Aims. Dual-mobility acetabular components (DMCs) have improved total hip arthroplasty (THA) stability in femoral neck fractures (FNFs). In osteoarthritis, the direct anterior approach (DAA) has been promoted for improving early functional results compared with the posterolateral approach (PLA). The aim of this study was to compare these two approaches in FNF using DMC-THA. Methods. A prospective continuous cohort study was conducted on patients undergoing operation for FNF using DMC by DAA or PLA. Functional outcome was evaluated using the Harris Hip Score (HHS) and Parker score at three months and one year. Perioperative complications were recorded, and radiological component positioning evaluated. Results. There were 50 patients in the DAA group and 54 in the PLA group. The mean HHS was 85.5 (SD 8.8) for the DAA group and 81.8 (SD 11.9) for the PLA group (p = 0.064). In all, 35 patients in the DAA group and 40 in the PLA group returned to their pre-fracture Parker score (p = 0.641) in both groups. No statistically significant differences between groups were found at one year regarding these two scores (p = 0.062 and p = 0.723, respectively). The DAA was associated with more intraoperative complications (p = 0.013). There was one dislocation in each group, and four revisions for DAA and one for PLA, but this difference was not statistically significant. There were also no significant differences regarding blood loss, length of stay, or operating time. Conclusion. In DMC-THA for FNF, DAA did not achieve better functional results than PLA, either at three months or at one year. Moreover, DAA presented an increased risk of intra-operative complications. Cite this article: Bone Joint J 2024;106-B(5 Supple B):133–138

Dual mobility cups (DMC) reduce the risk of dislocation in femoral neck fractures (FNF). Direct anterior approach (DAA), historically promoted for better stability, has been developed in recent years for better functional results. The aim of this study was to compare the early functional results of DMC in FNF by DAA versus posterolateral approach (PLA). A prospective study was conducted on a continuous series of patients who received DMC for FNF by DAA or PLA. The primary endpoint was Harris Hip Score and Parker score assessed at the first follow-up visit. Intraoperative complications were collected during hospitalization. One year clinical results and all cause revision rate were also collected. Radiographic data of cup positioning and limb length were evaluated. Fifty-two patients were included in the DAA group and 54 in the PLA group. Two patients were lost to follow-up. The mean age was 72.8 years. There was no significant difference in HHS or Parker score at 3 and 12 months follow up (p=0.6, p= 0.75). DAA was associated with more intraoperative complications with 4 fractures and 1 femoral nerve deficit (p=0.018). There were 3 revisions in the DAA group (1 infection, 1 dislocation, 1 peri prosthetic fracture) and 1 in the PLA group (infection), which was not statistically significant (p=0.34). Cup anteversion was 6° greater and inclination 9° lesser in DAA group (p=0.028, p<0.01). Results suggest that DAA does not provide any early functional benefit in THA-DMC for FNF compared to PLA. It could lead to more intraoperative complications and a higher revision rate. DAA requires an experienced surgeon and careful patient selection

Aims. The objectives of this study were to investigate the patient characteristics and mortality of Vancouver type B periprosthetic femoral fractures (PFF) subgroups divided into two groups according to femoral component stability and to compare postoperative clinical outcomes according to treatment in Vancouver type B2 and B3 fractures. Methods. A total of 126 Vancouver type B fractures were analyzed from 2010 to 2019 in 11 associated centres' database (named TRON). We divided the patients into two Vancouver type B subtypes according to implant stability. Patient demographics and functional scores were assessed in the Vancouver type B subtypes. We estimated the mortality according to various patient characteristics and clinical outcomes between the open reduction internal fixation (ORIF) and revision arthroplasty (revision) groups in patients with unstable subtype. Results. The one-year mortality rate of the stable and unstable subtype of Vancouver type B was 9.4% and 16.4%. Patient demographic factors, including residential status and pre-injury mobility were associated with mortality. There was no significant difference in mortality between patients treated with ORIF and Revision in either Vancouver B subtype. Patients treated with revision had significantly higher Parker Mobility Score (PMS) values (5.48 vs 3.43; p = 0.00461) and a significantly lower visual analogue scale (VAS) values (1.06 vs 1.94; p = 0.0399) for pain than ORIF in the unstable subtype. Conclusion. Among patients with Vancouver type B fractures, frail patients, such as those with worse scores for residential status and pre-injury mobility, had a high mortality rate. There was no significant difference in mortality between patients treated with ORIF and those treated with revision. However, in the unstable subtype, the PMS and VAS values at the final follow-up examination were significantly better in patients who received revision. Based on postoperative activities of daily life, we therefore recommend evision in instances when either treatment option is feasible. Cite this article: Bone Jt Open 2023;4(1):38–46

