Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture.

UNLABELLED: The study demonstrates that wintertime surgeries are associated with impaired fracture healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck fracture. Furthermore, the results raise the possibility of association between seasonal changes in vitamin D levels and impaired fracture healing of femoral neck fracture. INTRODUCTION: Although the changes of vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture. METHODS: This nationwide retrospective observational cohort study involved 2779 patients aged ≥ 60 years who underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000. Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian health insurance database were registered. Risk factors assessed included sex, age, fracture type, season of primary surgery and surgical delay. Competing-risks regression analysis was used for data analyses. RESULTS: During the observation period, 190 conversions to hip arthroplasty (6.8%) were identified, yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000 person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement, wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter, hazard ratio (HR): 0.50, 95% confidence interval [95% CI 0.33-0.76]; spring vs. winter, HR: 0.63, [95% CI 0.44-0.92]; summer vs. winter, HR: 0.62, [95% CI 0.42-0.91]). CONCLUSIONS: Our study demonstrate that wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help improving the outcome of primary fixation of femoral neck fractures.

Treatment of the displaced femoral neck fractures: indications and limits of osteosynthesis.

PURPOSE: Opinions about the optimal treatment of displaced femoral neck fractures in the elderly are still divided. The two main options are internal fixation and arthroplasty. The aim of our study was to determine the most adequate surgical procedure for displaced, Garden type III-IV femoral neck fractures: which patients should undergo an osteosynthesis or primary arthroplasty, with the least prospect of complications? METHODS: We analyzed 489 femoral neck fractures treated by percutaneous osteosynthesis. We also compared the results of displaced fractures treated with primary arthroplasty versus secondary arthroplasty performed due to the failure of primary osteosynthesis. RESULTS: The rate of redisplacement in the Garden type III group was 7.6%, and in the Garden type IV group, it was 25.5%, mainly in the case of subcapital fractures. Also, walking ability was examined 4 months after injury. In the ASA score II-III group, most of the patients were able to walk with or without walking aids, but in the case of ASA score IV, most of them were immobile or died during the hospital or posthospital phase. Our research also proved that, in cases of femoral neck fractures treated with primary arthroplasty, the complication rate is lower than after secondary arthroplasty due to failure of the primary osteosynthesis. CONCLUSIONS: Based on our results, we recommend osteosynthesis in the case of Garden type III femoral neck fractures and, in turn, arthroplasty with respect to the high rate of early redisplacement in the case of Garden type IV fractures, especially in the case of subcapital fractures. For patients confined to a bed and in poor general condition (ASA score IV), the first choice treatment option is the minimally invasive percutaneous osteosynthesis.

[Minimally invasive screw fixation of the intracapsular femoral neck fracture in elderly patients]. / Die minimal-invasive Schraubenosteosynthese der medialen Schenkelhalsfraktur bei betagten Patienten.

INTRODUCTION: Increasing life expectancy is associated with an increase of geriatric fractures such as intracapsular femoral neck fractures. Their treatment by arthroplasty imposes a significant burden on our health care system. METHODS: In an open clinical study we investigated the complication rate of a less expensive and less invasive, femoral head saving operative procedure. Between June 1997 and June 2000, 205 intracapsular femoral neck fractures of elderly patients (mean age 78.1 +/- 11.8 years) were fixed with cannulated screws. RESULTS: Seventy-seven percent were displaced fractures and 15.6% were impacted Garden I fractures. Reoperation after internal fixation occurred in 38 patients. The most frequent cause of reoperation was secondary arthroplasty due to redisplacement (14x), femoral head necrosis (10x) and non-union (7x). Implant removal (4x), wound hematoma (1x) and femoral head penetration by screws (2x) were other causes for reoperation. CONCLUSION: Less invasive cannulated screw fixation of intracapsular femoral neck fractures should be considered as a treatment option, because it is a smaller and less expensive operation than prosthetic replacement. Adequate reduction and screw placement, however, are a prerequisite for successful outcome.

[Five-year follow up of patients with femoral neck fractures]. / Combnyaktáji törés miatt kezelt betegek sorsának ötéves követése.

The authors report on follow-up of 754 patients (among them 713 patients aged over 50 years) with hip fracture, treated in the National Institute of Traumatology, in 1990. Excess mortality in a year amounted 23% of cases. One third (254) of the injured survived after 5 years, current health condition of 199 out of them has been evaluated in a questionnaire type survey. Analysis of results according to age, sex and fracture type was made. Definite correlation has been observed with the age, the increase being parallel to it, while age-specific mortality is higher in men. Again, mortality was higher in trochanteric fractures. On analyzing the patients' condition from the aspect of using walking aids, walking ability and complaints, particularly the high rate of painfulness differed from the literature data, though inadequate rehabilitation, already stated before, is reflected in other indicators, too. In addition to the improvement of early rehabilitation, based on their own results the authors emphasize, that further care of patients with complaints is also of great importance.

Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases.

We present a series of 247 undisplaced femoral neck fractures, of which 122 were primarily treated non-operatively, and 125 with primary operative stabilization. The background parameters did not differ significantly in the two groups. The length of hospitalization was 1 week shorter in the operatively treated group. They started to walk bearing full weight at an average of 11 days earlier. Two-thirds of the operatively treated but only one-quarter of the non-operatively treated patients were able to walk alone when they left hospital. General complications were recorded in 19 of the non-operatively and in four of the operatively treated patients during their hospitalization. Early displacement (within 6 weeks) was noted in 20 per cent of the non-operatively treated patients who required late operation. However, there was no early displacement in the operatively treated group. We therefore recommend primary operative stabilization of undisplaced femoral neck fractures.

[One-year follow-up experience in the rehabilitation of patients with femoral neck fractures]. / A combnyaktáji töröttek rehabilitációjának egyéves tapasztalata.

Authors have followed 754 patients with hip fracture and have found that about 60 per cent of them are alive after one year; their functional state further improved between 4 months and 1 year, it cannot be however considered as satisfactory even after one year. Analysing the operations performed in femoral neck and trochanteric fractures it should be stated that the operative indications are generally adequate and the conditions of further improvement are defined. More significant improvement of the lasting results can be expected from a well organized rehabilitation.

[Problems of rehabilitation after femoral neck fractures in Hungary and possible solutions]. / A combnyaktáji törés utáni rehabilitáció hazai problémái és a fejlesztés lehetöségei.

Authors examined the results of the 4 months rehabilitation of 753 cases of hip fractures treated in one year in their Institute. It was stated that a significant part of the patients had to be discharged too early. It is contributed to the inadequacy of the rehabilitation possibilities of the patients that 3/4 of those living after 4 months have complaints, only half of them can leave their flat, only 1/5 walks without a stick and 1/3 with one stick. On the basis of Swedish experiences they see the possibility of improving their results in a closer cooperation with the primary health care.

[Osteosynthesis of femoral neck fractures by double-cannulated screws (preliminary report)]. / A combnyaktörés osteosynthesise két cannulalt (furatos) csavarral. (Elözetes jelentés).

Authors report on a new osteosynthesis based on the double nailing of femoral neck fracture and screwing, and developed from the "Uppsala" double screwing. The preliminaries of the double cannulated screwing method, its advantages, the experiences gained in 30 cases operated in one year and the early results are described.

[Femoral neck fracture--selection of treatment method]. / A combnyaktáji törés--a kezelés megválasztása.

Authors followed for 4 months the life of 753 patients with femoral fractures of the hip and state, that with an extension of the operative indication the hospital mortality was decreased to the half during 15 years in spite of the further rise of the age. It is contributed first of all to the inadequacy of the rehabilitation that the later mortality is high and it is the double of that in the hospital: not more than 3 of 4 injured reaches the 4 months control.

[A case of repeated faulty operation of bilateral fracture of the femoral diaphysis causing bilateral fatigue fracture of the femoral neck]. / Kétoldali femur diaphysistörés ismételten hibásan operált esete mindkétoldali következményes fáradásos combnyaktöréssel.

Bilateral diaphyseal fracture of the femur on different occasions, repeated faulty use of medullary nails and postoperative therapy followed by bilateral fatigue fracture of the femoral neck. Author thought the case because of its lesson worthy of publication.

Four cone types characterized by anti-visual pigment antibodies in the pigeon retina.

Using three antibodies to visual pigments (monoclonal antibodies COS-1 and OS-2, and a polyclonal anti-opsin serum), four different types of cone cells could be distinguished in the red area (dorsoposterior part with the highest density of cones) of the pigeon retina. Both members of the double cone and the single cone with the red oil droplet were labelled with our monoclonal antibody COS-1 (type I cone). The single cone with the orange oil droplet was positive both with anti-opsin and monoclonal antibody OS-2 (type II cone). The single cone exhibiting a yellowish-green oil droplet, fluorescent in ultraviolet light, also reacted with anti-opsin but lacked the antigenic determinant recognized by OS-2 (type III cone). The thin cone with the small colorless oil droplet was negative with both COS-1 and anti-rhodopsin (type IV cone). We propose that the four immunologically distinguishable cone types correspond to cones expressing visual pigments with different (long-, middle-, short-wavelength and ultraviolet) color sensitivities.