Atypical femoral fractures in elderly women: a fracture registry-based cohort study.

An atypical femoral fracture (AFF), with a transverse fracture radiologically through the lateral cortex is a rare but serious condition. In order to improve our ability to identify patients with this condition, we retrospectively surveyed all subtrochanteric, peri-implant and diaphyseal femoral fractures in patients aged ≥ 65 years who underwent surgical treatment at our hospital between 2004 and 2011. We describe the incidence of atypical fractures and their characteristics, with observational data including a review of the hospital and general practitioner records. Clinical outcomes were evaluated using the Harris hip score (HHS) and the timed up-and-go (TUG) test. Atypical fractures only occurred in women with an incidence of 9.8 per 100,000 person-years. The incidence in those who were treated with bisphosphonates was 79.0 per 100,000 person-years; eight of 17 fractures occurred around metal implants. There was a high incidence of delayed union and revision surgery. A total of nine patients (ten AFFs) were available for review at a mean follow-up of 36.5 months (10 to 104). The clinical outcome was poor with a mean HHS of 58.9 (95% CI 47.4 to 70.4) and a mean TUG test of 25.7 s (95% CI 12.7 to 38.8). The delay in diagnosis and treatment of AFF may result from a lack of knowledge of this condition.

Impacted bone stiffness measured during construction of morsellised bone samples.

Impacted morsellised bone is widely used for filling bone deficiencies during revision of total hip arthroplasties. However, the physical properties and mechanical behaviour of this bone material are still not well understood. In this study we recorded the increase of stiffness in pellets of morsellised bone during their construction. The construction of bone pellets was measured stroke-by-stroke to ascertain optimal stiffness. We have derived an impact-constrained module of elasticity, which represents the dynamic resistance in the granulated bone mass to impaction. Drop level of the impaction slap hammer increases constrained bone stiffness during impaction and load. However, increasing the number of impaction strokes at the highest drop level does not improve stiffness properties; no significant increase in stiffness was achieved after five strokes on each layer of morsellised bone.

[Outplacement of medical students in local hospitals]. / Utplassering av legestudenter i lokalsykehus.

The organisation and content of the training of medical students in practical and clinical skills at Norwegian universities is presented and discussed. Based on experience from Tromsø University, an increased use of local hospitals for training medical students in practical and clinical skills is planned for all universities in Norway.

The use of Kirschner wires in diaphyseal fractures of the forearm.

This paper reports a case history in which a diaphysial radius fracture was treated by internal fixation with a spade tipped Kirschner wire. After one year, attempted removal of the spade tipped K-wire was unsuccessful. It is recommended that trocar tipped K-wire be used in patients with delicate bones and in bones of children.