Aims. It is well described that patients with bone and joint infections (BJIs) commonly experience significant functional impairment and disability. Published literature is lacking on the impact of BJIs on mental health. Therefore, the aim of this study was to assess health-related quality of life (HRQoL) and the impact on mental health in patients with BJIs. Methods. The AO Trauma Infection Registry is a prospective multinational registry. In total, 229 adult patients with long-bone BJI were enrolled between 1 November 2012 and 31 August 2017 in 18 centres from ten countries. Clinical outcome data, demographic data, and details on infections and treatments were collected. Patient-reported outcomes using the 36-Item Short-Form Health Survey questionnaire (SF-36), Parker Mobility Score, and Katz Index of Independence in Activities of Daily Living were assessed at one, six, and 12 months. The SF-36 mental component subscales were analyzed and correlated with infection characteristics and clinical outcome. Results. The SF-36 physical component summary mean at baseline was 30.9 (95% CI 29.7 to 32.0). At one month, it was unchanged (30.5; 95% CI 29.5 to 31.5; p = 0.447); it had improved statistically significantly at six months (35.5; 95% CI 34.2 to 36.7; p < 0.001) and at 12 months (37.9; 95% CI 36.4 to 39.3; p < 0.001). The SF-36 mental component summary mean at baseline was 42.5 (95% CI 40.8 to 44.2). At one month, it was unchanged (43.1; 95% CI 41.4 to 44.8; p = 0.458); it had improved statistically significantly at six months (47.1; 95% CI 45.4 to 48.7; p < 0.001) and at 12 months (46.7; 95% CI 45.0 to 48.5; p < 0.001). All mental subscales had improved by the end of the study, but mental health status remained compromised in comparison with the average USA population. Conclusion. BJIs considerably impact HRQoL, particularly mental health. Patients suffering from BJIs reported considerable limitations in their daily and social activities due to psychological problems. Impaired mental health may be explained by the chronic nature of BJIs, and therefore the mental wellbeing of these patients should be monitored closely. Cite this article: Bone Jt Open 2024;5(9):721–728

Purpose of the study: The constantly increasing incidence of extracapsular fractures of the proximal femur are a public health concern. The basic therapeutic options are screw-plate fixation and proximal reconstruction with nails. The purpose of this retrospective study was to assess the mid-term results with a new osteosynthesis material, the proximal femoral nail antirotation (PFN-A. ®. ) which has a spiral blade. Material and methods: One hundred eight 108 PNF-A. ®. performed from January 2007 to July 2008 were included in a retrospective clinical and radiographic study. These series included exclusively extracapsular fractures of the proximal femur in subjects aged over 70 years. All patients were assessed with the Parker score pre- and postoperatively. Blood loos, position of the spiral blade on the AP and laterals views and operative time were analysed. We searched for complications (femoral head slide, blade protrusion, head rotation, non-union, fracture on material, and operative site infection). We searched for risk factors. Results: One hundred eight patients (94% ASA 2 or 3) were reviewed at mean 5.3 months (±1.5). None of the patients were lost to follow-up. At revision, 19 patients had died (17.6%). The mean Parker score declined 1.4 points. All fractures healed at mean 10.4 weeks (±0.6). Six complications were noted: three operative site infections, three head slidings, one intraacetabular protrusion. No statistically significant could be identified. Nevertheless, the three cases with femoral head sliding occurred on fractures that were unstable (type 31-A2) which had a malpositioned blade. Discussion: There appears to be a consensus on the treatment of proximal fractures of the femur: screw-plate fixation for stable fractures, centromedullary nailing for the others. Arthroplasty is a second-line solution. There are few publications on the new spiral blade of the PFN-A. ®. This method spares bone stock and allows compaction of the cancellous bone, particularly adapted for osteoporotic bone: the efficacy is comparable with reference techniques with lower rates of sliding (2.%) and acetabular protrusion (< 1%)

