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Early surgical fixation of femoral neck factures in elderly patients has been suggested to decrease morbidity and mortality and to improve treatment outcome. This study evaluates the effect of the implementation of a diagnosis-related group payment method in our hospital on waiting time for surgery and the short-term outcomes of elderly patients following surgical fixation of hip fractures.Demographic and clinical characteristics of 75 consecutive patients, who underwent surgery for hip fracture in our hospital, before the implementation of a diagnosis-related group payment method, were compared with those of 75 consecutive patients, who were operated on after the implementation of the payment system.Demographic characteristics were similar for both groups. Before the implementation of a diagnosis-related group payment method, 84% of the patients waited longer than 48 hours for surgery, compared to only 24% of patients after the implementation (p0.001). Medical considerations and operation room availability were the main reasons for delaying surgery in both groups. Mortality and morbidity rates during the hospital stay remained similar, regardless of the implementation of the payment method.The implementation of a diagnosis-related group payment method shortened the waiting time for surgical hip fixation in elderly patients treated in our hospital, with no effect on the mortality and complication rate during the hospital stay.

Management of displaced femoral neck fracture in elderly patients is challenging due to the patient's high risk profile, poor quality bone stock and muscle weakness.Fifty-one patients with displaced (Garden 3-4) intracapsular femoral neck fractures were treated with a newly designed Fixion expandable stem hemiarthroplasty implant and followed thereafter for a minimum of 6 months.Thirty patients (58.8%) had concomitant diseases graded 3-4 by the ASA scoring system. Two patients (4.8%) incurred deep wound infections that necessitated hardware removal. One case (2.6%) of dislocation was treated by closed reduction. Forty-two patients (82.4%) survived6 months and cooperated with the study protocol. Mild groin/thigh pain was reported by 11 patients (26.2%). Twenty-six (61.9%) had lost 1-2 out of 4 grades of mobility.Fixion implant may be considered a further step in the evolution of femoral joint hemiarthroplasty. In the short term, it has proven to be as effective as cemented implant and to be user-friendly for the surgeon. It is also anticipated to be feasible whenever revision is required.

Introduction: The theoretical advantages of intramedullary fixation for peritrochanteric fractures were lessened in practice by implant-related operative problems and postoperative complication. Materials and methods: Forty-nine patients were treated with a newly designed expandable proximal femoral nail (EPFN) and followed thereafter for a minimum of 6 months. Results: After experience was gained in carrying out the procedure, its mean duration was limited to 43.4±20.2 min and total mean fluoroscopy time to 39.8±16.1 s. Due to minimal extent of soft tissue trauma blood loss was negligible and rate of postoperative infections reduced. Condensation of cancellous bone in the femoral head as an alternative to reaming and the blunt cone-shaped head of the peg reduced the frequency of head peg cut-out. Homogenic load distribution along the nail interface decreased the concentration of stress and thereby eliminated the risk of postoperative femoral fracture distal to the implant stem. Conclusion: The EPFN may be considered as a further evolution of implants designed to stabilize peritrochanteric fractures of all grades.

This is the first report which describes carbon dioxide laser photocoagulation of upper gastrointestinal bleeding via a flexible endoscope, using an infrared transmitting siver nalide fiber. Various laser parameters were checked to determine the optimal conditions for hemostasis. Both the acute effects of laser irradiation on tissue and the chronic effects on healing process were examined. Preliminary results indicate that carbon dioxide laser beam can successfully photocoagulate moderately bleeding ulcers.