Operation in hip fracture patients--analysis of the time factor.

The time that elapsed between the fracture, arrival at the hospital and subsequent surgery was studied retrospectively in 274 hip fracture patients. In 8.8 per cent of the patients the time of fracture could not be established. In 14.6 per cent there was delay before arrival at the hospital. Operative delay for medical conditions occurred in 6.6 per cent. When these groups were excluded, there was no difference in the mortality or hospital stay between patients from their own homes or old people's homes who had immediate surgery (within 8 h of arrival) and those in whom surgery was delayed for up to 48 h.

Three irrigation systems for motorized arthroscopic surgery: a comparative experimental and clinical study.

The purpose of this study was to compare experimentally and clinically three types of irrigation systems for arthroscopic suction surgery. A joint model was used in the experimental part of the study. It was found that a combination of inflow from a volume pump with extra gravity inflow through a separate cannula gave results comparable to those with more sophisticated automatic pumps. Clinically, none of the systems provided protection from high-pressure peaks during rapid movements of the knee joint. It was also found that the pressure differed in the superior and posteromedial compartments of the knee during rapid movement.

Elevated position of the irrigation outflow during arthroscopy: an experimental study.

The purpose of this study was to investigate different types of irrigation systems and to record pressures and flows in a joint model. Gravity inflow and three different pumps were compared, and the level of the outflow in relation to the model was tested. Flow rates of 100-200 ml/min and pressures ranging from negative to 100 mm Hg were found. There were minor differences between the irrigation systems, mainly concerning safety aspects. Elevated position of the outflow could be of value in controlling and optimizing pressures and flows during arthroscopy.

Elevated position of suction outflow during arthroscopic motorized surgery: an experimental study.

Different irrigation systems for use during arthroscopic suction surgery were investigated in a knee model. Gravity inflow and three different pumps were used. With suction at floor level, none of the systems was able to maintain a positive pressure within the model during suction even when the suction pressures were reduced. With elevated position of the suction outflow, a positive pressure could be maintained. This principle seems to minimize the problem and is recommended.

Hip fractures--patient background.

A consecutive series of 282 patients with hip fractures, with a mean age of 76 years, was studied. Two-thirds of the patients (182) lived in their own homes, half of them alone and one-third of the 182 requiring regular help. Widows were more common in the age group 75-84 years and widowers and single men in the age group 65-74 years. Thirty % of the patients used walking aids and had previously sustained fractures of the osteoporotic type. One-fourth of the patients were confused on arrival at hospital. Laboratory tests differed little from values in the normal population. Chest X-ray was of value and cardiac decompensation was diagnosed in a small group. Time aspects of the hip fracture accident are discussed. No increase in incidence in the age group over 70 years was found during the period 1971-1981.

Hip fractures--treatment and early complications.

A prospective follow-up study was performed on 282 patients with hip fractures with respect to early complications and their possible relation to patient or treatment variables. A hip fracture patient needed at least 1-2 hours in the operating theatre (length of anaesthesia), while the operating time was half or less. The operative trauma, measured in operating time and blood loss, was greater in patients with trochanteric fractures than in those with fractures of the femoral neck. Reduction was difficult and only half the internal fixations were satisfactory, as judged from X-rays at the end of the operation. The immediate results of the operations were satisfactory in the trochanteric group, but some problems were encountered in the group with fractures of the femoral neck. Complications were frequent and interrelated. At multiple discriminant analysis higher age, delay of operation, trochanteric fracture and long operating time were often found to be negative factors. Bladder catheterization increased the risk of urinary tract infection to some degree.

Influence of treatment factors on the outcome after hip fractures.

To investigate the influence of different treatment factors in the outcome and rehabilitation after hip fractures, a series of 282 consecutive patients with femoral neck or trochanteric fractures were followed up prospectively for two years postoperatively. The long-term results were analysed by a review of the patients' records after 10 years. The hospital stay and aftercare in the total material were shorter when the operation was not delayed. In patients from their own homes, the hospital stay was influenced by the day of operation in relation to admission, the duration of operation and the operative result (the possibility of achieving stable internal fixation). Social rehabilitation was affected by day of operation, duration of operation and postoperative complications in the femoral neck group and by postoperative complications in the trochanteric group. The walking capacity was reduced after the fracture in most patients and only about one-half of the patients became independent walkers. Reoperations led to a greatly increased length of hospital stay in patients with trochanteric fractures and to a moderate increase in those with cervical fractures. Fracture healing was influenced by treatment factors both in the femoral neck group (poor reduction and postoperative infection) and in the trochanteric group (postoperative infection and unstable internal fixation). Mortality was related to preoperative factors and was not influenced by the treatment. The frequency of the occurrence of another hip fracture up to 10 years postoperatively was 17.4%, with an equal distribution of fracture types.

Arthroscopy and stability testing of the shoulder joint.

A consecutive series of 32 patients with shoulder problems was examined with arthroscopy. Seventeen of these patients with suspected unstable shoulders were also tested for instability under fluoroscopic control. Results were analyzed for two age groups and with reference to preoperative diagnosis. Stability testing was of more value than arthroscopy in the treatment of younger patients with shoulder instability. Arthroscopy was of some value in choosing treatment in the older age group of patients.