Comparitive Analysis of Outcome of Proximal Femoral Nail Antirotation II (PFNA-II) and Dynamic Hip Screw (DHS) in the Management of Intertrochanteric Fractures of Femur

Background: To compare the clinical and radiological outcomes of patients with intertrochanteric fractures treated with PFNA-II versus DHS. Material & Methods:50 adult patients with inter-trochanteric fractures, >20 years old, were randomly distributed into the PFNA-II and DHS groups. DHS with side-plate and proximal femoral nail A-II of appropriate size was used. The patients were regularly followed up till 1 year post-operatively. The clinical, radiological and functional evaluations were done at regular intervals. The peri-operative, early and delayed complications were recorded, and the final outcome of either group was evaluated using the Harris Hip Score. Results:In the DHS group, the mean Harris Hip Score was slightly lower than that of the PFNA-II group at six month follow-up. However, at the 1 year follow-up, both the groups achieved similar Harris Hip Scores. Conclusion:PFNA-II provides a significantly shorter operative time with a smaller incision that leads to lesser blood loss and wound-related complications. However, the incidence of procedural errors was significantly higher in PFNA-II when compared with DHS as it is a technically more demanding procedure that leads to more implant failures and consequent re-operations.

Sex-ratio at birth in Nigeria: A demographic perspective

The study attempts at estimating the sex-ratio at birth in Nigeria. The study focuses on demographic surveys with complete maternity histories, including some 0.50 million births. It compares results with published estimates from births in health facilities and a few data from vital registration, including some 1.13 million births. Results from demographic surveys give an estimate of about 106 boys for 100 girls. There were no significant variations by large region in the country, and no significant trend over the years (1990-2018). Published estimates provided a similar value (106.2), with somewhat lower value in health facilities (105.3), and somewhat higher values in local vital registration (106.8), and major variations among available studies. Despite uncertainty, Nigeria appears to have higher sex-ratios than most African countries, with the exception of Ethiopia, and higher values than its five neighboring countries. Reasons for these high values of the secondary sex-ratio are discussed. (Afr J Reprod Health 2022; 26[4]: 92-97).

Prevalence and predictor stunting, wasting and underweight in Timor Leste children under five years: An analysis of DHS data in 2016

Stunting, wasting, and being underweight are indicators of malnutrition in a country. The high status reflects the poor nutritional and health status of children under five. We analyzed data from the Demographic and Health Survey conducted in Timor Leste from 2009 to 2016 to identify the prevalence and predictor stunting, wasting, and underweight. The variables analyzed were the mother's education, mother's age, mother BMI, mother's height, number of ANC visits, birth weight, sex of a child, sex of head household, type of residence, wealth index, toilet facility, source of drinking water and province. The sample in this study was 3,723 toddlers. Prevalence of stunting (44.4%), underweight (37.5%) and wasting (25.3%). In the bivariate analysis, the variables statistically significantly associated with stunting, underweight, and wasting was mother's education, sex of a child, type of residence, wealth index, and province. Improving the nutritional status of children in Timor Leste requires various nutrition and health interventions

Valgus Osteotomy with DHS Fixation in the Management of Malunited Intertrochanteric Fractures in a Rural Population

@#Introduction: Malunited intertrochanteric fractures are frequently seen in rural populations as they tend to go in for native treatment with traditional bone setters. The resulting Coxa vara is associated with shortening, abductor weakness, limp and decreased range of movement of the affected hip. The aim of this study was to evaluate the role of Valgus osteotomy with Dynamic hip screw (DHS) fixation in the management of these fractures and to evaluate the functional outcome using the Harris hip score. Materials and Methods: Fifteen patients with malunited intertrochanteric fractures who presented between January 2011 to January 2013 were managed by Valgus osteotomy with DHS fixation and were followed-up for a minimum period of three years. Results: There was a male preponderance seen in our study with the right hip being more commonly affected. The most common mode of injury was slip and fall followed by road traffic accidents. The duration of native treatment ranged from seven to 12 weeks and the time of presentation to the hospital ranged from four to nine months following injury. Pre-operative mean neck shaft angle was 94.73° while it was 134.6° post-operatively. The mean pre-operative Harris hip score was 72.33 and it was 91 at follow-up. All patients were happy with the procedure and the functional outcome. Conclusion: Valgus osteotomy with DHS fixation is an effective procedure in the management of malunited intertrochanteric fractures. It corrects the limb length discrepancy, restores the decreased neck shaft angle, improves range of movement, restores the integrity of the abductor mechanism of the hip and gives good functional results.

