Hip international : the journal of clinical and experimental research on hip pathology and therapy
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Parkinsonism in hip fracture (HF) patients is a potential source for complications during surgery, postoperative period and rehabilitation and a risk factor of second HF. We investigated whether parkinsonism was more prevalent in older subjects with HF than in other older patient groups undergoing surgery. We prospectively assessed patients who had suffered HF and controls. ⋯ Parkinsonism is very common in older patients admitted for surgery to a general hospital and extremely common in those with HF. It seems that parkinsonism, is heavily under recognised in the elderly. Our data seem to confirm that parkinsonism is a major risk factor of HF in the elderly.
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During a transgluteal approach to the hip joint the anterior part of the gluteus medius and minimus muscles are detached and subsequently reattached to the greater trochanter. Avulsion or rupture of these muscles may result in weak abduction, pain and/or instability. 15 patients with these symptoms were treated, of whom 13 had muscle avulsion at surgery. Reinsertion of these muscles resulted in improvement of pain in 6 (55%) patients and improvement of walking ability in 9 (82%) patients. Reinsertion of avulsed gluteal muscles after transgluteal approaches to the hip may relieve pain and improve walking ability.
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Randomized Controlled Trial
Local anaesthetic wound infiltration after internal fixation of femoral neck fractures: a randomized, double-blind clinical trial in 33 patients.
Pain control may assist early mobilisation after internal fixation of femoral neck fractures. Systemic opioids have significant side effects in elderly patients. We present an evaluation of the effect of local anaesthetic infiltration in such cases , the objective being to decrease the need for postoperative opioids and to improve pain control for patients after surgery. 33 patients undergoing internal fixation with 2 parallel hook pins were randomized into 2 groups in a double blind study (ClinicalTrials.gov: NCT00529425). 33 patients received intraoperative infiltration followed by 6 postoperative injections through an intraarticular catheter in eight-hour intervals. 19 patients received ropivacaine and 14 received saline. ⋯ Apart from a reduction in nausea in the study group on the second postoperative day, there were no significant differences in the occurrence of side effects between the groups. On day 2 the placebo group had less pain than the study group. Local anaesthetic infiltration after fixation of femoral neck fractures does not reduce opioid consumption or pain'.
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Case Reports
Late laceration of the superficial femoral artery by an intertrochanteric fracture fragment.
Injury to the femoral vessels is a rare complication after intertrochanteric fractures, and usually involves the profunda femoris artery. We report the case of a 79-year-old male with an intertrochanteric fracture, treated by closed antegrade intramedullary nailing, which was complicated by late injury to the superficial femoral artery 5 weeks after surgery. The injury was caused by a spike of bone from the anteriorly displaced lesser trochanter fragment. Direct suture of the injured artery was possible without subsequent complications.
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Multicenter Study
A review of 202 periprosthetic fractures--stem revision and allograft improves outcome for type B fractures.
We report a retrospective review of the outcome of treatment of 202 periprosthetic fractures around total hip arthroplasty (THA) from two specialised arthroplasty centres. Fractures were classified according to the Vancouver classification. The aim was to evaluate treatment methods with respect to stem revision and grafting. ⋯ Periprosthetic fractures of the femur are highly complex and challenging. Stem revision for transverse B1 fractures is now considered as a viable treatment modality as this fracture configuration is difficult to control with single plating, and fixation with a long stem bypassing the distal fracture line is necessary to achieve axial stability and healing. Bone allografting, whether used as a cortical onlay or in morselised impacted form for B2 and B3 fractures enhances fracture healing.