Aims. Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. Methods. A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. Results. In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. Conclusion. The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293–300

Purpose: The popularity of intramedullary nails (IMN) for trochanteric hip fractures has grown substantially with little supportive evidence that IMN are superior to conventional sliding hip screws (SHS). We aimed to assess the impact of SHS or IMN intramedullary nailing on functional outcomes and rates of re-operation in elderly patients with fractures. Method: We conducted a multi-center, pilot randomized trial including three clinical sites across Sweden, Denmark, and Canada. We randomized 85 elderly patients with stable and unstable trochanteric hip fractures to either SHS or an IMN. The primary outcome, revision surgery, was independently adjudicated at one year. Secondary functional outcomes included the Parker Mobility Score (PMS), the Merle D’Aubigne Score, the Short Form-12 (SF-12) and the Euroquol-5D. Results: Eighty five patients were enrolled. Fifteen patients died prior to the one year follow up. Across treatment groups, patients did not differ in age, gender and fracture type. The overall revision risk was 11.6% (8/69) and did not differ significantly between groups (IMN: 5; SHS: 3). Patients treated with IMN had significantly higher Merle D’Aubigne function subscores at 6 (p=0.01) and 12 months (p=0.05). Gamma3 nails approached significantly higher scores in the Parker mobility score at 6 (p=0.08) and 12 months (p=0.056). Non-significant differences were identified in the SF-12 and Euroquol-5D quality of life measures; however, in both scores, the Gamma3 nailed trended to higher scores than the sliding hip screw. Conclusion: Our findings of early functional gains without increased risk of revision surgery support the increased popularity of IMN for the management of trochanteric hip fractures in elderly patients

Purpose of the study: Three-screw fixation is the classical treatment for true Garden I in the elderly patient. Complication rates have been high in the literature. Furthermore, in this context outcome for arthroplasty after failed osteosynthesis is less satisfactory than first-intention arthroplasty. This is why functional treatment of Garden I fractures of the neck of the femur has been proposed, including rapid return to the upright position and strict radiographic and clinical control. The purpose of this work was to first evaluate the results of this management option for true Garden I fractures in patients aged over 65 years and second to search for factors predictive of secondary displacement. Material and methods: All patients aged over 65 years and admitted to the unit for true Garden I fractures from January 2005 to December 2006 were included in this prospective study. A functional treatment including early return to the upright position and walking test on day 1 was instituted, followed by radiographic controls on days 2, 7, 14, 21, and 45 then at 3 months and one year. Referral to a rehabilitation centre at discharge on day 5 was scheduled if there was no displacement. In the event of a displacement, arthroplasty was performed. Fifty-seven patients, mean age 82.8±8.5 years (range 65–99) were included. The radiographic and clinical follow-ups were made by an independent observer. Results: The displacement rate was 29.8%. These patients were treated by arthroplasty. In the group of patients without displacement, at minimum one year follow-up, there has been no need for surgical revision excepting one case of osteonecrosis at one year requiring implantation of a total prosthesis. The mean Parker score in this group was 6.4 and the mean Harris score 83, it was 85 in the arthroplasty group. Among the predictive factors identified at multivariate analysis were: age, gender, side, type of fracture, fracture orientation, degree of valgus or sagittal displacement, general status. Displacement was not statistically predictive. Discussion: The results of our prospective study show that 70% of patients included were treated successfully without surgery, confirming reports in the literature and justifying utilisation of this management strategy

