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A prospective population-based study of hip fracture treatment was performed during 1989 in the regional hospitals of Oulu (Finland) and Sundsvall and Lund (Sweden). For cervical fractures hemiarthroplasty was preferred in Oulu and osteosynthesis in Sundsvall and Lund. For trochanteric fractures screw-plate was preferred in Oulu and Lund and Ender-nailing in Sundsvall. A shorter mean time at the orthopedic department in Oulu (13 days) was compensated by a lower (14 percent) fraction of patients directly discharged to own home. A somewhat longer mean orthopedic hospitalization time in Sundsvall (19 days) and Lund (17 days) was combined with a higher discharge to own home (49 percent and 35 percent). Prospective multicenter comparisons of treatment combinations (both operation and rehabilitation) permit identification of programs that are optimal for both patient and society.

Fractures in the elderly, especially hip fractures, have increased during recent decades in the west. Due to their large number, and often extended demands on hospital resources, older persons with hip fractures make heavy demands on health care resources. The fractures are the result of both increasing skeletal fragility and increasing falling tendency with age. Preventive measures consist primarily of opposing the sedentary life style of modern society. A continued moderate physical activity since youth, combined with sufficient access to calcium and vitamin D, builds up and retains enough bone stock to resist the decay of 1-2% per year that starts from the fifth decade of life onwards. Falling accidents are probably easier to prevent by training of muscular activity and balance compared to the osteoporosis, which needs a long preventive perspective. The rehabilitation prognosis for the individual patient has greatly improved over recent years.

At the orthopedic departments in Sweden, the hip fracture patients continuously occupy up to one third of the bed resources. Hip fractures in Sweden consume more hospital days than all the cancer patients together. In the middle of the 1980s, the annual number of hip fractures amounted to 6,500 in Denmark, 4,500 in Finland, 260 in Iceland, 6,000 in Norway and 14,000 in Sweden. The calculated number of hip fractures in the year 2000 is dependent on if the prognosis is based solely on the increasing number of elderly in the population or if also the increasing incidence during the last decades is included. An increase up to the year 2000 of 50-100 percent is prognosticated for Scandinavia. The proportions cervical/trochanteric fractures varies. In Norway and Sweden it is close to 1/1, whereas Iceland and Finland have more cervical than trochan-teric fractures. In Iceland, however, trochanteric fractures are increasing. Finally, in all of Scandinavia, 3 out of 4 hip fracture patients are women.

We performed a prospective 2-year follow-up study of 626 consecutive femoral neck fractures treated with closed reduction and hook-pin fixation in all cases. The woman:man ratio was 2.9:1, the dis-placediundisplaced fracture ratio 2.6:1. Mean patient age was 78 (18-100) years. The first 476 fractures were operated on by one of six surgeons with special interest in the technique, while the remaining operations were performed by any of the 35 surgeons in the department, all specialists in orthopedic surgery. Mortality within two years was 31 percent. Healing complications (redisplacement, nonunion or segmental femoral head collapse) in the total material/survivors only were for undisplaced fractures 5/7 percent, for displaced fractures 30/41 percent and for the total material 23/32 percent. According to life-table analysis, the complication rate in the total material at two years was 24 percent. The rate of secondary arthroplasty for healing complications was 13/19 percent. For displaced fractures, as well as for the total material, the group of specially interested surgeons had better results than the department as a whole.

A 2-year follow-up regarding healing complications, such as redisplacement, nonunion, and segmental collapse of the femoral head, was performed in 306 patients operated on for femoral neck fracture and examined with 99mTech-netium-MDP scintimetry within 2 weeks postoperatively. Scintimetric evaluation was performed by selecting regions of interest over the femoral head on the fracture side and the intact side and by comparing the uptake. A femoral head ratio fractured/intact side thus was obtained.Of 199 patients with an intact femoral head uptake (ratio S1.0), 181 showed no signs of healing complications at 2 years, whereas 18 had developed healing complications. Of 107 cases with a deficient femoral-head uptake (ratio < 1.0), 96 had developed healing complications within 2 years from the operation, while 11 cases had no signs of radiographic complications.We conclude that 99mTc-MDP scintimetry performed within 2 weeks from femoral neck fracture can predict the outcome of the healing course with a prognostic accuracy of 91 per cent.

Current major orthopedic problems are dominated by the demands from the elderly to live an independent, mobile and painfree life. At the same time society has a strong demand on the elderly to be able to fulfill this. Diseases and trauma of the locomotor system have a dominating influence on the elderly's ability to perform everyday activities. With increasing age many problems are focused around the hip joint in the form of fractures and also development of arthrosis.

A residency analysis of 3,053 patients treated for cervical hip fractures either at surgical or orthopedic departments was made.Accumulated costs during and after treatment at surgical departments were almost twice as high as those accrued after treatment in orthopedic units.