The value of remanipulating a Colles' fracture which has redisplaced after primary reduction was assessed in 50 patients. In those over 60 years old, remanipulation failed to achieve a lasting improvement in position, while the majority of those under 60 years maintained a significant improvement in dorsal angulation. It is concluded that the elderly patient does not benefit from this procedure

1. High tibial osteotomy-above the tibial tubercle-gives good results in elderly patients disabled by arthritis of the knee. 2. A technique of operation is described in which fixation is secured by four pins gripped in compression clamps. 3. No other fixation is needed, and knee movements and walking are encouraged within a few days of operation. 4. The early results warrant further trial of the method

1. Five patients with seven fatigue fractures of the lower third of the tibia are described; two had bilateral fractures. There is a striking similarity in the site and appearance of these fractures. 2. All occurred in middle-aged or elderly people without a history of unusual activity or illness. 3. The fractures are so nearly identical as to constitute an entity which, as far as we are aware, has not been described before

We made a randomised prospective comparison of the Dynamic Hip Screw and the Gamma locking nail for the internal fixation of 200 petrochanteric femoral fractures in elderly patients. There was less intraoperative blood loss and a lower rate of wound complications in the patients treated by the Gamma nail. They had, however, a high incidence of femoral shaft fracture which we relate in part to implant design. We do not recommend the use of the Gamma nail for these fractures

We have performed simple bone grafting in four elderly patients with pain due to unstable pseudarthroses in the osteoporotic spine after compression fracture. At operation, we observed abnormal movement of the affected vertebral body which was covered with a hypertrophic membrane; this seemed to inhibit the blood supply to the lesion. The thick membrane and avascular granulation in the false joint were excised and bone grafting carried out. Symptoms were dramatically improved immediately after operation and bony union was confirmed in the three surviving patients

We present a retrospective study of 125 patients with an impacted valgus fracture (B1.1) of the proximal humerus. This fracture rarely occurs in young patients and is much more common in elderly fit subjects. All patients were documented prospectively and followed for one year. None was treated surgically. At one year, 80.6% of the patients had a good or excellent result, the quality of which depended on the age of the patient and the degree of displacement of the fracture. Mean outcome scores based on these two parameters are presented. A comparison with data from other studies suggests that operative fixation of these fractures is not necessary

The Denham knee replacement is a relatively simple unconstrained prosthesis. The design ensures good alignment and full extension, but does not allow flexion beyond 90 degrees or tibiofemoral rotation. The results after eight years' experience have been assessed in four different ways in over 600 cases. They show that for the limited needs of the elderly arthritic patient, the Denham arthroplasty provides a high proportion of satisfactory results with an unusually low rate of late failure

The joint surfaces of 60 hips obtained from the cadavers of elderly Asians were studied to determine the incidence, the grade and the distribution of both non-progressive (age-related) and progressive degenerative changes. It was observed that in the Asian population of 40 to 90 years of age, non-progressive changes were common, being seen in 66% of the acetabular specimens and 50% of the femoral heads. Only one specimen of the 60 showed unexplained progressive degenerative change. We conclude that primary osteoarthritis of the hip is rare in Asians

An elderly woman presented with a pathological fracture of the right humerus. Progressive dissolution of the shaft of this bone took place over six months. No cause could be established and the patient refused biopsy. With only simple splintage for treatment the humeral shaft gradually reformed and re-ossified over a period of two years. The patient has been under review for four and a half years and no further pathology has come to light. The cause of the osteolysis remains obscure

1. Five elderly patients who suffered acute synovitis of one or both knee joints are reported. 2. All showed radiological evidence in several joints of cartilage calcification. 3. It is suggested that the synovitis in each case was due to calcium irritation of the synovial membrane. 4. In three of the patients it is shown that the synovial fluid calcium content was raised during the acute attack. 5. In all patients acute symptoms were relieved by aspiration of the effusion

1. The use of acrylic cement in bonding femoral head prostheses to bone is described. 2. No sign of deterioration of the bond between the cement and bone has been seen in histological preparations up to three and a quarter years after operation, and no harmful effects have been recognised, or suspected, in 455 patients in whom it has been used. 3. The technique is considered justifiable in elderly patients where the medullary canal is large and the cortex of the femur is thin and brittle

We have undertaken a five-year prospective study of 126 translated two-part fractures of the proximal humerus and present an analysis of the epidemiology and of the factors which affect outcome in elderly patients. The fracture has a unimodal age distribution and rarely affects adults under the age of 50 years. Analysis showed that patients with two-part translated fractures of the surgical neck tended to be independent and relatively fit, despite the fact that their mean age was 72 years. Outcome was determined by the age of each patient and the degree of translation on the initial anteroposterior radiograph. Surgery did not improve the outcome, regardless of the degree of translation

Aims

A number of methods have been described to remove a well-fixed humeral implant as part of revision shoulder arthroplasty. These include the use of cortical windows and humeral osteotomies. The router bit extraction technique uses a high-speed router bit to disrupt the bone-implant interface. The implant is then struck in a retrograde fashion with a square-tip impactor and mallet. The purpose of this study was to determine the characteristics and frequency of the different techniques needed for the removal of a well-fixed humeral stem in revision shoulder arthroplasty.

We report a prospective study of the influence of various factors on the six-month mortality of 531 patients with subcapital hip fractures. We performed univariate and multivariate analyses on the 403 patients treated surgically. The most significant predictors of the six-month mortality were dementia, postoperative chest infection, malignant neoplasia, old age and deep-wound infection, in that order. A simple test of mental ability was the most significant prognostic indicator and this test should be included in future studies of the management of hip fractures in the elderly

We have reviewed 107 patients of 80 years or over who underwent primary total hip replacement. They had many more complications than younger patients. Thus, acute dislocation occurred in 15%, and became chronic in 9%; there were femoral shaft fractures in 4.6% and these, with shaft perforation gave universally poor results. Nevertheless, 75% of patients had a satisfactory outcome, with worthwhile relief of pain. It would seem sensible to warn elderly patients and their relatives of the increased risks in this age group

1. A lateral intermuscular approach to the hip joint is described for replacement of the head of the femur by a prosthesis. 2. Advantages claimed for it are that it is attended by little or no shock, because the operation is rapid and relatively bloodless; that adequate exposure can be gained without dividing muscle or tendon; and that muscle function is unimpaired and so walking can be allowed early. The exposure is easily extended if unexpected difficulty is encountered. 3. Prosthetic replacement of the femoral head through this incision is advocated as a primary measure for elderly or unfit patients with fractured femoral neck

Aims

The aim of this study is to evaluate the clinical results of operative intervention for femoral metastases which were selected based on expected survival and to discuss appropriate surgical strategies.