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Ever since its description by Cooper in 1822 as the “unsolved and even unsolvable fracture” the treatment of femur neck fractures has posed a dilemma for treating surgeons.

The basic conditions for a functioning and permanent use of the hip joint are based on a normal joint anatomy and physiological functional parameters of load capacity. The pathophysiology of defective positions in the hip joint area therefore has to be regarded pre-operatively at first under the aspect of the objective value of morbidity. This can be seen on the one hand because of pain and functional disablement, on the other side out of aesthetic causes from the sight of the patient. Missing possibility of compensation being endangered by an arthrosis either of posttraumatic or degenerative causes manifest an actual and therefore at the same time prospective sign of morbidity. Any osteotomy which has the aim to create an embettering of an actual situation only makes sense when it is guaranteed that the unphysiological loads can be abolished. The correction of pathological joint overloading can involve the indication either by prophylactic as well as by therapeutic reasons.

Osteoporosis is an increasingly frequent pathology, especially due to the remarkable increase in the average age of the population. It is a skeletal disorder characterized by a reduction in bone strength which predisposes to increased fracture risk. It has been calculated that there are more than 200 million osteoporotic subjects in the world: one in three women and one in eight men over 50 years of age have osteoporosis. Although it is very widespread, only one quarter of cases are treated, and a significant percentage is not even diagnosed. As a result of these serious consequences, diagnostic and therapeutic treatment is necessary to reduce its progression. The importance of acquiring reliable epidemiological data has also been proven, in order to emphasize the effects of the condition, and to provide elements to optimize the strategies of prevention and care.

Purpose The purpose of this study was to evaluate whether we have to stop the antiplatelet agents prior to hemiarthroplasty surgery in patients with displaced femur neck fractures to reduce postoperative complications. Materials and Methods We enrolled forty-three patients with displaced femur neck fractures who were treated by bipolar hemiarthroplasty and were taking antiplatelet agents. Group I included 21 patients who discontinued antiplatelet agents and had delayed operations at an average 5.7 days and group II included 22 patients who had had early operations within 24 hours without stopping the antiplatelet agents. We compared the pre- and postoperative levels of hemoglobin, the volume of postoperative transfusion requirement and complications. Student's t-test and chi-square test were used for statistical analysis. Results The average differences between preoperative and postoperative hemoglobin was 1.4±0.4 g/dL decrease in group I and 2.1±0.5 g/dL decrease in group II (P

PubMedID: 15589930 In this retrospective study, we evaluated the characteristics of 103 femoral neck fractures in 102 children seen our department between 1978 and 1994. In order to evaluate the correlation between the chosen procedure and complication risks, we further reviewed the late treatment results of 62 fractures in 61 children of the series whom we had followed for a minimum of 8 years. The ages of these children at the time of injury ranged from 2 to 14 years (average 10.2 years). Sixty-three hips were available for clinical and radiographic follow-up at a minimum of 8 years (mean 14 years). Overall, 67.2% radiologically good results were obtained. Complications were coxa vara in five (8%), avascular necrosis in nine (14.5%), premature epiphysis fusion in five (8%), coxa valga in two (3.2%), non-union in one (1.6%), limb shortening in seven (11.3%), and arthritic changes in two (3.2%). Our long-term follow-up revealed that the type of treatment influences the complication rate more than do the characteristics of the fracture itself, and that the end result cannot be satisfactorily determined until after physeal closure. © 2004 Elsevier Ltd. All rights reserved.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:28:31Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:32:18Z : No. of bitstreams: 1 2-s2.0-84874230579.pdf: 538432 bytes, checksum: e816faadad45510200b0cce4cb5d6030 (MD5) Made available in DSpace on 2014-05-27T11:28:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-20 Introduction: The aim of this study is to evaluate the serum activity of metalloproteinases (MMPs) -2 and -9 as predictors of pressure ulcer (PU), gait status and mortality 6 months after hip fracture. Methods: Eighty-seven patients over the age of 65 admitted to the orthopedic unit from January to December 2010 with hip fracture were prospectively evaluated. Upon admission, patient demographic information, including age, gender and concomitant diseases, was recorded. Blood samples were taken for analysis of MMP -2 and -9 activity by gel zymography and for biochemical examination within the first 72 hours of the patient's admission, after clinical stabilization. The fracture pattern (neck, trochanteric or subtrochanteric), time from admission to surgery, surgery duration and length of hospital stay were also recorded. Results: Two patients were excluded due to the presence of pathological fractures (related to cancer), and three patients were excluded due to the presence of PU before admission. Eighty-two patients, with a mean age of 80.4 ± 7.3 years, were included in the analysis. Among these patients, 75.6% were female, 59.8% had PU, and 13.4% died 6 months after hip fracture. All patients underwent hip fracture repair. In a univariate analysis, there were no differences in serum MMP activity between hip fracture patients with or without PU. In addition, the multiple logistic regression analysis models, which were adjusted by age, gender, length of hospital stay and C-reactive protein, showed that the pro-MMP-9 complexed with neutrophil gelatinase-associated lipocalin form (130 kDa) was associated with gait status recovery 6 months after hip fracture. Conclusions: In conclusion, serum pro-MMP-9 is a predictor of gait status recovery 6 months after hip fracture. © 2013 Gumieiro et al. Surgery and Orthopedic Department Botucatu Medical School Universidade Estadual Paulista (UNESP), Botucatu Internal Medicine Department Botucatu Medical School Universidade Estadual Paulista (UNESP), Botucatu Surgery and Orthopedic Department Botucatu Medical School Universidade Estadual Paulista (UNESP), Botucatu Internal Medicine Department Botucatu Medical School Universidade Estadual Paulista (UNESP), Botucatu

