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PubMed1993

Length of hospital stay and outcome after femoral neck fracture: a prospective study comparing the performance of two hospitals.

Length of hospital stay and outcome after femoral neck fracture were compared in a prospective study between two adjacent hospitals. In matched populations, mean length of stay was 30.8 days at Hospital X and 15.7 days at Hospital Y. Need for rehousing, age over 80 years and new nursing home placement prolonged length of stay at Hospital X, but not at Hospital Y. Hospital X had an orthopaedic rehabilitation ward and returned 88 per cent of patients to their own home, placing 9 per cent admitted from home in nursing homes. Hospital Y returned 76 per cent of patients to their own home and 19 per cent to nursing homes. The rapid discharge policy of Hospital Y saved significant resources within the acute hospital at the expense of returning significantly fewer patients to their own homes.

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PubMed1999

[Tests of durability characteristics of osteosynthesis of femoral neck fractures by different fixators under static and dynamic loading].

Test bench experiments on the models of femoral neck bone fractures with the use of various kinds of latches has been carried out for evaluation of durability characteristics of the osteosynthesis, using universal test machine "Zwick-1464". 40 preparations of proximal-diaphysis parts of the femoral bone from 28 females and 12 males (mean age 71 years) were used one day after death. The models of basal, transcervical and subcapital fracture were formed with the angle between its planes and horizontal plane (the angle of Pauel's) 30, 40 and 70 degrees. The models of fractures underwent static and dynamic loads, the results being fixed automatically in graphics. The obtained data have confirmed the dependence of the stability of the osteosynthesis by tested fixators on the size of Pauels' angle: the more was this value the less was the firmness of the junction. Dependence of the firmness of fixation of bone fragments on location of the fracture in femoral neck was noted. The differences of durability characteristics of created constructions in basal, and transcervical fractures of types I and II by Pauels are insignificant. The authors think that the least invasive mode for fixation among tested constructions is osteosynthesis with V-shaped bunch of needles, which produced minimal trauma for bone tissue and created resilient tension in the system of bone fixator (latch), which is especially important in osteoporosis.

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PubMed2005

Pre-operative analgesia for patients with femoral neck fractures using a modified fascia iliaca block technique.

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 of the block with a novel objective sitting score and by assessing the degree of passive hip flexion that could be achieved comfortably. Visual analogue scores were also used. We studied 30 consecutive patients, regardless of their mental state. One hour following the block, there was a significant improvement in the sitting scores as well as the passive hip flexion (mean increase 44 degrees ). Visual analogue scores also score improved significantly from 7.2 to 4.6 (S.D. 2.4) in the 18 patients without cognitive impairment. We conclude that fascia iliaca blocks can provide significant benefit in the pre-operative period and allow patients to sit up more comfortably while they await surgery.

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PubMed1995

[Hemiprosthesis in femoral neck fracture].

From 1968 to 1993 835 hemiarthroplasties were performed at the Department of Trauma Surgery of the University of Erlangen. Until 1984 Moore (297) and Thompson (148) prostheses were implanted. After this period 390 patients were treated with a bipolar headneck replacement. Average age of patients at the time of surgery was 80.2 years from 1968 to 1980 and 83.1 from 1981 to 1993. All hemiarthroplasties were performed due to intracapsular fractures of the femoral neck. 5.9% of the Thompson and Moore prostheses were revised to total hip arthroplasty, the rate of revisions of bipolar prostheses was 4.9%. Main causes of revision for Thompson and Moore prostheses were acetabular erosion and protrusion (5.2%). Revision of bipolar prostheses became necessary because of recurrent luxation in 4.1%. The social status of the patients was examined 1 year after the operation. From 1968 to 1980 67% of the patients lived in their own home or with their families, compared to 39% from 1981 to 1993. The percentage of patients in retirement homes tripled from 9% to 29% for the same period.

Activities of Daily Living↗

PubMed2006

Comparison of routine prophylaxis with vancomycin or cefazolin for femoral neck fracture surgery: microbiological and clinical outcomes.

