Introduction

We report the results of a prospective study of 1349 patients undergoing 1509 total knee replacements, identifying factors increasing the risk of infection.

Background: Intracapsular neck of femur fracture (# ICNOF) is one of the most common fractures in the elderly. In octa and nonagenarians, with age associated and other co morbidities, achieving a pre injury status of mobility is the deemed result. The physiological age, rather than the chronological one is an important factor determining the type of joint used and results in these patients.

Aim: We present here, a study of 349 patients in the age group of 80 to 100, who underwent hemiarthroplasty as primary treatment for # ICNOF.

Patients and Methods: We studied the data from a prospective hip database of patients undergoing hemiarthroplasty for # ICNOF between Jan 2000 and Jan 2005. All patients admitted with # ICNOF in our centre are assessed by a Hip audit nurse. Pre and post operative data is collected in a specific format. Patients undergo hemi-arthroplasty usually within 24 hours of admission. The type of joint used in decided by the operating surgeon. Patients were reviewed at the 4 month mark after the surgery. They were assessed for pain, mobility and complications. Seven outcomes and eight possible confounding factors were considered and statistical comparison was done to find specific correlation between these factors.

Results: 613 patients underwent hemiarthroplasty during the said period. 349 of these were more than 80 years of age. The mortality and mobility in this group was studied and various factors determining the outcome were assessed and statistical correlation tested. The mortality was expectedly higher in elderly population. Post operative mobility was mainly related to the preoperative functional status. In addition, age, other co-morbidities, ASA grade and joint type also had bearing on the Results:

Discussion: We are a busy District General Hospital in Scotland and hemiarthroplasty for # ICNOF is one of the routinely performed surgeries with more than 100 patients undergoing this procedure in a year. We have a dedicated Hip audit nurse who is responsible for maintaining a database for all these patients.

With increasing age of the population, # ICNOF in over 80s has evolved into a commonly encountered problem. Early mobilisation and aiming for pre injury functional status is an achievable goal in most. ‘The better they walked before, the better they will walk after’ is the golden rule to predict outcome. We use uncemented Austin Moore prosthesis for all patients but prefer to use a bipolar uncemented HAP coated prosthesis (JRI Furlong prosthesis) for patients who are relatively active and independent, regardless their age. The early results in this second group of patients are predictably better, but it will require further detailed study to determine whether these hold true in long term as well.

Aims: 1. To assess the results and the effectiveness in the treatment of the complete articular fractures of the distal radius (23-C of MY̌ller), treated surgically with external þxation or osteosynthesis. 2. To support or refuse (conþrm or deny) the hypothesis that the treatment with external þxation is more efþcient, and less expensive, than the treatment with plate osteosynthesis. 3. To evaluate the effectiveness of the classiþcation of the fractures of long bones in segment 23. Material and Method: We study 733 fractures recorded in the AOI Documentation Center, 474 of which were treated with external þxation, while 259 were treated with osteosyn-thesis with plate. We study the variables of Sheets A (þliation) and C (follow-up) statistically. Results: From Sheet A we found statistic signiþcance differences in the age between sexes, but not between both treatments, local associated injuries (þxation > plate), associated treatment and reduction (þxation < plate), a better stability for the þxation, higher proportion of senior surgeon, general anaesthesia, antibiotic treatment and associated therapies for the plate group. In post-operative functional treatment, the external þxation group was better than the osteosynthesis. From Sheet C (follow-up), the group treated with osteosynthesis was far better than external þxation group in all of the variables. Conclusions: 1- The classiþcation of fractures of long bones, follows a gradient of increasing gravity. 2- The setting of the bone fracture was far better in the group treated with plate osteosynthesis, than in the group treated with external þxation, regardless of the group of fracture. 3- The þnal result is remarkably better in the group of plate osteosynthesis. 4- The ORIF with osteosynthesis has favoured a more frequent use of the bone grafting. 5- The þnal total cost of the treatment is much higher in the external þxation group. 6- We will use the external þxation in open fractures (open G-II-III), or with fragments not synthesing for theit size.

We studied the effectiveness of treatment with AO-Mini external þxator in complete articular fractures of distal radius, type 23-C. Mat. and meth.: we were reviued 474 distal radius complete articular fractures treated with AO-Mini external þxator during 10 years. All of fractures were documented by de AOI sheets. We used de Classiþcation of long bones from M.E.MŸller because itñs a global system of classiþcation. Results: in 474 fractures, 246 are females and 228 males. The age are between 15 to 94 years, and the age average 51ñ59 years (63ñ14 females, 38ñ84 males).212 fractures are located in the right wrist, and 262 in the left wrist. 14% (66 cases) were open fractures. Etiology: 19% Work,23% Trafþc,8% Sports,30% Home, 20% Others. The 15% of cases had pathological antecedents previously, 27% had local injuries associated and 28% had general injuries associated. 68% were operated for a Senior Surgeon, 61% with loco-regional anaesthesia, 33% were treated with antithrombotic prophilaxis, and 25% with antibiotic treatment. The 46% of cases needed some other implant, and 15% needed surgery for collateral injuries. Complications: 4% local acute complications and 1% of general acute complications. In the late follow-up, 18% of cases were local late complications and 2% general late complications.

At the end of the follow-up, in 81% of cases the use of extremity was better than 75%, and 83% of patients were pain free.

X-Ray: 10% had Distrophy, and 56% had some articular alterations.

Four month post-operative, 54% were recovered, and at the end of the follow-up 68%, of cases the þnal disability is < 25%. The final evaluation: is good/excellent in the 75% of cases.

We studied the treatment with osteosynthesis in the 23-C fractures. Material and methods: we reviewed 259 complete articular fractures of the distal radius, type 23-C treated with plate osteosynthesis during 10 years. All cases are documented with the AOI sheets. All cases were classiþed with the Classiþcation of long bones of M.E.MŸller. Results: in the 259 fractures, 137 are females and 122 males, the age are between 10 to 84 years, the age average are 48ñ59 years (60ñ52 in females group, and 35ñ19 in the males group).

105 (41%) cases are in the right wrist, and 154 (59%) cases in the left wrist, 32 (12%) are open fractures. Etiology: 9% work,36% Trafþc,11% Sports,27% Home, 17% Others. The 17% had pathological antecedents previously. 18ñ5% had local injuries associated and 24ñ3% had general injuries associated. The 85% were operated for a Senior surgeon, 53% with loco-regional anaesthesia; 50% were treated with antithrombotic prophilaxis, and 26% with antibiotic treatment. 40% of cases needed some additional implant and the 24% needed surgery for the collateral injuries. We had 2% of acute local complications and 1% of general acute complications. During the follow-up, the 10% had local late complications and 1% had general late complications.

At the end of the follow-up, in 92% of patients (234 cases) use the extremity better than 75%, and 89% were pain free. X-Ray evaluation: 2% were Distrophy, and in 33% of cases had some articular alteration. Four months post-operative the 59% were recovered. The þnal disability is < 25% in the 85% of cases. Final evaluation: 88% of cases are good or excellent.