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Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 560 - 560
1 Oct 2010
Vilà G Palou EC Marco E Pidemunt G Puig L Suils J
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Introduction: Life expectancy is increasing, this leads to a major number of hip fracture and its subsequent complications and costs.

Proximal femur fracture is not only a medical problem but also a social handicap.

Our objective is to see, by means of a prospective observational study, how the function varies after hip fracture and which are the most influencing factors in order to get maximum benefits of resources for this patology.

Materials and Methods: 262 patients had been hospitalized suffering hip fracture in our centre between june 2006 and December 2007.107 of them were included in the study, the others were excluded for different reasons: cognitive impairment (based on Folstein test), previous hip fracture or pathologic fractures.

86 female and 21 male. Mean age 74 years (65–93).44 suffering subcapital fracture and 63 pertrochanteric fracture. 76 patients underwent gamma nail or canulated screws and 31 hemi or total hip replacement. Mean surgery delay 3 days (1–14) At the moment of hospital registration we also determined marital status, familiar support, living at home or institution, morbidity pre- fracture (according to Charlson index), level of dependence (Barthel index), mental status (Folstein Mini Mental State Examination)quality of life perceived (short form 36 (SF-36)) and depression symptoms (Geriatric Depression Scale 15 (GDS 15)).

At three months post discharge we determined again all the test mentioned before and also recorded the functional level (Harris test), which haven’t been passed preoperatively because it includes a part of physical evaluation, not possible to do in a fractured leg.

Statistics: Analysis of Variance for repeated measures, Spearman correlation coefficient, level significance 0.05

Results: Most part of patients came from their own houses (87,6%), where only returned 23% of them at hospital discharge. In the control visit al 3 months most of them had returned at home (79%)

There were no significant differences between functional outcome al three months and delay of the surgery (p 0.76) or the type of surgery (artroplasty vs osteosintesis) (p0.308).

There was a negative correlation (rho-spearman −0.656)between depression and functional outcome, the more depressed a patient is the worse functional outcome he has (p 0.002)

There was a positive correlation (rho-spearman 0.605) between function (Harris test) and dependency (Barthel index).Patients less independent pre fracture are the ones with low function at three months. (p 0.000)

Discussion: There are a lot of patients needing nursing or social facilities at hospital discharge with the high costs that this supposes. We have seen that depressed people at hospital income are going functionally worse than non depressed and consequently are more dependent persons. Maybe early diagnosis ant treatment of depression will help to get maximum results of rehabilitation procedure.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 138 - 138
1 Feb 2004
Jiménez-Gonzalo J Massons-Albareda J Arce AA Pidemunt-Moli G Morego-García V García-Portabella M
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Introduction and Objectives: The goal of this study is to present results from a series of arthroplasties performed in our hospital in the past 3 years in terms of pain and mobility.

Materials and Methods: In this study, a total of 14 arthroplasties were performed on 12 patients (including 2 revisions). Follow-up was lost on 3 patients. Of the 9 remaining patients, 5 were females and 4 were male. Average age was 59 years (42–75) at time of surgery. Two prosthetic models were used: Coonrad-Morrey in 5 cases (including one revision) and GSB-III in 6 cases (including one revision). The following conditions were treated: 5 cases of post-traumatic arthrosis of the elbow, one haemophilic arthropathy of the elbow with the elbow as the target joint, one case of rheumatoid arthritis, one supracondylar fracture with nonunion in an elderly patient, and one humeral fracture with post-traumatic arthrosis of the elbow.

Results: At the functional level, a postoperative articular balance of 118° flexion and −20° extension and free pronosupination was obtained, with the exception of 2 cases. There was complete elimination or a significant decrease in pain except in 2 cases where a certain level of pain persisted. Radiographically, poor positioning was not seen, but there was one case of septic loosening (resulting in resective arthroplasty) and one peri-prosthetic fracture requiring revision, since it led to instability and repeated dislocation. Other complications included neurologic problems (2), extension deficit > 30° (2), and residual pain (2).

Discussion and Conclusions: Although this study is still in the early stages and follow-up time is short (the study was initiated in 2000), we are seeing promising results in terms of mobility and cessation of pain, similar to various other studies. In terms of the percentage of revisions, complications, and patient satisfaction, results are also comparable to other studies, even though our study thus far has the disadvantage of being shorter. Nonetheless, we wish to present this study to demonstrate that even though elbow arthroplasties are in their infancy, results are promising, and there is hope that they will improve further in future with improved selection criteria, as happened in the past with knee and hip arthroplasties.