Cervical hip fractures do not occur in arthrotic joints. A clinicoradiographic study of 256 patients.

We studied endogenic factors for the occurrence of cervical hip fractures in 256 patients. 230 underwent hemiarthroplasty, and 26 were treated with internal fixation or without surgery. The condition of the fractured hip and of the ipsilateral knee, as well as the mobility of the patient before the fracture, were studied in all 256 patients. The removed femoral heads were examined, photographed and radiographs were taken with sensitive film. The acetabulum and the femoral head were macroscopically normal in all 230 cases and there was no radiographic evidence of arthrosis. 64% of the patients were fully mobile before the fracture, 34% were mobile with the aid of a cane and 2% were dependent. In 88%, the ipsilateral knee was normal both clinically and radiographically, and in 12%, there was moderate arthrosis. When comparing the mobility before the fracture and the condition of the ipsilateral hip and knee in 100 patients having a cervical fracture with 100 patients having a trochanteric fracture matched for age and sex, we found that a normal hip joint was sine qua non while a normal ipsilateral knee and a fully mobile individual were important additional conditions for the occurrence of a cervical hip fracture, instead of a trochanteric one, after a fall in an elderly person.

Screening school children for scoliosis on the island of Crete.

The present study is the first that reports the prevalence of scoliotic changes in the island of Crete. We examined 21,220 children (10,942 boys and 10,278 girls), which corresponds to 87.8% of the 6-12-year-old children living in the Iraklion district (city and rural areas). Of the examined population, 9.6% were referred for radiological examination; 1.7% of the screened children were found to have spine deformities with angular values > 10 degrees. The prevalence of severe abnormalities (> 20 degrees) requiring conservative treatment was 0.06%. Thirty percent of the scoliotic deformities involved the thoracolumbar region, whereas 48 and 22% of curves were confined to the thoracic or lumbar area, respectively. The cost of the screening per child during the 1st year was estimated to be $10 (U.S.), but it was reduced by 42% during the 2nd year. The screening program is continuing to include all four districts of the island of Crete and assess the impact of scoliosis screening programs and of conservative treatment on the natural history of the disease. Scoliometers are used for the selection of children who should be referred for radiological evaluation (> 7 degrees). The screening includes children older than 8 years of age.

Increasing incidence of hip fracture in Crete.

In Crete, 459 patients with a hip fracture were treated during 1986 and studied prospectively. The female/male and trochanteric/cervical fractures ratios were both 2. The majority of the patients (96 percent) were 50 years of age and over. The incidence was found to be 10 per 10,000 inhabitants for the whole population, whereas in the age group of 50 years and over, it was 30; and in the age group of 80 years and over, 140 per 10,000. From 1982 to 1986, the annual number of patients with a hip fracture increased by 20 percent, while the population 50 years and over remained practically unchanged. Compared with Scandinavia, the number of fractures in Crete is lower, and the proportion of trochanteric fractures is higher.