Walking ability before and after a hip fracture in elderly predict greater long-term survivorship.

AIM: The morbidity and mortality after a hip fracture in the elderly population are multifactorial. The aim of this study is to determine the long-term impact of specific factors to mortality rate and mobility after a hip fracture in the elderly. MATERIALS AND METHODS: Elderly suffering a hip fracture after a low-energy trauma was included in the study, whereas moribund patients with severe comorbid conditions and high-energy trauma were excluded. All the patients were treated operatively during 2003. Data for survivorship and mobilization was collected six months, one and ten years after the operation. Kaplan-Meier log rang test was used for the survival analysis and cox regression for multivariate analysis of prediction factors such as age, gender, time to surgery after trauma, type of fracture, ambulation status before injury and early walking ability after the surgery. RESULTS: Two hundred and thirty three patients were finally included to the study. Gender (p = 0.64) and type of fracture (p = 0.92) seem to have no statistically significant impact on survivorship. Age (p < 0.001), time of surgery after the trauma (p = 0.001), ambulation status (p < 0.001) and early walking ability after the surgery (p < 0.001) seem to have statistically significant impact on mortality, as independent factors. The significance is present one year and ten years after the surgery. However, according to the multivariate analysis, time to surgery after trauma and age lose significance, while early walking ability remain significant one and ten years after surgery (p < 0.001). Ambulation status seem to lose significance early after surgery, but reach significance ten years postoperatively (p < 0.001). CONCLUSION: In summary, it could be stated that early walking ability after an operation for a hip fracture in elderly is the most significant prediction factor of survivorship one and ten years postoperatively. Ambulation status before injury is a significant long-term predictor factor for survivorship.

Isolated acute dislocation of the proximal tibiofibular joint.

Lesions of knee's lateral side are less common than medial injuries. The anatomy of the lateral ligaments and the presence of additional structures (eg, fibula head) can cause diagnostic problems. Isolated dislocation of the proximal tibiofibular joint is unusual; therefore, it may be overlooked in the emergency department. Many cases are missed due to failure of diagnosis. This type of injury is common in athletes whose sports require twisting motions of the flexed knee (eg, wrestling, parachute jumping, judo, gymnastics, skiing, rugby, football, soccer, track, baseball, basketball, racquetball, and roller-skating). Anterolateral dislocation of the proximal tibiofibular joint is seemingly rare in soccer players, as less than a handful cases have been reported in the literature. The diagnosis can be made by clinical examination, plain knee radiographs, and, sometimes, computed tomography (CT) scanning for further confirmation. Treatment usually consists of closed or open reduction. In complicated cases, however, arthrodesis or resection of the fibular head may be required. This article reports a rare case of acute isolated anterolateral dislocation of the proximal tibiofibular joint in a soccer player and discusses the joint anatomy, types of dislocations, mechanisms of injury, and treatment options.

Simultaneous bilateral posterior dislocation of the shoulder: diagnostic problems and management. A case report.

We present the case of a patient who sustained simultaneous bilateral posterior dislocation of the shoulder after a possible epileptic fit. The confirmation of the diagnosis was reached only by a computed tomography (CT) scan, after the clinical suspicion. Under general anesthesia, close reduction of both shoulder dislocations was done. Posterior dislocation of the shoulder-especially the bilateral one-is very rare. When the history describes an electric shock or convulsive seizure, any shoulder injury demands a careful clinical and radiological evaluation. It is usually associated with reverse Hill-Sachs lesion (an impression defect of the anteromedial aspect of the humeral head), in which the size determines the treatment options.