Hip fractures are associated with excess mortality, and several studies have pointed out the burden on society health care costs and the need to optimize cost effectiveness in treatment. The goal of our study was to investigate if patients with a higher risk of death after hip fracture could be identified using routine blood tests taken on admission.

All 530 hip fracture patients admitted to the Department of Orthopedics, Bispebjerg University Hospital from October 2008 till December 2009 were included prospectively. Patients under the age of 60 (n = 39) were excluded. Furthermore, because the purpose was to identify blood tests at the time of admission that could predict outcome, we only included patients that had project blood samples taken at the day of admission resulting in 324 hip fracture patients for further analysis. Follow up data on mortality were obtained from the national civil registry the first of February 2010. Predictors for mortality were determined by logistic and cox regression models. P < 0.05 was regarded as statistically significant. Of the 324 hip fracture patients under study, 66 (20%) died within the study period.

The results of stepwise Cox multivariate regression models for survival during the first three months after admission revealed that age, plasma creatinine and albumin predict mortality. The hazard ratios were 1.04 (95% CI: 1.005–1.09, p = 0.02), 1.01 (per unit increase)(95% CI: 1.01–1.02, p<0.0001), and 0.87 (95% CI: 0.80–0.94, p = 0.002) for age, plasma creatinine and albumin respectively. The 90 day mortality was 13% and 42% in patients with normal and elevated plasma creatinine levels respectively.

Hip fracture patients are known to have a high risk of post- operative mortality. Our findings suggest that it might be possible to identify at- risk patients that could possibly benefit from increased attention the first months following surgery using already available blood samples.

Introduction

The calcium-PTH-vitamin D-axis has long been highlighted for its effects on bone status and much interest has been given to how this relates to the risk of sustaining an osteoporotic fracture. Little attention has on the other hand been given to how disturbances in this axis, as for example secondary hyperparathyroidism (SHPT), relate to mortality among hip fracture patients. We therefore wanted to determine if SHPT could predict mortality in this group of patients.

At Bispebjerg University Hospital in Denmark, an Optimized Hip Fracture Program, (OHP) is the standard of care for all hip fracture patients. Part of OHP is pain treatment with a femoral nerve catheter placed at the emergency room, dosed 4 times a day with Bupivacain until 4 days after surgery, combined with systemic analgesics as needed. In 2008, a database and a bio bank were created at the ward including all hip fracture patients to make a better description of the population and as a tool for further optimisation of the OHP. One of the aims was to identify possible subgroups having specific complications, which could lead to a differentiation of the OHP by markers known at the time of admission. In this analysis, we will focus on postoperative pain that inhibits mobilization by fracture type and type of surgery.

Aim

We studied the characteristics of patient attendances at the Camp Bastion Field Hospital in the peak period of clinical activity. It has been expected that the summer of 2009 in Afghanistan would cause increased battle intensity due to the Afghan presidential referendum. Furthermore it was expected that civilian casualties would make up an increasing share of the total number of patients.

There are differences of opinion about the pathogenesis of Perthes' disease. All are agreed that it is due to ischaemia, but the cause of this and the size and number of infarctions are in dispute. Through the generosity of the contributors six whole femoral heads and core biopsies of five other cases have been studied radiographically and histologically. The findings ranged from an ischaemic arrest of ossification in the capital articular cartilage without infarction to multiple complete infarctions of the epiphysial bone. The ensuing reparative process contributes to the pathology, which is of a range to warrant grading or grouping.

Specimens of femoral heads were studied at necropsy in two cases of Legg-Calve-Perthes' disease. One was that of a boy aged four years ten months who died from appendicitis; the other was from a boy aged six years who died from a malignant glioma. Both had been treated for one and a half years for Legg-Calve-Perthes' disease which was in a stage of repair at the time of death. The diseased femoral heads were moderately flattened but the surface cartilage was intact. Epiphysial bone and bone marrow were partly replaced by cartilage, fibrous tissue and granulation tissue, and new bone was being formed. Inflammatory reaction was inconspicuous. Enchondral bone formation was only slightly decreased, and the structure of the growth plate was undisturbed. There was no sign of systemic bone disease. In the first case the changes indicated that more than one episode of ischaemia had occurred, and an occlusion--probably from an old thrombus--was demonstrated in the posterior inferior retinacular artery of the femoral head. The last episode of ischaemia, furthermore, had caused infarction of part of the metaphysial bone. In both cases, the central area of the metaphysial bone of the affected femur contained fat, but there were few haemopoietic cells and it therefore looked pale. The findings are discussed in relation to previous work on the pathology in Legg-Calve-Perthes' disease, recent information on the vascularisation of the femoral head in children, and experimental and comparative animal studies.