[Change of daily life activity after femoral hip fracture in elderly patients]. / Veränderung der Lebenssituation des alten Patienten nach koxaler Femurfraktur.

Hospital mortality after hip fracture in elderly patients has decreased significantly in previous years. However, patients often show reduction of daily life activity. The aim of the following study was to assess clinical and radiological results nine months after operation of hip fracture. A total of 127 patients (mean age 77.2 years) were stabilized by arthroplasty because of femoral neck fractures or by gamma locking nail because of trochanteric fractures. Modified Harris-Hip-Score as well as social situation at time of follow-up compared to pretrauma situation were evaluated. Hospital mortality was 3.2 percent. Follow-up could be performed in 78 patients clinically and radiologically by examination in the hospital. At time of follow-up 19.7 percent of patients had already died independent of the operative procedure. Only 65 percent of patients were able to live at home. Modified Harris-Hip-Score at follow-up was decreased significantly by 16 points compared to the situation before the trauma. The reduction of the score was caused mainly by deterioration of hip function and less by femoral or hip pain. In future the main scope after hip fracture must be an improvement of rehabilitation of elderly patients.

[The femoral neck fracture in the elderly patient - cemented or cementless hip arthroplasty?]. / Die Schenkelhalsfraktur des alten Menschen - zementierte oder unzementierte endoprothetische Versorgung?

This is a report on the treatment results of femoral neck fractures with a cemented (group 1) and cementless (group 2) type of hip prosthesis, resp. 72 patients were enrolled. 35 patients were treated with a cemented hip prosthesis (mean age: 78 years), and 37 patients with a cementless modular hip prosthesis (mean age: 77 years). In the cemented group we observed 5 cases of hypotension during insertion of the prosthesis in the femoral shaft. One of these patients required mechanical resuscitation during surgery. In the second group 3 cases of proximal femur fissure and one case of distal femoral fracture were recorded. One year after surgery 43 patients presented for follow up evaluation (cemented group: n = 24; cementless group: n = 19). Both groups revealed comparable results according to the Harris Hip Score (75 versus 78,3 points). No prosthesis loosening was observed in either group. In our view the cemented hip prosthesis is the treatment of choice for femoral neck fractures among the old and very old, if no stabile osteosynthesis can be performed. Patients with cardiopulmonary risk factors, however, may profit from cementless hip arthroplasty to avoid the well known cardiodepression during surgery.

[Treatment of per- and subtrochanteric femoral fractures by gamma nails and modular hip prostheses. Differential indications and results]. / Versorgung der per- bis subtrochantären Femurfraktur durch Gammanagel und modulare Hüftprothese. Differentialindikation und Ergebnisse.

From January 1997 to August 1998 all stable and nonstable trochanteric femoral fractures (n = 72) were treated routinely by gamma nail using the correct operative technique. Patients showing additional osteoarthritis of the hip in radiographs hip replacement was performed by a cementless modular femoral hip prostheses from January 1996 to August 1998 (n = 28). Follow up period was 6 to 18 months. Operation time and blood loss were higher using the prostheses. However complications and lethality (< 5%) were not different during postoperative course. In each group three operative technical complications occurred. Using a modified Harris Hip Score (without range of motion, contractions) the score was decreased non significant comparing both groups first of all in unstable fractures until follow up. In each group one revision (loosening of prostheses, excessive shortening of femoral neck) was necessary. Using the correct operative technique, the gamma nail proved to be a save device with good outcome. Outcome using modular prostheses is comparable to gamma nail. Therefore the use of modular prostheses is justified in case of osteoarthrosis and in some cases of very unstable fracture.