[Femoral neck fractures in patients over 50 years old]. / Les fractures du col du fémur après 50 ans.

INTRODUCTION: Despite many papers and instructional course lectures, therapeutic guidelines are not clearly defined about treatment of femoral neck fractures. The aim of this multicentric French symposium was to prospectively study the results of current therapeutic options in order to propose scientifically proven options. MATERIAL AND METHODS: Three prospective studies were carried out in order to answer to these questions: (1) is it possible with anatomical reduction and stable fixation to lower the non union and osteonecrosis rate? (2) is functional treatment of Garden 1 fractures successful in more than 65 years patients? (3) what criteria are useful to choose the kind of arthroplasty for more than 65 years patients? RESULTS: For the 64 patients between 50 and 65 years old included in the first study, 44 ORIF and 17 prostheses were performed. No open reduction was performed in this series despite a 34% malreduction rate. The risk for displacement after functional treatment of Garden 1 fractures is 31%. For patients over 65 years old, almost fractures are treated in this series by an arthroplasty. The one-year mortality rate after displaced femoral neck fracture was 17%. Functional results were better in total hip prosthesis group than in bipolar or unipolar group. Non cemented stems were not safer than cemented ones in frail patients. DISCUSSION AND CONCLUSIONS: For young patients, ORIF should be the treatment of choice: the initial displacement and its effects on the femoral head vascularisation, the quality of reduction and fixation are the two most significant factors for good outcome. For Garden 1, fractures in patients 65 years old or more, it is proposed to performed an internal fixation despite in two thirds of the cases, it should be unnecessary because non identification of predictive factors of failure. For patients over 65 years old, the type of arthroplasty to perform in displaced fractures is to be chosen according to the preoperative mobility and comorbidities. Because of acetabular erosion with long-term follow-up, it is clearly indicated to perform total hip replacement for patients with life expectancy of 10 years or more. For frail patients, unipolar arthroplasty is the best option. The place for bipolar or uncemented implants is not yet well-defined and more prospective trials are needed. In this multicentric study, results appear quite different in terms of mortality, or functional status. These differences seem to be related to technical choice, geriatric care, nutritional consideration or surgical organisation, all factors that may be of major importance for prognostic.

An automated approach to the design of decision tree classifiers.

The classification of large dimensional data sets arising from the merging of remote sensing data with more traditional forms of ancillary data causes a significant computational problem. Decision tree classification is a popular approach to the problem. This type of classifier is characterized by the property that samples are subjected to a sequence of decision rules before they are assigned to a unique class. If a decision tree classifier is well designed, the result in many cases is a classification scheme which is accurate, flexible, and computationally efficient. This correspondence provides an automated technique for effective decision tree design which relies only on a priori statistics. This procedure utilizes canonical transforms and Bayes table look-up decision rules. An optimal design at each node is derived based on the associated decision table. A procedure for computing the global probability of correct classification is also provided. An example is given in which class statistics obtained from an actual Landsat scene are used as input to the program. The resulting decision tree design has an associated probability of correct classification of 0.75 compared to the theoretically optimum 0.79 probability of correct classification associated with a full dimensional Bayes classifier. Recommendations for future research are included.

Optical processing with residue LED/LD lookup tables.

Position-coded modulo m lookup tables (LUTs) with gate complexities equal to m(2), 2m, and 4 radicalm are discussed. The design of practical miniaturized LUTs is described along with results obtained from a prototype 7 x 7 laser diode LUT. A factored m(2) LUT technique that achieves large dynamic range is presented. Several LUT performance issues are also discussed.