[Analysis of mortality and its predictors in patients with contralateral hip fracture after femoral neck fracture]. / Ellenoldali csípotáji törésekkel összefüggo halálozás és kockázati tényezoinek vizsgálata.

INTRODUCTION: There is a high mortality with not well understood risk factors after the second hip fracture. AIM: Analysis of the 30- and 365-day mortality and its risk factors in patients with contralateral hip fracture. METHOD: Patients with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their primary hip fracture in Hungary in 2000. Risk factors as age, sex, concomitant and chronic diseases, type of fracture and surgery, surgical complications, day of admission were analyzed by logistic and Cox regression as well as Kaplan-Meier analysis. RESULTS: There were 312 eligible patients identified with 8.3 % mortality rate at 30 and with 38,4% at 365 days respectively. Significant risk factors for the 30 day mortality were intertrochanteric type of fracture (OR: 4.722; HR: 4.129) and non operative management (OR: 7.357; HR: 6.317) while for the 365 day mortality those were older age (OR:1.070; HR:1.050) and type of surgery (OR: 0.450). CONCLUSION: Age, type of fracture and type of surgery proved to be risk factors. There is a need to identify further risk factors in order to develop an efficacious prevention strategy for the reduction of the mortality after the second hip fractures. Orv Hetil. 2017; 158(20): 783-790.

Positioning of the wrist for scaphoid radiography.

PURPOSE: The purpose of this cadaver study was to determine the ideal position of the wrist for scaphoid radiography. MATERIALS AND METHODS: Four cadaver wrists were rotated around their longitudinal axis in 15 degrees increments and exposures were taken. Seven postero-anterior images were taken as well. Thus, 18 images of each wrist were available for assessment. Views were determined in which the main anatomic regions of the scaphoid were visualized undistorted. The size and localization of the overlap of other carpal bones were also evaluated. Finally, views with the best visualization of anatomic landmarks were selected. The results of these three investigations were compared to literature data. RESULTS: We consider the following four images the most valuable in the diagnostic imaging of scaphoid bone: (1) Postero-anterior view in ulnar deviation of wrist and fist position of the hand; (2) oblique view in 60 degrees of pronation; (3) oblique view in 60 degrees of supination; (4) lateral view. CONCLUSION: We concluded that our four views are sufficient for proper radiographic evaluation of the scaphoid.

Biomechanics of the membranous flexor tendon sheath: the role of Grayson's ligaments.

BACKGROUND: The biomechanical integrity of the tendon sheath of the fingers has a significant effect on the success of flexor tendon surgery. As nonweightbearing elements, the membranous parts of the sheath have received little attention, and their contribution to sheath movement is still obscure. The authors presumed that Grayson's ligaments, which have been described as force-transmitting elements, might play a role in the biomechanics of the membranous flexor tendon sheath. METHODS: Twenty-two long fingers of cadaver hands were examined. The authors studied the movements of the inner aspect of the tendon sheath and the positions and patterns of the septa of the palmar soft tissues on picrosirius red-enhanced sagittal and transverse sections and hematoxylin and eosin-stained light microscopy specimens. RESULTS: The movements of the membranous flexor tendon sheath are controlled by subcutaneous structures. The septal patterns of the palmar fat pads indicate the existence of a highly flexible subcutaneous fibrous system in which the deformable fat pad keeps the force-transmitting elements tight. Collagen bundles in the microscopy specimens, which frequently form layers within the septa, are thought to correspond to Grayson's ligaments. The subcutaneous fibrous system adheres predominantly to the membranous parts of the flexor tendon sheath. CONCLUSIONS: Folding of the membranous flexor tendon sheath is guided by the subcutaneous fibrous system, of which the macroscopically dissectible elements are Grayson's ligaments. The current surgical approaches might have a deteriorating effect on the biomechanics of the flexor tendon sheath.