Hip fracture: a review of 1,166 cases in a community hospital setting.

A consecutive series of 1,166 patients 50 years of age and older with acute hip fracture, treated at a community hospital over a 20-year period, is analyzed as to age, sex, type of fracture, associated diseases, and treatment in relation to mortality and morbidity. Mortality was 8.66% overall (6.58% for patients treated surgically, 30.39% for nonoperative patients). The postoperative complication rate for surgical patients was 21%. Associated diseases, type of treatment and delay prior to surgery were major factors contributing to mortality. It was found that a patient's survival chances are enhanced by adequate control of associated diseases prior to and following injury, early surgery, and competent treatment of the fractured hip. Also, the mortality rate for patients with fractured hips was found to be lower for patients treated in community hospitals than for patients treated in municipal or county hospitals.

Migration of left hip pin with involvement of left ureter.

This patient had hematuria and a history of hip fusion many years before. It was found that a left hip pin had broken, and its sharpened portion had migrated through the head of the femur into the adventitia of the left ureter. During exploratory surgery, a bonecutter was employed to cut off the tip of the pin flush with the pelvic wall. The patient has had no recurrence of hematuria. Review of the literature disclosed no report of a similar case.

Treatment of intertrochanteric and subtrochanteric fractures with Ender's intramedullary rods.

A series of 100 patients was treated with Ender's rods for intertrochanteric fractures, subtrochanteric fractures and intertrochanteric pathologic lesions. Healing occurred within 4 months in all 85 of the patients who could be followed, and fractures were prevented in all 4 of the patients with pathologic lesions. Every patient who was ambulatory preoperatively regained ambulation within 3 months after surgery. Inhospital mortality for the series was 3%, compared to 8.4% for a 20-year series of 1,204 hip fractures treated by conventional means. Other advantages of the Ender's rod method are simplicity of the insertion procedure, minimal trauma and blood loss, uniform distribution of stress, early ambulation and weight bearing, and lower morbidity.

Lumbar spinal stenosis. Radiographic diagnosis with special reference to transverse axial tomography.

Spinal stenosis due to malalignment and/or hypertrophy of the bony margins of the spinal canal is a recognized cause of cauda equina compression and nerve root entrapment. The plain lumbosacral spine roentgenograms reveal the number of lumbar vertebrae, their alignment, their interpedicular distances, the height of the intervertebral disk spaces and the presence of osteophyte formation. It correlates poorly with encroachment on the spinal canal. The transverse axial tomogram directly demonstrates a cross-section of the spinal canal and will show abnormal areas of bone encroachment usually arising from hypertrophied lamina and articular processes. These narrow the posterior portion of the spinal canal and encroach on the lateral recesses. This examination does not demonstrate soft tissue hypertrophy and the stenosis may be even greater than what is apparent due to the bony encroachment. The myelogram expresses how the narrowed spinal canal affects the dural sac and its contained cauda equina. Not infrequently there is an associated herniated disk.