Outcome Evaluation of Extracapsular Hip Fractures Managed with IMN and 32 mm Threaded Lag Screw DHS Plate

Background: Present prospective study is an effort to find out outcome of procedures opted for the fixation of the extracapsular hip fractures. Basic objective of the study is to search best mode of fixation for intertrochanteric fracture so that the patients especially older are benefitted the most. Methods: The present study is carried out in two medical college concomitantly. Total 80 patients have been included in this study. Patients were divided in two groups A, B (40 patients in each group). Surgical intervention of group ‘ A ‘was done in RNTMC, Udaipur with 32 mm threaded lag screw DHS plate & other 40 patients of group ‘B’ were managed surgically in AIMS & RC in Rajsamand with intramedullary nailing. Extracapsular hip fracture classified according to AO & fixed accordingly to their group plan. Functional status evaluated with Salvati & Wilson assessment score. Result-Both groups were evaluated up to 12 months minimum. At the end of 12 months result of group ‘B’ (treated with IMN) were quite superior & promising as compared to group ‘A’ (treated with 32 mm threaded lag screw DHS plate). Conclusion: Although there is no difference in long term follow up but early results in terms of convalescence, rehabilitation, early return to pre fracture level was found better in group ‘B ‘so the IMN should be considered as preferable mode of fixation in intertrochanteric fracture in all age groups.

Pantrochanteric Fracture: Incidence of the Complication in Patients with Trochanteric Fracture Treated with Dynamic Hip Screw in a Hospital of Southern Brazil / Fratura pantrocantérica: incidência da complicação em pacientes comfratura trocantérica tratados comparafuso dinâmico de quadril em um hospital do Sul do Brasil

Abstract Objective The aim of the present study was to investigate the incidence of pantrochanteric fractures in cases of trochanteric fractures treated with dynamic hip screw in our service. Methods A sample of 54 patients with trochanteric fractures treated with dynamic hip screws was included in this retrospective study. Preoperative radiographs were evaluated for fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation, in German)/Orthopedic Trauma Association (AO/OTA) system for the identification of radiographic osteoporosis and for the measurement of the lateral femoral wall thickness. In the immediate postoperative images, the presence of pantrochanteric fracture was evaluated. Results The final sample presented an incidence of 16.7% of pantrochanteric fractures. The thickness of the lateral wall was significantly lower in the group with the complication (p < 0.001). Although fractures classified as 31-A2 were more numerous in the group with pantrochanteric fracture, the difference was not statistically significant (p = 0.456). Conclusion The percentage of pantrochanteric fractures in this service is in accordance with previous studies. There was an association between lateral femoral wall thickness and the occurrence of iatrogenic fracture of the lateral cortex. There was no significant difference between fracture classification and pantrochanteric fracture, possibly due to sample size.

Resumo Objetivo Investigar a incidência de fraturas pantrocantéricas nos casos de fraturas trocantéricas tratadas com parafuso dinâmico de quadril em nosso serviço. Métodos Uma amostra de 54 pacientes comfraturas trocantéricas tratadas comparafuso dinâmico dequadril foi incluída neste estudo retrospectivo. Foramavaliadas radiografias précirúrgicas para classificação das fraturas com o sistema AO/OTA, identificação de osteoporose radiográfica emensuração da espessura da cortical lateral, enquanto nas imagens pósoperatórias imediatas foi avaliada a presença de fratura pantrocantérica. Resultados Aamostrafinal apresentou a incidência de 16,7%defraturaspantrocantéricas. A espessura da parede lateral foi significativamentemais baixa no grupo coma complicação (p < 0,001). Embora a incidência de fraturas classificadas como 31.A2 tenha sido maior no grupo com fratura pantrocantérica, a diferença não foi significativa (p = 0,456). Conclusão O percentual de fraturas pantrocantéricas nesse serviço encontra-se em acordo com trabalhos prévios. Houve associação entre espessura da cortical lateral e ocorrência de fratura iatrogênica da parede lateral. Não houve diferença significativa entre classificação das fraturas e fratura pantrocantérica, possivelmente devido ao tamanho da amostra.

Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture

@#Introduction: Although the treatment of choice for unstableintertrochanteric fractures in elderly patients has beeninternal fixation for a long time, several studies have shownmechanical and technical failures. Primary cemented bipolar(PCB) hemiarthroplasty has been proposed as an alternativewith some advantages concerning earlier mobilization andminimal postoperative complications.Materials and Methods: This is a prospective cohorthospital-based study conducted at three tertiary hospitalsover a period of two years. A total of 98 patients wereenrolled in the study, 38 patients treated with Dynamic HipScrew (DHS) and 60 patients treated with PCBhemiarthroplasty. Intraoperative events (e.g. duration ofsurgery and blood loss), hospital stay, weight bearing, HarrisHip score and post-operative complications were used aspredictors of final outcome. Mean follow-up was 13.66±5.9months in hemiarthroplasty group and 11.8±2.7 months atinternal fixation group.Results: The two groups were comparable in age, sex,comorbidity, mode of trauma, and classification of fracture.Early mobilisation was significantly better inhemiarthroplasty (p<0.001) where 93.3% of patients startedpartial weight bearing on postoperative Day 1, while in theDHS group, 73.7% of patients started partial weight bearingafter two weeks postoperatively. At the final follow-up, themortality rate did not differ between the two groups, butgeneral and mechanical complications were more commonin the DHS group. The mean Harris Hip score was better inthe hemiarthroplasty group (91.14 vs 74.11).Conclusion: Primary cemented bipolar hemiarthroplasty is asafe and valid option in treating unstable intertrochantericfracture. Although it has been shown to have someadvantages over DHS in certain circumstances, lack ofrandomization and difficulties in standardization of patientsand treating surgeon raise a need for more studies withbigger sample size and proper randomizatio

Factores asociados a fallo en la osteosíntesis de fracturas transtrocantéricas / Factor associated in the failure of the ostheosyntesis of transtrocantheric fractures

Resumen: Las fracturas transtrocantéricas representan la mitad de las fracturas del fémur proximal. La mayor incidencia es en > 65 años, mujeres y presentan mortalidad al año del 14 al 50%. Los objetivos de tratamiento son: fijación estable, restaurar la movilidad y recuperar la función. Las complicaciones tienen una incidencia de 17%, siendo las más comunes: desplazamiento en varo, no unión y cut out. Objetivo: Evaluar la asociación entre falla de la osteosíntesis y los siguientes factores: mala reducción, inestabilidad, índice punta ápice > (TAI) 25 mm, punta ápice modificado al calcar (TAICal) > 20 mm e índice de Parker. Material y métodos: Se realizó un estudio de casos y controles anidado en una cohorte de pacientes con fracturas transtrocantéricas. De enero del 2009 a diciembre del 2014, se incluyeron 91 pacientes que cumplieron los criterios de selección. El seguimiento se hizo a 6 meses para valorar complicaciones. Resultados: Se incluyeron en el grupo 1 a 27 pacientes que presentaron falla y en el grupo 2 a 64 pacientes. Se obtuvieron en el grupo 1 valores de TAI 13.7 a 45 mm y en el grupo 2 valores de 11 a 31.2 mm. Se encontró que la posición central en lateral e inferior en AP no presentó fallo. Conclusiones: Se encontraron 27 pacientes con complicaciones (29%). La estabilidad inicial es un factor determinante, se recomienda fijación con CCM en los casos de fracturas inestables. Se confirmó la validez de un TAI > 25 mm como un predictor de fallo.

