Habitual physical inertia and other factors in relation to risk of fracture of the proximal femur.

Physical inactivity is associated with low bone mass in adults, and might therefore be a risk factor for proximal femoral fracture in old age. This hypothesis was tested in a case-control study of 139 selected patients with confirmed proximal femoral fracture and 139 age- and sex-matched community controls, using an interviewer-administered questionnaire. Patients had been significantly less physically active in middle age than had controls, a difference that was greater in the younger subjects. It is suggested that the progressive decrease during the present century in the amount of physical activity associated with everyday life has resulted in increased numbers of elderly people being at risk of femoral fracture and may be the cause of the rises in age-specific incidence rates now being observed. If this explanation is correct, a planned increase in leisure-time physical activity in middle age and beyond may be the most effective method of preventing these fractures.

Outcome after general anaesthesia for repair of fractured neck of femur. A randomized trial of spontaneous v. controlled ventilation.

One hundred and fifty-two patients undergoing surgery for fractured neck of femur were randomly allocated to receive either general anesthesia with spontaneous ventilation with nitrous oxide and halothane in oxygen or general anaesthesia with controlled ventilation with fentanyl, nitrous oxide and halothane in oxygen. Atracurium was used to provide muscle paralysis in 65% of the latter group, the remainder receiving no neuromuscular blocking agent other than suxamethonium for intubation. Patients were followed up for 6 months. Mortality and outcome were not significantly different between the groups. Overall mortality at 4 weeks was 5.2%, and at 6 months was 15.1%--figures which are considerably lower than in some other comparable studies. This study does not support the suggestion that general anaesthesia with controlled ventilation is associated with increased postoperative mortality.

Rising incidence of fracture of the proximal femur.

Cases of fracture of the proximal femur in Oxford were recorded prospectively in 1983. The incidence was compared with rates obtained in the same population 27 years before. The earlier rates were validated against an independent source of data. After allowing for the rise in numbers of elderly people, the incidence was found to have doubled in both sexes and the increase was apparent at all ages. This study shows that the often-noted rise in numbers of fractures of the proximal femur is more than just a consequence of demographic change. The increases in the age-specific incidence must be due to changes in the aetiology of the fracture.