[Analysis of hip fracture care in Hungary between 2004-2009]. / A csípotáji törések hazai ellátásának elemzése a 2004­2009 közötti idoszakban.

INTRODUCTION: Proximal femoral fractures with severe outcome are most common in the increasing group of elderly patients. AIM: Based on the regular data gathered by the EuroHOPE research, the most important aspects and results of the treatment of proximal femoral fractures were studied. METHOD: Data of hospital admissions due to proximal femoral fractures were analyzed. RESULTS: There was a slight increase in the number of hospitalized patients between 2004 and 2009 in Hungary. 88% of the patients received operative treatment, 41% suffered femoral neck fractures. Mortality rates did not change significantly in the analyzed period. Standardized annual mortality rates for patients who had suffered a femoral neck fracture were 28% when prosthesis was implanted; this result was somewhat more favorable than in case of other surgical procedures. Annual mortality rates were higher in the peritrochanteric fracture group where intramedullary nailing was performed (36%). The ratio of operated patients did not differ significantly from international results. Mortality rates in Hungary were significantly less favorable. 30 day standardized mortality rate was 13.6% in 2008, twice as high as the rate in Finland, The Netherlands, Norway, Scotland and Sweden. The 40% mortality rate calculated for 365 days was significantly higher than international results. CONCLUSION: To define the measures needed to improve results, systematic analysis of both in-hospital treatment protocols, and follow-up treatment is necessary. Orv. Hetil., 2016, 157(41), 1642-1648.

Short-term results of total hip replacement due to acetabular fractures.

OBJECTIVES: This study aims to evaluate short-term results of total hip replacement performed for post-traumatic osteoarthritis and/or femoral head necrosis caused by acetabular fractures. PATIENTS AND METHODS: We performed 39 arthroplasties due to acetabular fractures on 25 male and 14 female patients during the course of a five-year period. The mean age of the patients was 45 years (range 25 to 73 years) at the time of surgery. Cemented cup was implanted in 29 patients and uncemented cup in 10 patients. Bone replacement was indicated in eight patients for different degrees of acetabular deformities. Implantation of an acetabular socket was indicated in six patients. RESULTS: The evaluation was based on the Harris hip score (HHS). The mean HHS score was 42 prior to arthroplasty and 81 after arthroplasty. Repeated surgery was required for infection in two patients. Dislocation of the prosthesis occurred in three patients, deep venous thrombosis in one patient and the lesion of the sciatic nerve in one patient after surgery. CONCLUSION: Our study results suggest that the selection of the cup type depends on the condition and bone deformity secondary to acetabular fracture. Surgical interventions are technically more difficult, and take longer with a high rate of the postoperative complications and prolonged rehabilitation period, compared to arthroplasties for degenerative hip diseases.

Comparison of stability in the operative treatment of pelvic injuries in a finite element model.

PURPOSE OF THE STUDY: The comparison of the stability of four surgical methods for the treatment of vertically and rotationally unstable type C pelvic ring injuries. METHODS: We produced a type C pelvic ring injury (type Denis II fracture of the sacrum and symphysiolysis) on a finite element model, in the case of standing on both feet. We stabilized the symphysiolysis with a five-hole reconstruction plate; the sacrum fracture was fixed in the first experiment with two, two-hole reconstruction plates on the ventral surface, in the second one we applied dorsally the transsacral, narrow DC plate, in the third one with KFI-H plate, and in the last one with iliosacral screw. Finite element modeling was performed by the use of the ALGOR software. Not only bones and joints, but joints and mechanically important ligaments were modeled as well. We measured the shift between the two surfaces of the fracture gap, compared to the results of measurements accomplished on cadaver models. RESULTS: Larger shift could be elicited after transsacral plating than after direct plating. These results correspond to those of the parallel investigation of the bony ligamentous cadaver pelvis specimens. The shift values after KFI-H plating and iliosacral screw fixation are larger than after direct plating, but smaller than after transsacral plating. The tension created in the implants is less than the allowed values; therefore, the choice of operation should depend on the type of injury. CONCLUSIONS: The finite element model may be utilized for the comparison of different methods of osteosynthesis for the treatment of injuries described above. Due to several difficulties in investigations performed on cadaver specimens, this model has undoubted utility.