3/36, P=0.05) or who had a long-term catheter (7/16 versus 3/36, P=0.01) in the sepsis group.

Aged↗
PubMed2006

Prosthesis survivorship and clinical outcome of the Austin Moore hemiarthroplasty: An 8-year mean follow-up of a consecutive series of 500 patients.

The results of a consecutive series of 500 patients treated with Austin Moore hemiarthroplasty prosthesis are reported. The range of follow-up was from 5-12 years and the mean was 8 years. Only 10 patients were lost to follow-up and 398 (81%) patients died within the follow-up period. The mean age of the patient population was 82 years, and 85% were women. The cumulative survivorship of the prosthesis was calculated at 94% (95% CI 90-96%) at 5 years and 83% (95% CI 65-94%) at 12 years. A total of 66 secondary operations of any type were required in 46 (9%) patients. Revision of the Austin Moore prosthesis was performed in 23 cases (5%). Of the long-term survivors contacted for follow-up, 66 (81%) had no pain or minimal pain, whilst 5 (6%) reported constant pain in the hip. The revision rates in our series were higher for younger patients, those from their own home and with good pre-fracture mobility and mental function. For the frail elderly with a displaced intracapsular fracture this prosthesis can still be recommended. This paper presents the largest consecutive series, with the longest follow-up, currently available.

Aged↗
PubMed2006

Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review.

OBJECTIVES: To present the updated results of systematic review of the current evidence for the effectiveness of hip protectors from reports of completed randomised trials, and to explore the evolution of that evidence. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Cochrane Bone, Joint, and Muscle Trauma Group trials register (January 2005), Cochrane central register of controlled trials (Cochrane Library Issue 1, 2005), Medline (1966 to January 2005), Embase (1988 to January 2005), and CINAHL (1982 to December 2004). Other databases and reference lists of relevant articles were searched and some trialists were contacted. REVIEW METHODS: Randomised or quasirandomised controlled trials reporting the incidence of hip fractures, pelvic fractures, and other fractures in elderly people offered hip protectors compared with a control group that was not. RESULTS: Outcomes for fracture were available from 14 randomised and quasirandomised trials. Pooling of data from 11 trials carried out in nursing or residential care settings, including six cluster randomised studies, showed evidence of a marginally statistically significant reduction in incidence of hip fracture (relative risk 0.77, 95% confidence interval 0.62 to 0.97). Pooling of data from three individually randomised trials of 5135 community dwelling participants showed no reduction in hip fracture incidence with provision of hip protectors (1.16, 0.85 to 1.59). No evidence was found of any significant effect of hip protectors on incidence of pelvic or other fractures. No important adverse effects of hip protectors were reported, but compliance, particularly in the long term, was poor. CONCLUSIONS: On the basis of early reports of randomised trials, hip protectors were advocated. Accumulating evidence indicates that hip protectors are an ineffective intervention for those living at home and that their effectiveness in an institutional setting is uncertain.

Aged↗
PubMed2006

Compliance with a pharmacological secondary fracture prevention policy.

The aim of this study was to monitor the compliance of a specific group of patients to the initiation of pharmacological fracture prevention therapies, in particular calcium and Vitamin D3 supplements. We used a cohort of 276 patients admitted to one hospital with an acute hip fracture. Therapy was started in hospital and compliance checked at out patient follow-up. Written and verbal advice was given to support therapy. The mean age was 80.8 years and 82% were female. One hundred and ninety-nine patients were alive at one year from injury. For these patients 22 (11.1%) were on therapy prior to fracturing their hip. Of the remainder, 111/177 (62.7%) stated they were taking therapy to reduce the risk of fractures. These results demonstrate that an aggressive policy of prescribing can result in good levels of compliance with therapy.

Aged↗
PubMed2005

Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures.

The results for a consecutive series of 1024 trochanteric hip fractures surgically treated by internal fixation with a sliding hip screw in a single centre are presented. The mean age of patients was 81.7 years and 78% were female. Seventy-five percent of fractures were classified as unstable. At 1 year from injury, 69% of patients were surviving. Of these, 95% had minimal or no pain, 85% had at least returned to their pre-fracture level of accommodation and 50% to their pre-fracture level of mobility. Complications related to surgical fixation were encountered in 3.6% of cases. Overall, 2.6% of patients required further surgery as a result of these. While significant mortality remains an issue, the overall fixation failure rate and re-operation rate for trochanteric fractures fixed with a sliding hip screw is low. The final outcome of surgery for the survivors is good, with most patients returning to their pre-fracture level of accommodation and mobility, with minimal pain 1-year post-fracture.

Accidental Falls↗
PubMed2005

Reverse obliquity and transverse fractures of the trochanteric region of the femur; a review of 101 cases.

