Accuracy of in situ neck-shaft angle and shortening measurements of the anatomically reduced, varus malreduced and shortened proximal femur: can we believe what we see on the postoperative films?

OBJECTIVES: Measuring the neck-shaft angle (NSA) and amount of shortening of the femoral neck on the anterior to posterior (AP) X-ray is important when treating proximal femur fractures. To compensate for proximal femoral external rotation, the X-rays need to be taken with the leg internally rotated, an act that cannot always be performed or verified. This study aims to define the utility of in situ AP X-ray in NSA and shortening measurements. METHODS: Computed tomography (CT) scans of 50 patients undergoing abdominal CT scans were assessed for the in situ rotation of the femoral neck relative to the AP beam. Three proximal femur fracture Sawbones models were made and AP X-rays of the models were taken with changing proximal femur rotation. NSA and shortening were measured on all X-rays. RESULTS: In situ femoral neck rotation averaged 25.4±10.6° of external rotation (range, 0.9-51.8°, 80% of measurements less than 35°). NSA measurements varied less than 5° with less than 35° of rotation in all models, and were always greater than the true value. Femoral neck vertical length (VL) measurement was independent of proximal femur rotation whereas the horizontal length component was found to be highly dependent on the same. CONCLUSIONS: NSA measured on AP X-ray will be accurate to within 5° in 80% of patients with the hip left in situ and in 100% of the patients if the hip is internally rotated 15°. Measurement of significant varus or loss of VL of the femoral neck can be considered accurate regardless of leg rotation at the time of X-rays being taken.

Comparison of medical visits by active duty and National Guard soldiers at a forward deployed medical facility in Iraq.

STUDY OBJECTIVE: To compare differences in disease nonbattle injury data between cohorts of deployed active duty (AD) and National Guard (NG) soldiers. METHODS: This study compared AD and NG soldiers presenting for medical visits to a level I clinic in Iraq. Retrospective data were collected from the Department of Defense (DOD) electronic records system, on soldiers in two AD and two NG companies with populations of 391 and 425, respectively, regarding number of visits, age, gender, diagnosis, and evacuation for laboratory tests or X-rays (level II care) or for hospitalization or subspecialty services (level III care). Visits occurred during the 11-month period of October 1, 2006 through August 30, 2007. RESULTS: In the AD group, 180 of 391 (46%) soldiers presented for 594 visits (1.5 visits per soldier). In the NG units, 300 of 425 (71%) soldiers made 1,294 visits (3.1 visits per soldier). There were 67 AD evacuations, 54 sent for level II care and 13 for level III care as compared to 151 NG evacuations, 116 to level II and 35 to level III. The leading diagnoses for visits in both groups were musculoskeletal and dermatologic and the leading cause for evacuation was genitourinary. Gender utilization rates were 3.4 and 7.4 visits per AD and NG female compared to 1.2 and 2.8 visit per group matched male. CONCLUSION: NG soldiers presented for care and required evacuation twice as frequently as AD soldiers. NG patients were typically older. Female soldiers in both groups had higher utilization and evacuation rates than males.