Electronic consultations and referrals in Kymenlaakso Hospital District.

The meaning of this paper is to introduce the medical network which has been taken to Kymenlaakso Hospital District and the primary experiences in utilizing. Actual numeral results are not ready because of short time. First results will be ready in August 1999.

Hip fractures in two health care regions in Finland in 1989: an analysis of treatment.

We studied prospectively the demographic data, fracture types and modes of treatment in 390 patients with acute traumatic hip fractures in two health care regions in Finland, the Middle Finland region and the Kymenlaakso region in 1989. In Middle Finland population (251,203 inhabitants) 199 patients with a hip fracture were admitted to two acute care hospitals, while 191 patients were admitted in Kymenlaakso (population 189,726) to four acute hospitals. There were no significant differences in the sex- and age-specific incidences between the two regions. In Middle Finland, 70% of the fractures were of the femoral neck, 28% were trochanteric and 2% subtrochanteric. The corresponding figures in Kymenlaakso were 57%, 38% and 5% (P < 0.05). In Middle Finland, 73% of the femoral neck fractures were treated primarily with a hemiendoprosthesis, 2% with primary total hip replacement and 25% by osteosynthesis. The corresponding figures in Kymenlaakso were 81%, 7% and 12% (P < 0.001). The mean duration of hospital stay was 14 days in Middle Finland and 21 days in Kymenlaakso (P < 0.01).

Hip fractures in urban population in Finland.

We studied prospectively the occurrence of hip fractures among the over 49-year-old urban populations (n = 88,206) in the cities Tampere, Jyväskylä and Kotka in 1989 and compared the results with a parallel Scandinavian multicentre study. During 1989, there were 266 inhabitants who were treated for a hip fracture, 213 of them were women. Women had in 132 cases a femoral neck fracture and in 81 cases a trochanteric fracture, and the corresponding numbers for men were 22 and 31. Among women, the total hip fracture incidence in Jyväskylä (n = 22) was the lowest when compared with the ones in Tampere (n = 47) and Kotka (n = 36). These incidences were on average lower than in the other Scandinavian cities studied in parallel. The all over ratio of femoral neck/trochanteric fractures was 1.1 in Tampere, 3.0 in Jyväskylä and 2.2 in Kotka and in Tampere, women had 9.3 times more femoral neck fractures than men. Our study showed that in Finland in three major cities the hip fracture incidence was lower than what has been similarly registered in corresponding urban populations in other Scandinavian countries. We also point out that the relative part of trochanteric fractures appears to be increasing.

Tibial osteotomy for osteoarthritis of the knee. A five to ten-year follow-up study.

Of the 141 osteoarthritic knees treated by tibial osteotomy at the Kotka Central Hospital from 1969 to 1974, 103 (ninety-two with a varus deformity and eleven with normal alignment) were followed for at least five years, the average follow-up being 6.9 years. In eighty-six knees (83.5 per cent) the result was good or fair. In the ninety-two knees with a varus deformity, the best results were achieved when the postoperative femorotibial angle was 167 to 175 degrees. In the eleven knees with normal preoperative alignment, the osteotomy was designed to shift the load to the compartment in which there was less osteoarthritis involvement. In nine of these eleven knees there was an average change in angulation (varus or valgus) of 5.3 degrees (range, 3 to 9 degrees) and the result was good or fair. All osteotomies united without reoperation. The incidence of delayed union was 3.6 per cent when the osteotomy was proximal and 14 per cent when it was distal to the tibial tubercle. The elimination of the tethering effect of the fibula by osteotomy or release of the proximal tibiofibular joint did not prevent the recurrence of varus deformity. At an average of 3.4 years after the osteotomy, deterioration was demonstrable in twenty-six knees in which the initial result had been good. This is a higher incidence of deterioration than in previously published series. In sixteen of the 103 knees, a total arthroplasty subsequently was performed because of a poor result, at an average of 7.6 years after the osteotomy.

Acromioclavicular joint dislocation - surgical results in 36 patients.

45 patients were operated on because of acromioclavicular joint dislocation in the period reviewed. 36 patients attended for follow-up examination in 1979, on an average 4.8 years after the operations. In these patients, acromioclavicular joint dislocation was surgically treated as follows: A-O cortical screw in 27 cases, two Kirschner wires in five cases, and wire loop in three cases. Repair of the coracoclavicular ligament by Henry's procedure was performed in two patients in connection with acromioclavicular joint transfixion. Late resection of the distal end of the clavicle was performed in one case. The results were good in 28 patients, fair in five and poor in three cases (Ejeskär in 1974). In cases with a poor result, the findings were: 1) increased displacement of the joint surfaces on stress radiographs, 2) disabling pain at work, 3) restriction of movement of more than 20 degrees in several directions and 4) age over 42 years at operation.

Lateral instability of the ankle and results when treated by the Evans procedure.

Between 1968 and 1976 81 ankles of 77 patients with lateral instability of the ankle joint were operated on in the Kotka Central Hospital. Sixty patients with 62 ankle surgeries had postoperative followup. The average follow-up time was 5.2 years and the mean age of the patients was 28.3 years. In addition to the interview during the postoperative examination, all patients had anteroposterior (AP) mortice, lateral AP stress, and sagittal stress x-ray films. In the clinical examination ankle joint mobility, stability, peroneal function, predisposition to swelling, and circumference of the calf were investigated. Of the 62 ankles the result was excellent or good in 54 (87%). satisfactory in 5 (8%), and poor in 2 cases (5%). Of the 16 athletes' 18 ankles treated the result was excellent or good in 16 and satisfactory in 2 cases. The Evans procedure prevented talar tilting and gave good stability in anteroposterior direction.