Fundaments: The surgical management of proximal femoral extra-capsular fractures in the elderly remains controversial. Bone quality and purchase of the cephalic screw are the main limitations of the currently available therapeutic options, dynamic hip screws-blade and proximal femoral nailing systems being the standard fixation Methods: which however report a revision rate of 7% due to mechanical failures. Main complications include implant-related fractures and cut out of the head-neck device with subsequent penetration into the acetabulum. The new PFNATM helical blade appears to improve the stability of the whole construct by providing better compaction of the cephalic cancellous bone around the blade. Hypothesis, Type of Study: We conducted a retrospective radiographic-clinical study of a series of PFNATM osteosyntheses. Assessment of the mid-term results was based on the hypothesis that the PFNATM would reduce the occurrence of secondary deviations. Materials and Methods: Between 2006 and 2008, 108 osteosyntheses were performed. Only traumatic fractures were included in this study. Parker’s quality of life scoring system (0 to 9) and Harris hip score (0 to 100) were used for functional evaluation. The PFNA blade position was assessed using intraoperative radiographs while a postoperative radiographic control was performed during follow-up to evaluate the occurrence of complications. Results: 98 patients (98 hips) were reviewed at a mean follow-up of 5.3 months +/− 1.5. At last follow-up, the mean Parker score had decreased by 2.3 points and the Harris hip score by 24 points. All fractures united at an average time of 10.4 weeks (+/− 2.1). Six complications were reported (6.1%). They included 3 infections of the operative site and 3 cut-out of the femoral head. Three patients required reoperation for removal of the helical blade (3%): Two for significant migration and one for intra-acetabular penetration. No statistically significant risk factors could be observed. However, the three cut-out of the femoral head occurred in unstable fractures (type 31-A.2 and 31-A.3 according to the AO classification) with mispositioning of the helical blade. Discussion: Extra-capsular proximal femoral fractures are common in the elderly population but there is currently no ideal implant available. Unstable fractures as well as mispositioning of the head/neck device are considered risk factors for secondary varus deviation and external rotation. The new PFNATM helical blade has been rarely studied. It appears as a reliable osteosynthesis option since it reports encouraging results at a mean follow-up of 6 months. However, our results do not give evidence of the superiority of the helical blade over the neck screw

The femur is a common site for skeletal metastases. The Gamma2 nail has proved effective in relieving pain and restoring function. Little data exists on the use of the Gamma3 Long Nail (GLN) in this condition. Improved instrumentation is suggested to reduce operative time and facilitate minimally invasive surgery. This study reports a series of patients treated in a District General Hospital. A retrospective casenote review was performed of all patients treated with the GLN for femoral metastatic disease over a five year period. Patients were followed-up for a minimum of one year. Functional level was assessed using the Parker Mobility Score (PMS). 12 patients underwent 15 nailings. Mean age was 75.4 years (median 75.7, range 61-92). In bilateral cases, the operations were performed during the same hospital admission. There were seven prophylactic nailings for impending fracture from proximal femoral lesions, seven procedures for actual fractures distal to the intertrochanteric line, and one basicervical fracture associated with multiple femoral metastases. Primaries were four prostate, two breast, two lung, one bowel, one bladder, one renal, and one myeloma. Average anaesthetic time for all procedures was 134 mins (median 125, range 90-210). Average peri-operative drop in serum haemoglobin was 2.3g/dL (median 2.1, range 0.6-4.8). Five patients with actual fracture and one patient with impending fracture required blood transfusion, receiving 2.2 units on average. In-hospital mortality rate was 0.83%, with only one patient not surviving to discharge. One year mortality was 83.3%. Only two patients were alive one year post-operation. Of the remaining patients, average survival was 3.2 months (median 3, range 1-6). Patients spent an average of 17 days on an acute orthopaedic unit (median 14, range 4-80). Two patients required further convalescence in a rehabilitation unit. There were three surgical complications. Two impending fractures became complete, One intra-operatively and one post-operatively. In the case of basi-cervical fracture, the proximal screw cut out of the femoral head, requiring revision to a long-stem bipolar hemiarthroplasty. This was the only re-operation required in this series. Average pre-operative PMS was 5.2 (median 4, range 2-9). Average peri-operative drop in PMS was two points (median 1.5, range 0-6). Of the 11 patients who survived to discharge, 10 were independently mobile and returned to their pre-operation residence. Nine required a change in walking aids. Only one patient reported post-operative pain. This small patient series suggests that the Gamma3 Long Nail is a suitable treatment option for impending and actual metastatic femoral fractures in the District General setting. Length of stay, in-hospital mortality and re-operation rates compare favourably with published data on the Gamma2. There was a significant drop in Parker Mobility Score but all patients bar one were independently mobile and returned to their home. Anaesthetic time was not lower than with the Gamma2, suggesting little tangible benefit of the new instrumentation

Aims

We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty.

