Comparison of hip fracture mortality: 1946 to 1955 vs. 1982 to 1986.

Hip fracture mortality was compared for patients treated surgically at the same hospital from 1946 to 1955 and from 1982 to 1986. Almost all hip fractures were treated surgically (98%) in the 1980 series, compared to the 1950 series (69%). The four-week surgical mortality rate decreased significantly from 13% to 4.2%. The internal fixation implants were different except for Knowles pins. The use of prostheses had increased four-fold from 4% to 17%. Most hip fracture patients were mobilized out of bed and earlier in the 1980 series, and most patients started physical therapy earlier. Possible factors contributing to this decrease in mortality include better medical management, better implants to allow rapid mobilization of the patient, emphasis on early physical therapy and advances in anesthesia.

The impact of the prospective payment system on the treatment of hip fractures in the elderly.

A review of 386 Medicare patients with hip fractures admitted to a private, suburban, teaching hospital from 1981 through 1987 revealed that since the implementation of the prospective payment system in 1984, average hospital stays declined from 17.0 days to 12.9 days (24.1%). Although the mean number of physical therapy sessions declined from 11.1 to 9.8 (11.7%), the average number of treatments per day during the physical therapy phase actually increased from 1.2 before to 1.4 after the prospective payment system. The proportion of patients discharged to nursing homes remained the same (52.9% vs 53.6%); the proportion of patients remaining in a nursing home 6 months after hospital discharge did not differ significantly (22.6% vs 19.9%). Furthermore, there were no differences in the 6-month ambulation status. Total adjusted average hospital charges for the pre- and post-prospective payment system groups did not increase significantly ($7295 vs $7565). These findings do not support the contention that the quality of care provided Medicare patients with hip fractures has deteriorated in this hospital environment.

Correction of equinus in cerebral palsy by the Murphy procedure of tendo calcaneus advancement: a preliminary communication.

The biomechanics of the Murphy procedure for correction of equinus in cerebral palsy are presented. A series of 79 surgical procedures on 48 patients, with a follow-up period of from one to four years, is reviewed. Correction of equinus was succeswful in 89-9 per cent of the procedures. Using the Murphy procedure the following advantages over other methods of correction are anticipated: (1) no loss on 'push-off' in gait; (2) no loss of correction (recurrence) during longitudinal growth of the child, necessitating repeated surgery; and (3) no need for continual night bracing during the growth period.