Introduction

Perthes' disease is associated with coxa breva, plana and magna, and a high riding prominent greater trochanter causing abductor shortening and weakness, leg shortening and extra-articular impingement. A trochanteric advancement with an infero-lateralising oblique sliding osteotomy of the proximal femur would lengthen femoral neck, improve abductor length and strength, relieve impingement and improve leg length. We assessed the mid-term outcomes for this procedure.

Introduction

Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure.

Introduction

Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure.

Introduction

Perthes disease is associated with coxa breva, plana and magna, and a high riding prominent greater trochanter causing abductor shortening and weakness, leg shortening and extra-articular impingement. A trochanteric advancement with an infero-lateralizing sliding osteotomy of the proximal femur would lengthen femoral neck, improve abductor length and strength, relieve impingement and improve leg length. We assessed the mid-term outcomes for this procedure.

Background: The exact incidence of cancer (primary/metastatic) leading to pathological fracture in femoral neck is not clear. Bone specimen is often sent for histology in suspicious cases. This retrospective study was aimed to answer the above question and to review our hospital practice in managing these patients.

Materials & Methods: All patients with fracture neck of femur undergoing surgery and had bone specimen taken for histo-pathological examination between 01.01.2002 and 31.12.2003 were included. Case notes and histology reports were reviewed.

Results: Out of total 533 patients with femoral neck fracture, 32 (6%) patients had bone specimen taken for histology. 9 male & 23 female patients with mean age of 82 years. 58% had past history of cancer (commonest being breast) with/without suspicious lesion on x-rays where as the remaining had no history of cancer but suspicious lesion on x-rays. 4 (12.5%) had positive histology results. All four had metastatic disease (2 from breast, 1 from renal and 1from multiple myeloma). Only 19% had results documented in case notes but 81% had reports filed in notes. Appropriate referral was made to oncology team for three patients. The fourth patient with multiple myeloma died in hospital before the referral. Four of 28 (14%) patients with negative results died within 3 years following the surgery compared to only 1 (multiple myeloma) out of 4 patients with positive results.

Conclusion: The incidence of suspicious pathological femoral neck fracture was 6% but incidence of cancer was 0.7%. All positive cases were metastatic. Commonest primary was from breast – adenocarcinoma). Mortality in negative cases was 16% at average of 3 years compared to 25% in metastatic fracture patients.

Introduction: It was noted that INR levels transiently increased before dropping after stopping warfarin pre-operatively in warfarinised patients with femoral neck fractures. Surgery was more likely to be delayed in these patients. The aim of this retrospective study was to determine the trend of INR level after stopping warfarin and to determine the morbidity and mortality in these patients.

Material and Methods: All patients with femoral neck fracture who were on warfarin between 01.01.2002 and 31.12.2003 were included. Case notes and haematology reports were reviewed.

Results: 22 (4.2%) out of 533 patients with femoral neck fractures were found to be on warfarin on admission. 21 case notes were obtained. 7 male and 14 females with mean age of 81 years. In 11 (52%) cases, INR level increased before coming down after stopping warfarin. 60% of them had morphine as analgesic compared to 40% in the other group. Average rise in INR was 0.4. Average delay in surgery due to high INR was 3.5 (range 1–8) days. It took average of 4 days to achieve desirable INR after restarting warfarin. 6 (28%) needed blood transfusion. Nine (43%) patients developed complications including: intra-operative bleeding-1, postoperative DVT-1, fast AF-2, post-operative anaemia-1, other medical-3. One patient (5%) died from large CVA 12 days after surgery. No further mortality was found within 30 days of surgery.

Conclusion: Incidence of femoral neck fractures on warfarin was 4.2%. In over half of the cases, the INR level went up before going down after stopping warfarin. Morphine may be responsible for this trend. Delay in surgery does not seem to increase mortality or morbidity compared to published studies.