Objective: To study potential predictors of functional outcome six months after the injury in elderly patients who sustained a hip fracture and who had been able to go out alone.

Design: Prospective Multi-center Cohort Study

Setting: 14 Hospitals in Japan

Patients and Methods: A cohort was consisted of 387 patients with a mean age of 81 who had a hip fracture, between December 2004 and January 2006. Inclusion criteria were that patients were at least sixty-five years old and who had been able to go out independently. Level of activity of daily living, medical complications, residential environment and family structure at injury was interviewed from the patient, the relatives and a nursing caretaker and recorded. Advancement of mobility was also recorded during the hospital stay. Patients were contacted or interviewed again by the investigator at six months following injury to assess functional outcomes. Primary outcome of interest was changes in mobility to go out independently at six months after injury.

Results: 178 patients (46%) lost their independency to go out at six month following surgery. Logistic multivariant regression showed that age, cognitive function, hemiplegia and mobile ability at discharge were the independent predictable factors for losing independency of mobility. At hospital discharge, T-cane walk was accomplished in only 53% for looser group but 86% for maintain group.

Conclusions: We believe that it would be the key factor to improve the mobility of the healthy patient with hip fracture that we lead them to T-cane walk before hospital discharge.

Axial radiographs were obtained under valgus and external rotation stress at 45° of knee flexion with and without contraction of the quadriceps muscle in order to assess the dynamics of patellar subluxation or dislocation. The radiography was performed on 82 knees in 61 patients with patellofemoral instability, and on 44 normal knees. The lateral patellofemoral angle and the congruence angle were measured and compared with the conventional Merchant views. Both parameters showed greater differences between symptomatic and normal knees on the stress radiographs obtained without quadriceps contraction. There was a major difference in the lateral patellofemoral angles between the groups, which clearly distinguished symptomatic knees from normal controls. Congruence angles on stress radiography had a significant correlation with the functional scores obtained after a period of conservative treatment and a positive correlation with the frequency of patellar subluxation.

When the quadriceps contracted, two patterns of patellar shift were observed. While the patella reduced into the trochlear groove in all normal knees and about 70% of the symptomatic knees, contraction of the quadriceps caused further subluxation of the patella in the remaining symptomatic knees. All the knee joints which showed this displacement failed to respond to conservative treatment and eventually required surgical treatment. Thus, this technique of stress radiography is a simple, cost-effective and useful method of evaluating patellar instability and predicting the prognosis.