Abstract: Pertrochanteric fractures account approximately a half of the proximal femoral fractures. Incidence of these fractures is highest in women, age > 65 years and presents a mortality rate of 14 to 50%. Treatment goals include stable fixation, immediate mobilization and restore activities. Complications after treatment present in 17% and include: nonunion, cut out and varus displacement. Objective: Correlation between complications after surgical treatment and presence of instability, inadequate reduction, Tip Apex Index (TAI) > 25 mm, Tip Apex Index to calcar (TAIcal) > 20 mm and parker index. Material and methods: A case control study was conducted in patients with pertrochanteric fractures treated between January 2009 and December 2014, 91 patients were included and complications were measured up to 6 months after surgery. Results: 27 patients were included in group 1, which were the ones who presented complications. Values of TAI measured in this group were 13.7 to 45 mm, and were significantly higher than group 2. Position of the blade/screw central in the lateral view and inferior in the AP view didn´t present complications. Conclusions: We found 27 patients with complications in the follow up (29%). Initial reduction and stability is determinant to success. We recommend the use of proximal femoral nail in all unstable fractures. It is confirmed that TAI > 25 mm as a predictor of failure.

Atenção em saúde reprodutiva no Brasil: eventuais diferenciais étnico-raciais / Reproductive health care in Brazil: searching for ethnic differentials

Resumo Este estudo teve por objetivo comparar indicadores da atenção à saúde reprodutiva das mulheres negras e brancas. São utilizadas informações obtidas no âmbito da Pesquisa Nacional de Demografia, Saúde da Criança e da Mulher (PNDS 2006). Trata-se de uma pesquisa domiciliar por amostragem probabilística complexa com representatividade nacional. Permite inferência para cinco macrorregiões, incluindo o contexto urbano e rural. Foram estudadas 14.625 mulheres brancas e negras de 15 a 49 anos de idade, que representam, respectivamente, 40% e 54% da amostra total da pesquisa. Para análise da assistência à gestação, ao parto e ao puerpério avaliaram-se as gestações dos filhos nascidos vivos nos cinco anos anteriores à entrevista segundo seis variáveis: ter feito pelo menos uma consulta de pré-natal; ter realizado no mínimo seis consultas; o tipo de parto; ter tido a dor no parto normal aliviada; ter contado com presença de acompanhante no parto e ter feito consulta no puerpério. Além da cor, constituíram-se em variáveis independentes para cada um desses desfechos: idade da mulher na data da entrevista, macrorregião de moradia, residência urbana ou rural, estar ou não casada/unida, anos de estudo, religião atual, classificação econômica (critério Brasil) e posse ou não de convênio/plano de saúde. Na análise bivariada, mulheres negras, com menor escolaridade, pior classe econômica e não portadoras de plano de saúde apresentaram desfechos mais desfavoráveis. No entanto, após análise multivariada, as diferenças entre brancas e negras perderam significância estatística. Desigualdades sociais e econômicas mantêm-se determinantes das iniquidades na atenção em saúde reprodutiva.

Abstract This study intended to compare reproductive health care indicators between white and black women in Brazil. Data collected at the 2006 Demographic and Health Survey (DHS) were analyzed. The sample allows inferences for the country's five great regions and rural/urban residence. Among 14.625 females aged 15 to 49, white and black women accounted respectively for 40% and 54% of the total sample. Health care during pregnancy and child bearing were assessed by six indicators: attendance to at least one antenatal care visit, having attended to at least six antenatal care visits, attendance to at least one health care visit after child bearing, type of delivery, having received pain relief during a vaginal birth and having someone (relative or friend) with her during delivery. Besides skin color, the following independent variables were considered: age, region of residence, urban/rural residence, religion, marital status, schooling, economic status and having or not private health insurance. At bivariate analysis, all outcomes were unfavorable for black women, for those with low both educational level and economic status, as well for those without health private insurance. However, after multivariate analysis results showed no statistical differences between black and white women. On the other hand, social and economic inequalities remained important determinants of inequities on reproductive health services access.

Comparative Study Of Dynamic Hip Screw And Trochanteric Nail For Management Of Stable Intertrochanteric Fracture.

