The purpose of this study was to identify changing
trends in the pattern of distribution of the type and demographics
of fractures of the hip in the elderly between 2001 and 2010. A
retrospective cross-sectional comparison was conducted between 179
fractures of the hip treated in 2001, 357 treated in 2006 and 454
treated in 2010. Patients aged <
60 years and those with pathological
and peri-prosthetic fractures were excluded. Fractures were classified
as stable extracapsular, unstable extracapsular or intracapsular
fractures. The mean age of the 179 patients (132 women (73.7%)) treated
in 2001 was 80.8 years (60 to 96), 81.8 years (61 to 101) in the
357 patients (251 women (70.3%)) treated in 2006 and 82.0 years
(61 to 102) in the 454 patients (321 women (70.1%)) treated in 2010
(p = 0.17). There was no difference in the gender distribution between
the three study years (p = 0.68). The main finding was a steep rise in the proportion of unstable
peritrochanteric fractures. The proportion of unstable extracapsular
fractures was 32% (n = 57) in 2001, 35% (n = 125) in 2006 and 45%
(n = 204) in 2010 (p <
0.001). This increase was not significant
in patients aged between 60 and 69 years (p = 0.84), marginally
significant in those aged between 70 and 79 years (p = 0.04) and
very significant in those aged >
80 years (p <
0.001). The proportion
of intracapsular fractures did not change (p = 0.94). At present, we face not only an increasing number of fractures
of the hip, but more demanding and complex fractures in older patients
than a decade ago. This study does not provide an explanation for
this change. Cite this article:
The residual shortening of the affected limbs in 55 patients treated by subtrochanteric varus derotation osteotomy was compared with that in 71 patients treated with weight-relieving calipers. When last examined, 43 of the former group and 47 of the latter had reached complete or near-complete skeletal maturity. The average follow-up was 9.1 years in the osteotomised patients and 5.25 years in the conservatively treated group. The average residual shortening (0.9 cm) was identical in both groups. In most patients the initial shortening caused by the osteotomy gradually corrected as, over a period of several years, the postosteotomy angle gradually became less varus. Any residual shortening depended principally on the severity of inhibition of endochondral ossification at the proximal femoral growth plate. Less residual shortening was seen in children who were under seven years of age at the onset of symptoms (under eight at operation) in whom the open-wedge technique of osteotomy was employed and who had good anatomical results.
Disruption of the major ligaments of the knee was seen in six young men, five parachutists and a house painter, after what we have termed abduction-traction injury. This unusual complaint results from the application of a sudden block to the ankle while falling head first, leading to traction and abduction of the knee. All the patients underwent operations, generally with unsatisfactory results. At operation tears of the anterior cruciate ligament, medial collateral ligament and posterior oblique ligament were seen in each case; in four patients the posterior capsule and in three the posterior cruciate ligament also were torn. In one patient the lateral collateral ligament was torn and the lateral meniscotibial ligament was avulsed. The compression component is absent in this type of injury and consequently the menisci and the osteochondral surfaces of the tibia and femur remained intact in each case.