A 76-year-old man, without systemic disease but with progressive disability due to bilateral hip pain in 1 month, was brought to the emergency department. He denied any episode of trauma and was able to walk during his first visit to the emergency department. Pelvis radiography showed generalised osteopenia along with a bilateral femur neck fracture (figure 1). The patient was admitted …

노년층에서의 고관절부 골절은 의료 수준의 향상으로 평균 수명이 증가하면서 그 빈도가 증가 추세에 있고, 치 료 및 재활 기법의 발달에도 불구하고 합병증과 사망률이 매우 높은 질환이다. 이러한 고관절 주위 골절은 65세 이 후의 노년층에서 주로 발생되며 평균 발생 연령은 여성이 77세, 남성이 72세를 보이며, Melton 등은 80대에서는 여 자 3명 중 1명, 남자는 6명 중 1명에서 고관절 주위 골절 을 일으킨다고 하였다. 미국의 통계의 의하면 매년 25만 명 이상의 고관절 주위 골절 환자가 발생하고 있으며, 2050년에는 그 숫자가 2배 증가가 예상되며, 고관절 주위 골절은 골절 자체도 문제이지만 그로 인한 장기간의 입원 과 재활 치료, 국소적 합병증이나 전신적인 합병증으로 사 망률이 증가하며, 이에 따른 사회경제적 손실은 막대하다 고 할 수 있다. 고관절 골절의 위험 인자와 손상기전 등을 파악하여야 하며, 특히 노년층의 골다공증성 고관절부 골절 환자들은 많은 기존질환을 가지고 있으며 또한 치료 과정에서 내과 적 합병증을 유발하므로 조기 거동 및 보행을 가능하게 하 여 빠른 시일내에 기능 회복시키는 것이 치료의 목표이다. 이를 위해서는 대부분의 골절은 수술적 방법에 의한 견고 한 내 고정술이나 인공관절 치환술로 치료하여야 한다. 골 다공증성 골절이 있는 환자의 경우에는 12개월 이내에 20%에서 다시 골절이 발생할 가능성이 있으므로 고관절 부 골절의 수술적 치료와 더불어 반드시 골다공증에 대한 치료가 필요하다. 이에 저자는 고관절부 대퇴경부 골절 과 전자간 골절에 대한 수술적 치료를 중심으로 기술하고 자 한다.

Thoracic empyema can result from the pleural accumulation of infected fluid or the infection of accumulated pleural fluid. The causes of empyema are pneumonia, surgery of lung, mediastinum, diaphragm, trauma, and so on. The impact of anesthetic technique (regional versus general versus combination of both) on the respiratory complication rate has not been established. A 86-yr-old male patient, who had COPD about 15 years and chronic empyema for several months, scheduled to operation for a femur neck fracture. We report a case that this patient with COPD and empyema operated under combined spinal-epidural anesthesia and converted to general anesthesia because of the rupture of the chronic empyema.

Total hip replacement surgery with K. Y. M. rotation type prosthesis were performed on 44 hips in 37 cases. The head of this prosthesis is made of high density polyethylen.The replacement surgery was done in 19 hips with ostheoarthritis, 7 hips with rheumatoid arthritis, 3 hips with aseptic necrosis of the femur head, 8 hips with femur neck fracture and 6 hips with weared high density polyethylen artificial head.Short term results on 18 hips, from 3 years to 4 years after operation, showed fairly good result except one case with cup loosening.

Es wird uber eine histochemische Methode berichtet, die es ermoglicht, bei der medialen Schenkelhalsfraktur intraoperativ die Vitalitat des Kopfes zu beurteilen. An Hand der zweijahrigen Nachuntersuchung wird gezeigt, das bei allen Fallen, bei denen ein negativer Befund (keine Fermentaktivitat) erhoben wurde, in der Folgezeit eine Kopfnekrose auftritt. Man kann daher die Methode zur Indikationsstellung fur eine primare Kopfprothese verwenden.