Background& objectives : Intertrochanteric fractures of hip are relatively one of the common fractures and it is imposing a huge burden on patients in terms of medical expenses and morbidity .A sliding hip screw (DHS) and trochanteric nail (TN) both are described for fixation of these fractures. The discussion about the selection of ideal implant is controversial in terms of outcomes in various studies. Methods: Ninety patients with intertrochanteric fracture were treated in our hospital from Jan 2009 to Dec 2011. All AO 31-A1 patients who were between 40-80 years old were included to compare Dynamic hip screw and Trochanteric nail in the management of intertrochanteric fractures by analyzing operative time, duration of hospital stay, complications, time taken to union and post operative mobility. 63 patients were enrolled in DHS group and 27 were enrolled in intertrochanteric nail group.Results: Patients treated with DHS had shorter operative time ,less radiological exposure ,easy reduction and fewer intraoperative and postoperative complications .Implant failure and non union was noted in one out of twenty seven patients treated with trochanteric nail group.Interpretation & Conclusions : The analysis of our study supports the use of DHS rather than trochanteric nail for the treatment of stable intertrochanteric fractures in elderly patients.

DHS, GAMMA NAIL, PROXIMAL FEMORAL LOCKING PLATE FOR TREATMENT OF PROXIMAL FEMORAL FRACTURES IN ELDERLY / 现代医院

Objective To explore dynamic hip screw (DHS), Gamma nail and proximal femoral locking plate treatment effect of the proximal femoral fractures in elderly patients .Methods treated 129 cases of proximal femoral fractures in elderly patients from January 2013 to May 2014 were selected .48 patients were treated with prox-imal femoral locking plate;42 cases were treated with dynamic hip screw ( DHS) treatment;and 39 cases were trea-ted with Gamma nail treatment.The patient's surgery status, the healing time, hospital stay, complications and effica-cy were observed .Results 5 patients in the proximal femoral locking plate group had complications , and the rate was 10.4%;the treatment rate of 93.75% excellent.10 cases of dynamic hip screw ( DHS) group had concurrent disease, and the rate was 23.8%;the treatment was excellent 83.33%.9 patients of Gamma nail group had compli-cations, and the rate was 23.1%; the treatment rate of 84.62% fine.Proximal femoral locking plate group of pa-tients with complications was significantly less than the dynamic hip screw ( DHS) and the Gamma nail group of pa-tients.The treatment groups were significantly higher than excellent (p<0.05).Conclusion In the elderly proxi-mal femoral fractures with proximal femoral locking plate of treatment , surgery is recommended with better and faster cure, fewer complications and a significant effect .

Fixation of basicervical and related fractures using DHS with DRS.

Background: Basicervical fracture is a fracture through the base of femoral neck at its junction with the intertrochanteric region. Due to this location, it represents an intermediate form between femoral neck, usually fixed with multiple cancellous screws, and the intertrochanteric fracture, fixed with a sliding screw device. Previous studies recommended treating basicervical fractures as intertrochanteric fractures with the dynamic hip screw (DHS). However, because basicervical fractures have greater instability than stable intertrochanteric fractures, poor functional outcome may be expected when the DHS used alone. Aims & Objective: To evaluate the outcome of fixation of basicervical and related fractures using DHS with DRS. Materials and Methods: We prospectively studied 42 patients in order to identify a group of proximal femoral fractures having liability for axial and rotational instability, and to present results of their fixation using the dynamic hip screw (DHS) with derotation screw (DRS). Results: At 12 months postoperatively, patients were functionally evaluated and the radiological outcome was analysed. All fractures united within an average period of 11.5 weeks. The mean sliding distance was 5.5 mm and mean shortening of the limbs was 2 mm. According to the criteria of Kyle et al. (J Bone Joint Surg [Am] 61-A:216–221), 39 patients obtained excellent results, two good and one fair. Conclusion: We conclude that the AO types B2.1, A1.1, A2.1, A2.2 and A2.3 have a common instability denominator and therefore should be treated alike. The sliding component of the DHS allows solid fixation of the two major fragments in two planes and the DRS in the third plane.

Estudio biomecánico hueso-implante DHS y fijador externo en la consolidación de la fractura de cadera / Étude biomécanique de la vis-plaque dynamique (DHS) et du fixateur externe dans la consolidation de la fracture de hanche / Biomechanical study of bone-DHS implant and external fixator in hip fracture