OBJECTIVE: To assess the impact of antibiotic prophylaxis on the emergence of vancomycin-resistant strains of Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus and the incidence of surgical site infection (SSI) after vancomycin or cefazolin prophylaxis for femoral neck fracture surgery. DESIGN: Prospective cohort study. SETTING: A hospital with a high prevalence of methicillin-resistant S. aureus (MRSA) carriage. PATIENTS: All patients admitted with a femoral neck fracture from March 1, 2004 through February 28, 2005 were prospectively identified and screened for MRSA and vancomycin-resistant (VRE) carriage at admission and at day 7. Deep incisional and organ/space SSIs were also recorded. RESULTS: Of 263 patients included in the study, 152 (58%) received cefazolin and 106 (40%) received vancomycin. At admission, the prevalence of MRSA carriage was 6.8%; it was 12% among patients with risk factors and 2.2% among patients with no risk factors (P=.002). At day 7 after surgery, there were 6 patients (2%) who had hospital-acquired MRSA, corresponding to 0.7% in the cefazolin group and 5% in the vancomycin group (P=.04); none of the MRSA isolates were resistant to glycopeptides. The rate of VRE carriage at admission was 0.4%. Three patients (1%) had acquired carriage of VRE (1 had E. faecium and 2 had E. faecalis); all 3 were in the cefazolin group (2% of patients) and none in the vancomycin group (P=.27). Eight SSIs (3%) occurred, 4% in the cefazolin group and 2% in the vancomycin group (P=.47). CONCLUSIONS: This preliminary study demonstrates that cefazolin and vancomycin prophylaxis have similar impacts on the emergence of glycopeptide-resistant pathogens. Neither MRSA infection nor increased rates of SSI with other bacteria were observed in the vancomycin group, suggesting that a larger multicenter study should be initiated.

Aged, 80 and over↗

PubMed2002

Femoral neck fractures in the elderly: functional outcome and quality of life according to EuroQol.

The main purpose of this prospective study was to investigate the functional outcome and health-related quality of life according to EuroQol (EQ-5D) after a femoral neck fracture treated with internal fixation in relatively healthy elderly patients. We also aimed to validate the use of the EQ-5D in routine clinical follow-ups of this group of patients. The inclusion criteria were more than 65 years of age, absence of severe cognitive dysfunction, living independently, and unhindered walking ability preoperatively. The mean follow-up period was 17 months. The rated prefracture EQ-5Dindex scores showed good correspondence with the scores of an age-matched Swedish reference population. The EQ-5Dindex scores decreased from 0.78 before the fracture (based on recall) to 0.59 at 4 months and 0.51 at 17 months after surgery. The decrease was significantly larger among patients with fracture healing complications. There was a good correlation between the EQ-5Dindex scores and other outcome measures such as pain, mobility, independence in ADL and independent living status. The questionnaire response rate (EQ-5D) was 89-100% on different follow-up occasions. The EQ-5D appears to be an easy-to use instrument even for elderly patients with femoral neck fractures. Changes in the quality of life may be useful to identify patients who might benefit from reoperation, i.e. arthroplasty. The EQ-5D also appears to be a relevant clinical end-point in outcome studies.

Activities of Daily Living↗

PubMed1986

Vitamin D deficiency in women with femoral neck fracture.

Calcium (Ca) metabolism, with particular reference to serum vitamin D metabolites, was investigated in 40 women with femoral neck fracture (mean age 77.1 +/- 8.6 yr). All the patients were ambulant before the fracture; eight were long-term geriatric in-patients. Serum total and ionised calcium and serum albumin levels were significantly lower, and serum parathormone (PTH) levels significantly higher in fracture patients than in controls. Both serum 25-OH-D and 1,25-(OH)2D were significantly lower in fracture patients than in controls. We concluded that vitamin D, serum PTH and calcium levels should be checked with greater frequency in patients at high risk for osteoporosis and osteomalacia before they reach the age of 70.

25-Hydroxyvitamin D 2↗

PubMed1994

Postoperative Tc-scintimetry in femoral neck fracture. A prospective study of 46 cases.

13 men and 33 women with 8 undisplaced and 38 displaced fractures of the femoral neck treated with internal fixation were included in a prospective study of Tc-scintimetry performed early (1-3 weeks), as well as after 2 and 12 months. 9 fractures redisplaced and 5 had late segmental collapse. Healing complications were associated with decreased uptake in early and 2-month scintimetry, but the specificity was only 50 percent. With normal or increased uptake, uncomplicated healing of the fracture was predictable with 90-100 percent sensitivity.

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PubMed1968