BACKGROUND: Reverse obliquity and transverse fractures of the proximal femur represent a distinct fracture pattern in which the mechanical forces displace the femur medially thus increasing the risk of fixation failure. There is a paucity of published literature in this area of trauma. This study constitutes the largest series of such fractures. METHODS: Using a retrospective analysis of prospectively collected data from a single institution, 101 reverse obliquity and transverse fracture patterns were identified from 3336 consecutive hip fractures. All surviving patients were followed up for 1 year. RESULTS: Of 100 patients treated operatively, 59 were treated with 135 degrees sliding hip screws (SHS), 19 with a Medoff plates modification of the SHS, three with a sliding hip screw and trochanteric stabilising plate and 19 with intramedullary sliding hip screw devices. Nine fracture fixation-healing complications occurred, with cut-out being the commonest complication (seven cases). Cut-out of the implant was associated with femoral medialisation and a larger tip to apex distance. CONCLUSION: This fracture pattern is a challenge for the orthopaedic surgeon with a high risk of fracture healing complications. The 135 degrees SHS and the intramedullary devices had similar failure rates.

Adult↗
PubMed2005

Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures.

UNLABELLED: Intracapsular hip fractures in young adults have a significant risk of complications. Consequently, some authors advocate urgent and/or open fracture reduction. Our aim was to analyse outcomes following such fractures with reference to influence of fracture displacement, timing of surgery and method of reduction (open/closed) on the incidence of non-union (NU) and avascular necrosis (AVN). METHODS: Specific search terms were used to retrieve relevant published studies from 1966 to May 2003. RESULTS: Eighteen studies involving 564 fractures were analysed. The overall incidence of NU was 50/564 (8.9%) and AVN was 130/564 (23.0%). There was a higher incidence of NU and AVN following displaced than undisplaced fractures. NU occurred more frequently after open reduction than closed reduction (10/89 [11.2%] versus 13/275 [4.7%]). There was an increased incidence of AVN after closed than open reduction but this was no longer statistically significant when one study with a markedly higher reported incidence of AVN was excluded. The difference in the incidence of NU and AVN following early (<12h) or late (>12 h) surgery was not significant for either NU or AVN. CONCLUSION: Early or open reduction of these fractures may not reduce the risk of NU or AVN. There is a suggestion of a higher incidence of NU following open reduction than closed reduction. Randomised studies with 2 year follow-up are required to report on a larger number of patients before definite conclusions on treatment can be made.

Adolescent↗
PubMed2005

Varus impacted intracapsular hip fractures.

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 presented with a history of progressive hip pain over several days without a definite history of trauma. For the 16 fractures treated by internal fixation without any attempt at fracture reduction, fracture healing occurred in 11 cases.

Aged↗
PubMed2005

Anticoagulation management in hip fracture patients on warfarin.

The management of patients admitted with a fracture requiring surgery who are taking warfarin anticoagulation is unclear. We examined the anticoagulation management for 33 hip fracture patients on warfarin at the time of admission. Hospital course and complications were recorded on all patients. The mean INR on admission was 3.2 and prior to surgery 2.2. Eight patients (24%) had percutaneous cancellous screws for an intracapsular fracture regardless of the admission INR. In 21 (64%) patients, surgery was delayed whilst the INR came down, with an average delay of 72 h from admission to surgery. No specific treatment to lower the INR, other than wait and watch policy adopted in 11 (33%) of these patients. Pharmacological methods used to reduce the INR were fresh frozen plasma in nine cases, and intravenous Vitamin K in four patients. One patient died from post-operative haematemesis and three died from medical complications unrelated to the warfarin therapy. There were no wound haematomas or other bleeding complications. Delaying surgery whilst waiting for the INR to fall to acceptable levels may result in significant delays to surgery and we would recommend a more aggressive policy to enable earlier surgery.

Administration, Oral↗
PubMed2004

Stability of hip hemiarthroplasties.

It has been stated in the literature that a bipolar hemiarthroplasty has a lower risk of dislocation compared to a unipolar hemiarthroplasty. As this statement has not been substantiated we undertook a systematic review of the literature of published articles from the last 40 years. In addition we used our own database of hip fractures. One hundred and thirty-three published articles were included in the review to give a total of 23,107 cases. The overall dislocation rate for all types of hemiarthroplasty was 791/23,107 (3.4%). An increased risk of dislocation was associated with a posterior surgical approach and the use of a cemented prosthesis. After adjustment for surgical approach and the use of cement there was no difference in risk of dislocation between unipolar and bipolar hemiarthroplasties. There was an increased risk of open reduction for a bipolar hemiarthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2004

Basal fractures of the femoral neck: intra- or extra-capsular.

The method of treatment and outcome for 83 patients presenting with a basal fracture of the femoral neck were determined. This represented 2.3% of all hip fractures admitted to one institution. The mean age of patients was 80 years, 25% were male. Seventy-one fractures were treated with a sliding hip screw, one of which cut-out. No other failures of fixation occurred or re-operations were required. Two fractures were fixed with cancellous screws, one healed in varus and the other fixation failed requiring re-operation. Six were managed with an arthroplasty and four treated conservatively. At 1-year from injury 29% of patients had died. For the survivors 87% were able to return home and only 6% had significant residual pain.

