Hip fractures in Finland--a comparison of patient characteristics and outcomes in six hospitals.

BACKGROUND AND AIMS: To compare six Finnish hospitals for the quality of treatment of hip fractures and to obtain information for the development of care. MATERIAL AND METHODS: Data of 1179 consecutive hip fracture patients (about 200 patients per hospital) was collected prospectively, using similar standardized forms and focusing on background factors and the four-month functional outcome. RESULTS: There were significant differences between the hospitals in patient characteristics (age, place of residence, walking ability, use of walking aids, morbidity and type of fracture) and in the unadjusted outcome variables at four months' follow-up (place of residence, mobility, use of walking aids and pain in injured hip). After adjustment for baseline characteristics, there was a significant difference in the post-fracture walking ability between the centres but no significant differences in post-fracture place of residence. Unadjusted mortality did not vary between the centres, but adjustment resulted in significant differences. The most marked difference in surgical methods between the hospitals was seen in the use of either sliding hip screw or Gamma Nail for trochanteric fractures, but this difference was not reflected in the results of multivariate analysis. CONCLUSIONS: We found minor differences in mobility and mortality between the participating hospitals, and these might serve them as a stimulus for improving their standard of good practice. Continuous quality improvement by repeating the audit cycle is recommended in order to reach and then improve the prevalent standards in the care of hip fracture patients. Confounding factors should be adjusted when comparing the medical centres treating hip fractures, and the evaluation of the results should be multidimensional.

A novel reconstruction technique for chronic lateral ankle instability: comparison to primary repair.

Twenty patients with lateral ankle instability were treated by a novel anatomical reconstruction technique (group A) and the results compared with 20 patients (group B) who, during the same period of time, underwent primary repair of ruptured lateral ligaments of the ankle. We reviewed 15 patients from group A and 17 patients from group B at a mean follow-up of between 2 and 4 years. The mean functional scores were good in both groups without significant difference, and there was no difference in the mean anterior talar translation between the two groups. We therefore conclude that chronic lateral instability of the ankle may be successfully treated, even in the presence of severely damaged, attenuated or absent ligament tissue.

Local thrombolytic therapy as a support for catheter embolectomy in limb arterial occlusions.

Eleven patients with acute arterial occlusion of the lower limb were treated by standard balloon catheter embolectomy. Residual thrombus seen in intraoperative arteriograms was treated with streptokinase: after an initial dose of 10.000 IU, streptokinase was infused intra-arterially in a dose of 5.000-10.000 IU/hour. The average infusion time was 40 hours (range 15-94 hours) and the total amount of streptokinase used was on average 210.000 IU (range 35.000-470.000 IU). All legs were saved. Complete recanalization occurred in eight patients and partial recanalization in three patients. Excluding three inguinal haematomas no other complications occurred.

Spiral autogenous venous graft in the replacement of large vessels. An experimental study with special reference to replacement of the inferior vena cava.

The replacement of large veins poses a difficult problem. Autogenous venous grafts have turned out to be the best replacements for veins. There is, however, no vein available for direct substitution of large veins. The purpose of the present work was to develop a method for replacing a large vein or artery with a vein of smaller caliber, using the dog as the experimental animal. The following conclusions can be drawn on the basis of the present findings: 1. When a small-caliber vein is cut open and then sutured in spiral form over a Haegar stent to obtain the desired caliber, the graft can be used to replace a large vein. The method is sufficiently simple and rapid for clinical application. 2. In the vein that is most difficult to replace, i.e. the infrarenal vena cava, the spiral autogenous venous graft remained patent without medication or concurrent peripheral A-V fistula in 88 per cent (15/17) of cases over a long follow-up. No late occlusions occurred. The spiral grafts that remained patent showed no essential morphologic changes, and the grafts retained soft, vein-like walls throughout the study. 3. The spiral venous grafts implanted into the canine abdominal aorta also functioned well. All nine grafts remained patent, and none showed aneurysmal dilatation over a one-year follow-up. The spiral aortic grafts were regularly "arterialized", i.e. developed distinct thickening of the graft wall. The new layer that grew on the inner surface of the graft, the neointima, gradually thickened, but its growth ceased after six months postoperatively. 4. In the infrarenal vena cava of the dog the spiral venous graft and synthetic PTFE graft behaved in completely different ways. The patent spiral grafts showed no essential changes during the follow-up: no caliber variation, no signs of thrombosis, and no late occlusions. All the PTFE grafts, on the other hand, showed various signs of thrombosis. This resulted in an occlusion rate of 50 per cent (5/10) of the grafts within three months. In the PTFE grafts that remained patent the neointima seemed to have developed through organization of the thrombotic layer on the inner surface of the graft. In the dogs followed up for more than six months, the middle part of the PTFE graft was coated by a loosely attached, hard thrombus, which might cause occlusion if it later detaches.

Intracompartmental pressure increase on exertion in patients with chronic compartment syndrome in the leg.

Intracompartmental pressure in the leg was measured continuously during running in thirty-two patients who had either a medial or an anterior chronic compartment syndrome. It was found that on exertion the patients had significantly higher increases in pressure compared with the pressures in a control group. There were no remarkable differences between the two groups in terms of pressure at rest before exertion. After fasciotomy, the pressure returned to normal. The method that we employed to measure pressure can be use in diagnosing painful conditions of the leg.