Aims: To describe the proþle of patients older than 65 years of age with a fracture of the upper extremity, and the consequence of such an injury. Methods: Retrospective cohort study of 667 patients presenting to the emergency department between January 1999 and December 2000 with a fracture of the upper extremity. Variables included sex, age, location of fracture (± additional fractures), treatment, length of stay (in hospital and convalescent care), and place of habitation before and after injury. Follow-up continued until patientsñ deþnitive residential status. Results: The majority of patients were women with fractures of the wrist and proximal humerus. 42% were treated and returned to their previous residence. 37% were admitted to the hospital, of whom 90% had an operation; 97% returned to their previous residence. 21% of patients did not require an operation, but were unable to function independently and were admitted directly to our Geriatrics Hospital. This group was signiþcantly older and more frequently sustained a fracture of the proximal humerus or 2 fractures. 20% required long-term placement. Conclusions: Fractures of the upper extremity in this age group are frequent. A particular subset of signiþcantly older patients are unable to function independently, thus requiring hospitalization, extended periods of convalescence, and a greater likelihood of a permanent change in habitation.

Aims: The diagnosis of a prosthetic joint infection is difþcult, but crucial for appropriate treatment. Scintigraphy with speciþc markers for infection (labeled white cells or immunoglobulin-G) has been reported as a more reliable diagnostic tool than clinical assessment (fever, þstula), laboratory studies [polynuclear neutrophils blood count (PNC), erythrocyte rate sedimentation (ESR), and C-reactive protein (CRP)], and preoperative aspiration. Methods: In the þrst part of this study, we retrospectively reviewed 230 patients admitted with a suspected prosthetic joint infection and compared the validity of these different diagnostic tools. 209 patients had an infection. Results: Pain, fever, ESR, and PNC are unreliable for identifying occult infection. The presence of a þstula is inconstant, but when present is very reliable to detect infection. Our study revealed sensitivity, speciþcity, positive and negative predictive value as follows: CRP: 97%, 81%, 98%, 71% respectively; aspiration: 82%, 94%, 99%, 43% respectively, and labelled scintigraphy 74%, 76%, 91%, 44% respectively. In the second part, we reviewed 23 articles which included 1,722 prosthetic joints with preoperative evaluation of infection. Conclusions: Both our study and the literature review indicate that CRP and joint aspiration are the best tools to diagnose prosthetic joint infection.