Femoral neck fractures in the geriatric population: the influence of perioperative health upon the selection of surgical treatment.

The use of a primary prosthetic replacement such as an Austin-Moore hemi-arthroplasty in patients sustaining fractures of the femoral neck has been associated with increased post-operative medical morbidity and mortality. A retrospective review was performed using the medical records of patients greater than 59 years of age who sustained femoral neck fractures and were treated with either internal fixation or primary hemi-arthroplastic replacement at Loyola University Medical Center between 1969 and 1979. Peri-operative data were reviewed and evaluated using computer-aided statistical analysis. Comparing the two forms of surgical treatment, statistically significant factors associated with primary hemi-arthroplastic replacement included: pre-injury nursing home residence, pre-injury ambulation requiring assistance, age greater than 79 years, slight elevation in serum creatinine values, abnormal electrocardiograms in patients over 77 years of age, time from injury to surgery of four or more days, and the use of spinal anesthesia (P less than 0.05). Factors associated with internal fixation were: patient age of 79 years or less, independent ambulation, non-nursing home residence, normal lab values, normal EKGs, less than four days from injury to surgery, and the use of general anesthesia. Within the limits imposed by a retrospective review in this specific patient population, there appears to be a tendency for older, less healthy patients to have been treated with primary hemi-arthroplasty. Possibly the previously reported increased post-operative medical morbidity and mortality associated with this procedure, as compared with internal fixation, may be a result of biased patient selection, and not a fault of the procedure.

Guide pin fragment in the hip joint: a new method of retrieval a case report.

A case of a broken guide pin fragment retained in the femoral head and hip joint during compression screw fixation of a femoral neck fracture is presented. A new method for its retrieval is described.

Use of nuclepore filters for counting bacteria by fluorescence microscopy.

Polycarbonate Nuclepore filters are better than cellulose filters for the direct counting of bacteria because they have uniform pore size and a flat surface that retains all of the bacteria on top of the filter. Although cellulose filters also retain all of the bacteria, many are trapped inside the filter where they cannot be counted. Before use, the Nuclepore filters must be dyed with irgalan black to eliminate autofluorescence. Direct counts of bacteria in lake and ocean waters are twice as high with Nuclepore filters as with cellulose filters.

Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency.

Peripheral defects in the proximal tibia can be difficult to treat during total knee arthroplasty. Attempts can be made to solve the problem with cement, cement with screws, bone grafts, metal wedges, and custom components. In vitro testing has shown that a custom-augmented prosthesis with a built-up metal wedge is mechanically superior in resisting deflections when loaded. Using modular metal wedges, the tibial tray can be customized at the time of surgery. In vitro testing has also shown the wedge to be superior to the use of cement alone or cement reinforced by screws. The authors report on modular metal wedges to augment tibial bone stock deficiency. Twenty-two knees (20 patients) were followed for a minimum of two years with an average follow-up time of 37 months. The average age of the patients at the time of surgery was 70 years. There have been no failures of this technique and no loosening of tibial components. The incidence of nonprogressive radiolucent lines was 27%. All but one patient was pain-free, and this patient's discomfort was not related to the tibial component fixation. No patient has had subsequent revision surgery. This technique should be considered in the treatment of severe peripheral tibial deficiencies in the elderly, low-demand patient.

Metastatic tumors of the foot: case report and literature review.

Metastatic lesions to the bones of the foot occurred in three elderly patients. Biopsy established the diagnosis in a 90-year-old woman. In a 72-year-old man and a 79-year-old man, the diagnosis was possible from roentgenographic features. In the latter, biopsy of an additional osseous metastatic site established the diagnosis. A thorough review of the literature has yielded 72 previously reported cases of metastasis to the foot. Only 38 of these cases were histologically confirmed. Primary tumors of the colon, kidney, and lung are the most common sources of metastasis to the bones of the foot. Metastatic disease should be considered in elderly patients presenting with foot pain and osteolytic lesions, especially when there is a history of a previously diagnosed malignancy. The generally poor prognosis indicates that treatment should be clearly designed to relieve pain.