The value of a special surgical team in preventing complications in the treatment of hip fractures.

The incidence of the major complications of operation have been studied prospectively in 1,722 patients with a proximal femoral fracture treated by either insertion of a hemiarthroplasty, internal fixation with a Dynamic Hip Screw (DHS) or multiple parallel screws. Major complications occurred in 8.0%. A special surgical "Hip Fracture Team" reduced the incidence of major complications from 12.5% to 5.0%. The most significant benefit from employment of the special team was in reducing the incidence of wound sepsis and of failure of fixation following the operative management of displaced intracapsular and extracapsular fractures. Assigning hip fracture surgery to designated personell will result in a significant reduction in morbidity.

Proximal femoral fractures: prevalence in different racial groups.

This paper describes the methodology and the results of a study performed in Central England. The predominant racial group here is "White European" (Europid). There are smaller numbers of people of Indian origin (Indids) and still smaller numbers of Afro-Caribbean and of Mongolian ancestry (Mongoloids). We found no significant differences in the incidence of hip fractures in the first two groups. The study population was 1600 consecutive patients with proximal femoral fractures (PFF). The difficulties of racial classification are discussed. To elucidate the predisposing factors for PFF, large scale collaborative studies between medical centres in the major European, Asian, African and American conurbations are suggested. Racial burden may be one such factor; osteoporosis may be another.

A comparison of presenting characteristics of patients with intracapsular and extracapsular proximal femoral fractures.

The presenting characteristics of 1423 consecutive admissions with proximal femoral fractures were prospectively studied, to determine any differences that may exist between patients, dependent on the radiological site of the fracture. Patients with intracapsular fractures were of a lower average age, more mobile, less likely to use walking aids or live in residential accommodation, they also had a considerably shorter length of hospital stay than for those patients with extracapsular fractures. Comparison against previous series shows that the average age of hip fracture patients and the proportion of trochanteric fractures is increasing.

Cost-benefit analysis of hip fracture treatment.

We have determined the quality-adjusted-life-years and cost of such in several types of hip fracture and various treatment options. Operative treatment proved more cost-effective than other methods for displaced subcapital fractures and for extracapsular fractures. For undisplaced subcapital fractures conservative treatment was almost as cost-effective as surgery.

Incidence of neonatal hip instability: are there seasonal variations?

We wanted to establish whether the season of birth affected the incidence of neonatally diagnosable hip instability in Eastern England. Data relating the numbers of maternities to the numbers of cases of congenital displacement of the hip diagnosed in neonates were analyzed month by month over a period of 8 years. The study covered 185,744 maternities and 154 cases of displaced hips during the period 1979-1986. While there were wide fluctuations in the monthly incidence, there was a striking excess of the malformation in late winter and early spring, i.e. in January, February, March and April, and a progressive decline in the succeeding months. The cause or causes of the seasonal variation are unknown.

Early discharge after hip fracture. Prospective 3-year study of 645 patients.

The effectiveness of providing additional community resources to enable early discharge following hip fracture surgery has been prospectively evaluated in a consecutive series of 645 patients. For those discharged under the scheme, the average hospital stay was 9.3 days, and this resulted in a substantial saving of hospital bed days.

Team management of the elderly patient with hip fracture.

The management of 200 consecutive patients with hip fracture by a joint hospital and community team in Peterborough has shown that over half the patients could be discharged considerably earlier than is usual. The patients are cared for at home by the hospital-at-home nursing service and generally need much less nursing care than patients treated conventionally. In the first 10 months of the scheme 733 inpatient bed-days were saved and the average hospital stay of patients discharged home was reduced from 22.0 to 14.6 days.

A specialized walking frame for children with cerebral palsy.

To help severely physically handicapped children with cerebral palsy gain some independent mobility, a special walking frame of great stability has been evolved. It incorporates a variable-resistance roller and automatic reversing brake, and can be folded.