Epidemiology of fractures in 15,000 adults: the influence of age and gender.

We report a prospective study of the incidence of fractures in the adult population of Edinburgh, related to age and gender. Over a two-year period, 15,293 adults, 7428 males and 7865 females, sustained a fracture, and 5208 (34.0%) required admission. Between 15 and 49 years of age, males were 2.9 times more likely to sustain a fracture than females (95% CI 2.7 to 3.1). Over the age of 60 years, females were 2.3 times more likely to sustain a fracture than males (95% CI 2.1 to 2.4). There were three main peaks of fracture distribution: the first was in young adult males, the second was in elderly patients of both genders, mainly in metaphyseal bone such as the proximal femur, although diaphyseal fractures also showed an increase in incidence. The third increase in the incidence of fractures, especially of the wrist, was seen to start at 40 years of age in women. Our study has also shown that 'osteoporotic' fractures became evident in women earlier than expected, and that they were not entirely a postmenopausal phenomenon.

Orthopaedic casualty evacuation to the Royal Hospital Haslar November 1995 to April 1996.

A survey of the orthopaedic casualties evacuated (casevacs) to the Royal Hospital Haslar between November 1995 and April 1996 was performed. A total of 464 service persons and civilians were casevaced. Orthopaedic cases amounted to 55% of all evacuations. Of these, 54% were British Army personnel. Conditions necessitating casevac were classified as either acute, (occurring during the deployment), or chronic (where the condition was present prior to deployment). Of the acute cases, there was an even mix between bony and soft tissue injuries (STIs). Sporting activities were the commonest cause of injury. The condition had been present prior to deployment in 16% of cases. Half of these were considered to have been unfit for deployment. Strategies for prevention of unnecessary casevacs are discussed.

Results of an operative policy in the treatment of periprosthetic femoral fracture.

OBJECTIVE: To determine the clinical outcome of patients with periprosthetic femoral fractures treated operatively. DESIGN: Retrospective analysis from 1986 to 1993. SETTING: Edinburgh Orthopaedic Trauma Unit, Edinburgh, Scotland. PATIENTS: Forty-five patients identified from a computer database as being admitted to the Edinburgh Orthopaedic Trauma Unit with periprosthetic femoral fractures. MAIN OUTCOME MEASURES: Clinical outcome grade (good, fair, poor) dependent on integrity of fixation, refracture rate, and ability to perform activities of daily living analyzed against age, type of fracture, prosthetic alignment, loosening, and method of fixation. RESULTS: Type I fractures were more common in uncemented or loosely cemented prostheses, whereas type II fractures occurred predominantly in securely cemented prostheses. Type I fractures treated by revision had the poorest results. Outcome in type II fractures was equally good whether treated by internal fixation or by revision. Age, loosening, and prosthetic alignment did not influence outcome. The mortality rate in this series was 20%. CONCLUSIONS: If a prosthesis is loose, it should be revised, or treatment varies with fracture and prosthetic type. In type I fractures, an uncemented stem may be revised to a cemented one; however, a securely cemented prosthesis probably is better when fixed internally. Type II fractures should be fixed internally because there is less operative insult. Type III fractures probably are not related to the prosthesis and should be fixed internally according to normal practice. The results of an operative policy compare well with the results of conservative management and avoid the problems of long-term immobilization.

The functional prognosis of thoracolumbar vertebrae fractures without neurological deficit: a long-term follow-up study of British Army personnel.

Seventy-three British Army personnel were followed up for a mean of 64 (range 6-120) months after sustaining a thoracolumbar vertebral fracture without neurological deficit. Road-traffic accidents were the commonest cause of injury. An excellent functional outcome was achieved in 74 per cent of cases, good in 15 per cent, fair in 10 per cent and poor in 1 per cent. The functional outcome was not significantly affected by the fracture type, severity, region or treatment received. This study has important medico-legal implications.

Native American youths and cancer risk reduction. Effects of software intervention.

PURPOSE: Toward developing attractive and effective means to reduce cancer risks faced by Native American people, this study developed and tested interactive computer software to improve dietary choices and prevent tobacco use among Native American adolescents. METHODS: Based on a legend of the Seneca Nation, a cancer prevention lesson was developed and programmed for software. A sample of 368 Native American adolescents were divided randomly into intervention and control arms. Youths in both arms were pre-tested, youths in the intervention arm interacted with the software, and all youths were post-tested. Pre-test and post-test measures covered information and attitudes about cancer risks from dietary practices and tobacco use. RESULTS: Pre-test scores differed between the two arms on youths' age and on one outcome variable. Relative to their counterparts in the control arm, youths in the intervention arm increased their post-test scores on 8 of 12 outcome measurement variables. Process data gathered during intervention delivery indicated that nearly all youths were involved with the interactive software and lesson. CONCLUSION: Interactive computer software holds promise for delivering cancer risk reduction intervention aimed at modifying dietary habits and preventing tobacco use among Native American youth.

Heterotopic ossification.

Heterotopic ossification is well recognized following trauma to the head and spinal cord, total hip arthroplasty and internal fixation of acetabular fractures. Fortunately, effective prophylactic measures exist to minimize this occasionally devastating complication. This article reviews the pathophysiological events involved in heterotopic bone formation and outlines its clinical presentation and management.

Polyorchidism: functional classification and management strategy.

Polyorchidism is rare. We report a recent case and review the literature. A simple classification based on anatomic and functional arrangements of the testes and their drainage systems is described. Combining this classification with a knowledge of potential complications, we propose a management strategy.

Hand injuries sustained during jungle training.

During the initial six week period of deployment and jungle training in Belize, a 634 man strong infantry battalion group sustained twenty-three machete hand injuries. Eighteen were treated at battalion level, while five required hospital treatment. The management of these injuries is considered.