Objetivos: determinar el comportamiento biomecánico de los conjuntos placa Dinámic Hip Screw-hueso y fijador externo monolateral-hueso y la influencia de estos en la distribución del estado tensional, antes, durante y después de retirado el implante. Métodos: se realizó el estudio aplicando el método de los elementos finitos, se tuvo en cuenta la acción de los músculos y el peso corporal en la fase monopodal del ciclo de marcha, así como las propiedades anisotrópicas en el tejido cortical, e isotrópicas para la parte esponjosa del hueso. Se ejecutó un estudio comparativo del estado tensional del implante y su influencia en la variación del estado tensional-deformacional del hueso, durante el tiempo en que se mantiene el implante en este y luego de ser retirado Resultados: se obtuvo la variación porcentual de las zonas sometidas a tracción y compresión en el hueso sano durante el estado de carga correspondiente a la marcha monopodal, el valor de las tensiones actuantes en cada elemento de los implantes analizados durante la consolidación de la fractura, así como la influencia de estos en la distribución del estado tensional del hueso, durante su funcionamiento y después de retirado el implante. Conclusiones: en relación con el comportamiento mecánico del implante Dinámic Hip Screw y el fijador externo, la situación más desfavorable la presenta el primero, al mostrar tensiones por encima del límite elástico del material en el tornillo inferior de fijación al hueso. Se nota en ambos casos una ligera variación del estado tensional del hueso después de haberse colocado el implante. Al retirar los implantes se produjo una elevación de las tensiones de compresión en los bordes de los agujeros que fijaban uno y otro implante(AU)

Objective: to determine the biomechanical behavior of the bone-Dynamic Hip Screw plate and the bone- monolateral external fixator sets and their influence on the distribution of stress before, during and after the removal of implant. Methods: the study was based on the finite element model, taking into account the muscle actions and the body weight at the monopodal phase of the gait cycle as well as the anisotropic properties of the cortical tissue and the isotropic properties of the spongy part of the bone. A comparative study was also conducted on the stress condition of the implant and its influence over changes in the stress-deformation condition of the bone as long as the implant remains in the bone and after being removed. Results: the variation percentage of the areas under traction and compression in the healthy bone was estimated for the loading condition in the monopodal gait along with the acting stresses in each element of the implants analyzed during the consolidation of fracture and the their influence in the distribution of stresses in the bone during the functioning of implant and after its removal. Conclusions: regarding the mechanical behavior of the Dynamic Hip Screw implant and the external fixator, the most unfavorable situation was found in the first system since stresses were greater than the material's elastic limit in the lower fixation screw. A slight variation of the bone stress was noticed after placing the implant. When both implants were removed, there was a rise of compressive stresses at the borders of the holes they fixed(AU)

Objectif: le but de cette étude est de déterminer le comportement biomécanique de la vis-plaque dynamique (DHS) et du fixateur externe unilatéral, et l'influence de ceux-ci sur la distribution de la tension avant, pendant et après l'enlèvement de l'implant. Méthodes: une étude a été réalisée en utilisant la méthode des éléments finis. On a tenu compte de l'action des muscles et du poids corporel dans la phase d'appui de la marche, ainsi que des propriétés anisotropiques du tissu cortical et isotropiques du corps spongieux de l'os. Une étude comparative de la tension de l'implant et son influence sur la variation de tension et de déformation de l'os avant et après son enlèvement, est effectuée. Résultats: on a obtenu une variation des pourcentages entre les zones soumises à traction et celles soumises à compression de l'os sain au cours de l'état de charge correspondant à la phase d'appui de la marche; un taux des tensions agissant sur chaque élément des implants analysés pendant la consolidation de la fracture, ainsi que leur influence sur la distribution de l'état de tension de l'os au cours son fonctionnement et après l'enlèvement de l'implant. Conclusions: par rapport au comportement mécanique de la vis-plaque dynamique (DHS) et du fixateur externe, on peut conclure que la situation la plus défavorable est présentée par la DHS, dû à ses tensions surmontant la limite élastique du matériel de la vis inférieure de fixation à l'os. Dans tous les deux, on peut constater une légère variation de la tension de l'os après le placement de l'implant. Une fois que les implants sont enlevés, les tensions de compression sur les bords des trous de fixation s'élèvent(AU)

Community Characteristics of Female Autonomy, Status and Adolescent ChildbearingRelated Behaviour: Demographic Health Survey Nicaragua 1998 and 2001 / 国際保健医療