The October 2023 Trauma Roundup³⁶⁰ looks at: Intramedullary nailing versus sliding hip screw in trochanteric fracture management: the INSITE randomized clinical trial; Five-year outcomes for patients with a displaced fracture of the distal tibia; Direct anterior versus anterolateral approach in hip joint hemiarthroplasty; Proximal humerus fractures: treat them all nonoperatively?; Tranexamic acid administration by prehospital personnel; Locked plating versus nailing for proximal tibia fractures: a multicentre randomized controlled trial; A retrospective review of the rate of septic knee arthritis after retrograde femoral nailing for traumatic femoral fractures at a single academic institution.

Background. Hip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of distal femoral fractures in this population has not had the same emphasis. This study defines the epidemiology, current practice and outcomes of distal femoral fractures in four English centres. Methods. 105 patients aged 50 years or greater with a distal femoral fracture, presenting to four UK major trauma centres between October 2010 and September 2011 were identified. Data was collected using an adapted NHFD data collection tool via retrospective case note and radiograph review. Local ethics approval was obtained. Results. Mean age was 77 years (range 50–99), with 86% female. 95% of injuries were sustained from a low energy mechanism, and 72% were classified as either 33-A1 or 33-C1. The mean Parker mobility score and Barthel Independence Index were 5.37 (0–9) and 75.5 (0–100) respectively. Operative management was performed in 84%, and 86% had their surgery within 36 h. Three quarters were fixed with a peri-articuar locking plate. There was no consensus on post operative rehabilitation, but no excess of complications in the centres where weight bearing as tolerated was the standard. 45% were seen by an orthogeriatrician during their admission. Mean length of stay was 29 days. Mortality at 30 days, 6 months, and 1 year was 7%, 16% and 18% respectively. Conclusions. This study demonstrates that the distal femoral and hip fracture populations are similar, and highlights the current disparity in their management. The metrics and standards of care currently applied to hip fractures should be applied to the treatment of distal femoral fractures. Optimal operative treatment and rehabilitation remains unclear, and further research is in progress. Level of evidence. 2b. Ethics. Local approval was obtained

Aims

Postoperative malalignment of the femur is one of the main complications in distal femur fractures. Few papers have investigated the impact of intraoperative malalignment on postoperative function and bone healing outcomes. The aim of this study was to investigate how intraoperative fracture malalignment affects postoperative bone healing and functional outcomes.

The PFNA device was developed to address problems of rotational instability in proximal femoral fractures whilst simultaneously employing a single femoral neck element. The PFNA makes use of a helical blade that compresses rather than destroys osteopaenic cancellous bone. All subtrochanteric fractures admitted to the department were treated with the PFNA (AO 31A3). Demographic and clinical data during admission was recorded and formal post-operative X-Rays performed. Outcome assessment consisted of a 4 month follow-up appointment with clinical and radiological assessments, VAS, SF36, Jensen Social Function Score and Parker Mobility Score. From April to December 2006, 46 patients were included in the study. 4 month follow up has been completed in 17 of 23 patients. The average age was 78. 11 short and 7 long nails were inserted. Four patients required open reduction and internal fixation. There were no significant intra-operative or immediate postoperative complications. 1 short nail fractured through the site of the distal locking bolt during the follow up period and required revision. At follow up, 5 patients had tenderness over the greater trochanter and 2 had leg length discrepancy. None had malrotation. Only 2 patients regained their pre-operative mobility status. The mobility and social function scores were significantly reduced at follow up compared to pre-operative status (p=0.003 and p=0.001 respectively). All domains of SF36 were low compared to normative data. The mean VAS was 3/10. All fractures united and there was no migration, lysis around or cut out of the helical blade. In total, 25 distal locking bolts were utilised. Four of these had migrated or become loose. Patients with subtrochanteric fractures do not return to pre-fracture function at 4 months post injury. The PFNA appears to work well although there may be concern about bone hold of the distal locking bolts. Correspondence should be addressed to Major M Butler RAMC, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon

Introduction: The PFNA device was developed to address problems of rotational instability in proximal femoral fractures whilst simultaneously employing a single femoral neck element. The PFNA makes use of a helical blade that compresses rather than destroys osteopaenic cancellous bone. It is hammered into place over the guide wire and then locked laterally to prevent rotation. Study Design: Prospective cohort. Methods: All subtrochanteric fractures (AO 31A3) admitted to the department were treated with the PFNA. Demographic and clinical data during admission was recorded and formal post-operative X-Rays performed. Outcome Measures: 4 month follow-up appointment with clinical and radiological assessments, VAS, SF36, Jensen Social Function Score and Parker Mobility Score. Results: From April 2006 to June 2007, 62 patients were included in the study. 4 month follow up has been completed in 30 patients (77% of those available). 11 are awaiting follow up, 12 died and 9 were unable to attend follow up for various reasons. The mean age was 79.9 years. 13 short and 17 long nails were inserted. 6 patients required open reduction and internal fixation. There were no significant intra-operative or immediate postoperative complications. 1 patient with a short PFNA nail sustained a fracture of the femur through the site of the distal locking bolt during the follow up period and required revision. At follow up, 9 patients had tenderness over the greater trochanter and 1 had leg length discrepancy. None had malrotation. Only 7 patients regained their pre-operative mobility status. The mobility and social function scores were significantly reduced at follow up compared to preoperative status (p=0.001). All domains of SF36 were low compared to normative data. The mean VAS was 3/10. All 30 fractures united and there was no migration, lysis around or cut out of the helical blade. In total, 46 distal locking bolts were utilised. 4 of these had migrated or become loose. Conclusions: Subtrochanteric fractures in the elderly are a devastating injury. Patients do not return to pre-fracture function at 4 months post injury. Early results suggest that the PFNA appears to work well as evident by the fact that all of the fractures united. We recommend adding 4 to 6mm to the measured length of the distal locking bolts to prevent migration

PURPOSE: Oldest elderly trochanteric fractures treatments are common but long term follow up studies are indistinct. Previous data about all outcomes are not reported for oldest one. The purpose was to update all the results for these oldest old patients. METHODS: A prospective, longitudinal study was undertaken of 455 “31 A1, A2, A3” (OTA) peritrochanteric femur fractures through 2002. There were 84% female patients. The age was 88 (80–105) ±5 years. Associated hip arthritis rate was 10%. 31 A1 and 31 A2 really trochanteric fractures were 90% (31 A1: 52% and 31 A2: 38%), 31 A3 subtrochanteric were 10%. Surgical treatment was achieved for 97%: [extramedullary internal fixation (dynamic hip screw): 36%, intramedullary (trochanteric nail): 56%, hip arthroplasty: 5%]. Functional treatment (not displaced or contra-indicated) was achieved for 3%. Katz, mental, Parker, walking scores, live place before and at long term after fracture, radiological healing and complications were registered. RESULTS: The radiological healing rate after 3 months was 85% and after 6 was 97%. Complications rate: the general complications rate during 1st month was 12% and between 1st and 3rd month was 8%. The local complications rate during the 1st month was 4% (local infection: 1%) and between 1st and 3rd month was < 1%. The new surgical procedures rate during the 1st month was < 0.5%, between 1st and 3rd month was 3%, between 3rd and 6th month was 3%. Clinical results: Post-operative weight bearing was uncertain. 6th month after fracture 72% of the patients were alive (dead: 28% and non-surgically treated: twice more). All scores and live place demonstrated dependence increase. > 6th month after fracture mortality was common. CONCLUSION AND SIGNIFICANCE: Intra/extra capsular hip fractures ratio increases after 80. These are older, more dependant and help demanding. Hip arthritis inflates hip fracture risk. Success points technical procedures had been demonstrated by randomised studies: dynamic hip screws for stable fractures and trochanteric nails for unstable; hip prosthesis for arthritis or poor bone. Practice surgery for all trochanteric fractures. Don’t separate trochanteric/subtrochanteric. The prognostic is rather poor (mortality rate, functional outcomes), depending on initial functional score and dependence. Modern internal fixation is reliable. Arthroplasty should be considered

We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90° of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140° and 15° respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment.

We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction.

Cite this article: Bone Joint J 2014;96-B:530–4.