Adult↗
PubMed2004

Prediction of fixation failure after sliding hip screw fixation.

Cut-out of the lag screw is the commonest cause of fixation failure after sliding hip screw fixation of extracapsular hip fracture. A number of technical aspects of surgery have been used to asses the risk of cut-out. This study was to determine which of these indicators was the most reliable predictor of cut-out. The anterior-posterior and lateral post-operative radiographs of 23 cases of cut-out were compared with those of 77 cases of uneventful fracture healing. The tip-apex distance with correction for magnification was found to show the most significant difference between patients with cut-out against those without (P = 0.001), followed by the lag screw position on the lateral radiographs (P = 0.0095 and 0.014), reduction of the fracture on the anterior-posterior radiograph (P = 0.011 and 0.016) and the uncorrected tip-apex distance (P = 0.019). We recommend that for audit and research purposes the corrected tip-apex distance, fracture reduction and implant positioning methods should be used. For routine clinical practice, the uncorrected tip to apex distance, which is sum of the distance from the tip of the lag screw to the apex of the femoral head on anterior-posterior and lateral radiograph, and fracture reduction angle on the anterior-posterior radiograph are recommended.

Aged↗
PubMed2004

Closed suction drainage for hip and knee arthroplasty. A meta-analysis.

BACKGROUND: The use of closed-suction drainage systems after total joint replacement is a common practice. The theoretical advantages for the use of drains is a reduction in the occurrence of wound hematomas and infection. The aim of this meta-analysis was to determine, on the basis of the evidence from randomized controlled trials, the advantages and adverse effects of surgical drains. METHODS: All randomized trials, as far as we know, that compared patients managed with closed-suction drainage systems and those managed without a drain following elective hip and knee arthroplasty were considered. The trials were identified with use of searches of the Cochrane Collaboration with no restriction on languages or source. Two authors independently extracted the data, and the methods of all identified trials were assessed. RESULTS: Eighteen studies involving 3495 patients with 3689 wounds were included in the analysis. The pooled results indicated that there was no significant difference between the wounds treated with a drain and those treated without a drain with respect to the occurrence of wound infection (relative risk, 0.73; 95% confidence interval, 0.47 to 1.14), wound hematoma (relative risk, 1.73; 95% confidence interval, 0.74 to 4.07), or reoperations for wound complications (relative risk, 0.52; 95% confidence interval, 0.13 to 1.99). A drained wound was associated with a significantly greater need for transfusion (relative risk, 1.43; 95% confidence interval, 1.19 to 1.72). Reinforcement of wound dressings was required more frequently in the group managed without drains. No difference between the groups was seen with respect to limb-swelling, venous thrombosis, or hospital stay. CONCLUSIONS: Studies to date have indicated that closed suction drainage increases the transfusion requirements after elective hip and knee arthroplasty and has no major benefits. Further randomized trials with use of larger numbers of patients with full reporting of outcomes are indicated before the absence of any benefit, particularly for the outcome of wound infection, can be proved.

Aged↗
PubMed2004

Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients.

Three hundred seventy-five patients with an undisplaced intracapsular proximal femoral fracture were treated with internal fixation. Nonunion occurred in 24 patients (6.4%) and avascular necrosis occurred in 15 patients (4.0%). Reoperation with an arthroplasty was required in 29 patients (7.7%). The age, walking ability of the patient, and degree of impaction seen on the anteroposterior radiograph or angulation seen on the lateral radiographs were of statistical significance in predicting fracture healing complications. The results for this series of patients were compared with the results in published reports identified by a comprehensive literature search. Summation of the results indicated that the overall risk of redisplacement or nonunion of the fracture was 4.3% (95% confidence interval, 3.4%-5.3%) with internal fixation of an undisplaced intracapsular fracture. For conservative treatment, the failure rate was 19.6% (95% confidence interval, 17.2%-22.1%). The incidence of avascular necrosis with internal fixation at 1 year was 2.2% (95% confidence interval, 1.6%-2.9%) compared with 2.8% (95% confidence interval, 1.9%-4.0%) with nonoperative treatment. Internal fixation is recommended for the treatment of undisplaced intracapsular hip fractures.

Aged↗
PubMed2003

Seasonal variation of proximal femoral fractures in the United Kingdom.

A prospective study including 3034 consecutive hip fracture patients admitted to a single unit in the United Kingdom over a 12-year period was performed. The daily incidence of hip fractures was compared between all four seasons throughout the year. Information was recorded for each patient including level of mobility, mental test score, type of residence, fracture type and total length of stay. Mortality rates at 30, 120 and 365 days were also calculated. More hip fractures occurred during the winter compared to summer (P=0.002). There was an increase in the number of extracapsular fractures (P=0.006) and tendency to a higher mortality for those patients admitted in the winter months. There was no significant difference in patient characteristics between the winter and summer seasons. Funding and resources within the health service may need to be adjusted to accommodate this variation in patient load.

Aged↗