<B>Objectives</B><BR>High adolescent fertility rates still persist in many developing countries. Adolescent childbearing often leads to negative outcomes including physical and mental disorders of mothers, a high incidence of infant death and household poverty. Obviously, it is important to explore the determinants of adolescent reproduction and its related behaviour to ensure its prevention. This study assesses the impact of the level of female autonomy and status of the community on adolescent childbearing, age of sexual debut and age of marriage.<BR><B>Methods</B><BR>This paper uses the pooled micro data from the Demographic and Health Survey Nicaragua 1998 and 2001. A logistic model is used to estimate the impact of the level of female autonomy and status of the community on adolescent childbearing, age of sexual debut and age of marriage. These variables are aggregated for each municipality using data on women aged over 20. Four female community autonomy variables are used. They are the percentage of women who have the final say on: own healthcare, making large household purchases, visit to family or relatives, and what food is to be cooked each day. Three variables of female status in the community are mean age at first marriage, mean age differences between spouses, and the percentage of those enrolled in secondary level education.<BR><B>Results</B><BR>Analysis proved that the level of autonomy and status of women in the community influence adolescent childbearing, age of sexual debut, and age of marriage. Particularly, the probability of younger sexual debut and younger marriage decreases when a community has a higher level of female autonomy and status.<BR><B>Conclusion</B><BR>The results indicate the importance of community intervention to strengthen female autonomy and promote female status in order to prevent adolescent childbearing.

Clinical analysis of 58 elderly patients with intertrochanteric fracture accepted surgery treatment / 中国基层医药

Objective To investigate the clinical significance of DHS and LCP in treating elderly patients with intertrochanteric fracture.Methods 58 elderly patients were randomly divided into 2 groups.30 of them( DHS group) were treated with DHS,while 28 cases of them were treated with LCP.Blood loss,operation time,bone healing time and Harris score were analyzed.After 1-year follow time,effective rate and complication rate were also recorded and evaluated in the 2 groups.Results The complication rate in LCP group was lower than that in DHS group(P ＜0.05),while the effective rate and Harris score in LCP were higher than that in DHS group( P ＜0.05 ).There were no significant differences in blood loss,operation time and bone healing time between the 2 groups ( P ＞ 0.05 ).Conclusion Compared with DHS,LCP is effective in treating elderly patients with intertrochanteric fracture.

The Comparison between ITST(TM) (Intertrochanteric/Subtrochanteric) & DHS (Dynamic Hip Screw) in Unstable Femur Intertrochanteric Fracture

PURPOSE: To evaluate between DHS and ITST nail (2nd generation) on the treatment of unstable femur intertrochanteric fracture in patients over 70 years old. MATERIALS AND METHODS: 61 cases of unstable intertrochanteric fracture (grouped 37 patients with DHS and 24 patients with ITST) who were taken the operation from Mar. 2003 to Sep. 2007 were analysed regarding to union time, sliding length of lag screws, operation time, blood loss, postoperative complications and functional recovery score by Skovron. RESULTS: The mean union time was 14.7 weeks in study group (ITST). The mean union time was 16.2 weeks in control group (DHS). The lag screw slidings were 7.2 mm in study group and 8.7 mm in control group. The operation times were 57.9 min in study group and 76.9 min in control group. The amount of blood loss were 67.7 ml in study group and 227.4 ml in control group. The complications were 4 cases in study group and 4 cases in control group. The Skovron recovery scores were 76.5% in study group and 73.7% in control group. CONCLUSION: From a practical point of short operation time, less amount of bleeding and less complication, author think that the ITST nail is useful implant for treatment of unstable femur intertrochanteric fracture in patient of old age.

Percutaneous insertion of dynamic hip screw fixation for osteoporosis intertrochanteric fractures in the elderly / 中国基层医药

Objective To observe the clinical effect and follow-up outcome of the osteoporotic femoral intertrochanteric fractures after treatment with DHS in the elderly. Methods Sixty-six cases with OFIF were treated with open reduction and percutaneons insertion of DHS during February 2003 to April 2007. All patients took the microclosed reduction and anti-osteoporotic medicines during the treatment and they were followed up for outcome and complications. Results All patients were followed up for a mean duration of 13.5 (6～18) months, the average fracture healing time was 3～4 months. Harris scores excellent was 34 cases and good was 22 cases. The excellent and good rate of osteoporosis was 100%. No non-union mechanical fixation failure, bone cut out or severe nerve and vessel injury was noticed. Percutaneous insertion of DHS is effective in treatment of osteoporotic intertrochanteric fractures in the elderly. Conclusion The surgical principles include use of simple, effective and safe method, less functional influence and good mechanic fixation, which can reduce the complications and promote early recovery.

Clinical observation of PFN-A and DHS on the treatment of intertrochanteric fracture / 中国基层医药

Objective To compare the current trcmment of intertrochanteric fracture fixation commonly used in the two systems:proximal femoral nail(PFN-A)and the dynamic hip screw(DHS)of clinical efficacy and evaluate the treatment of the two intertroehanteric fracture of the gifted bad.Methods The clinical use on closed reduction and traction,respectively PFN-A with DHS and the treatment of intertrochanteric fracture patients with 106 cases and 115 cases,compared with its ease of operation,and the effect of surgery,postoperative complications.Results The clinical material demonstrated that in after PFN-A treatment thighbone thick pmsperom bone fracture technique,technique,the complication is short in DHS.Conclusion PFN-A well-designed,with simple anti-rotation indeed,surgical trauma,less bleeding,fewer complications,etc.,is the treatment of intertrochanteric fracture fixation one of the ideal.

Methods to Increase the Effectiveness of Trochanteric Stabilizing Plate for Unstable Femoral Intertrochanteric Fractures with Gtreater Trochanteric Fracture: Fixation of Greater Trochanter with Wire and Screw

PURPOSE: The clinical outcome is favorable for the treatment of unstable femoral intertrochanteric fractures using both dynamic hip screw (DHS) and trochanter stabilizing plate (TSP) in elderly patients. However, there are sometimes complications related to excessive sliding. Therefore, the aim of this study was to evaluate the value of additional fixation of greater trochanter using wires and screw in the unstable femoral intertrochanteric fractures with a greater trochanter fracture. MATERIALS AND METHODS: From March 2004 through December 2005, thirty-seven patients, who were more than sixty-five years of age and were diagnosed with osteoporosis, were treated with DHS and TSP in unstable femoral intertrochanteric fractures with a follow-up of more than 6 months (mean duration, 13.5 months). The patients were divided into two groups. One group (group A: 20 patients) was treated with DHS and TSP only, whereas the other (group B: 17 patients) was treated with DHS and TSP augmented by a wire and screw. The average age was 80.9 (range 68 to 89) and 83.2 years (range 72 to 91) in groups A and B, respectively. All the patients in both groups were assessed radiographically immediately after surgery and at the last follow-up. The level of sliding of the lag screw and displacement of the greater trochanter were evaluated statistically. RESULTS: Bony union was achieved in all cases except for two cases in group A. At the last follow-up, the average of lag screw sliding in groups A and B was 8.96+/-5.98mm and 4.80+/-3.68, respectively, showing a statistical difference (P value0.05). CONCLUSION: Unstable femoral intertrochanteric fractures can be treated successfully using a hip screw and TSP alone. However, the addition of wires and screws in the greater trochanter can prevent excessive sliding that occurs after displacing the greater trochanteric fragments out of the plate in the presence of a greater trochanteric fracture line or severe bone defect in the lateral aspect.

DHS Combined with Hollow Traction Bolt Treat Thighbone Interrotor Fracture / 浙江中医药大学学报

[Objective]To explore clinical effect of DHS combined with hollow traction bolt treating thighbone interrotor fracture. [Method]From May 2003 to July 2006,apply DHS combined with hollow traction holt to treat thighbone interrotor fracture 9 ca- ses,6 males,3 females,aged 47～72,62.6 in average,5 cases of left side,4 right side;classify under Evan's:5 cases of typeⅡ, 2 ofⅢ,2 ofⅣ.[Result]Follow up for 6～21 months,12 months in average.Appraise the clinical effect by Huang Gongyi's standard,7 cases were very good,1 good,1 bad,the good rate was 89%.[Conclusion]DHS combined with hollow traction bolt treating thighbone interrotor fracture can obviously increase stability of fracture point,reduce local rotation,helpful to fracture cure and early exercise,as well as the complication.