John E. Kenzora

Survival experience of aged hip fracture patients

Hip fracture has long been considered a major threat to survival in aged populations. This report describes the survival experience of 814 aged, community dwelling hip fracture patients treated in seven Baltimore hospitals between 1984 and 1986: 4.3 per cent died during hospitalization; 8.2, 12.6, and 17.4 per cent died within three, six, and 12 months after fracture, respectively. The mortality rate for the entire population approaches expected mortality approximately six months post-fracture, but varies by age and sex. The most important factors predicting mortality are presence of serious concomitant illness and marked delirium (in the absence of dementia) at the time of hospital admission. The authors suggest that medical factors that may contribute to patient disorientation be investigated and treated, when possible, in an effort to improve the survival status of hip fracture patients.

The biology of osteonecrosis of the human femoral head and its clinical implications. III. Discussion of the etiology and genesis of the pathological sequelae; commments on treatment.

I t is anomalous that the clinical disabilities arising as a result of osteonecrosis of the femoral head, which by definition refers to the death of the cells of the bony portion of this organ, are not directly related to the bone tissue pathologyper se but rather to the structural changes which develop in the articular cartilage of the femoral head and acetabulum. and which eventually lead to osteoarthritis and destruction of the hipjoint. The development of osteoarthritis of the adjacent joint following the death of bone cells in one of the articulating members is indeed puzzling and is not predictable from first principles. In the first place, the chondrocytes of adult articular cartilage receive their nutrition wholly from synovial fluid and are therefore independent of pathologi-

A longitudinal examination of functional recovery among older people with subcapital hip fractures

OBJECTIVE: Few studies have examined the time‐dependent change in functional recovery along with the factors that affect the change among older hip fracture patients. The focus of this study is to examine the predictors of functional recovery in community‐dwelling older people with subcapital fractures using longitudinal data analysis methods.

Mobility after hip fracture predicts health outcomes.

OBJECTIVES: Balance and gait are essential to physical functioning and the performance of activities of daily living. The objective of this study was to determine the predictive value of a balance and gait test on subsequent mortality, morbidity, and healthcare utilization among older hip fracture patients.

Outcome After Hemiarthroplasty for Femoral Neck Fractures in the Elderly

A prospective outcome study was performed on 270 patients, 65 years of age and older, who sustained a femoral neck fracture and underwent hemiarthroplasty. The treatment compared was the use of a noncemented unipolar versus either a cemented or a press fit bipolar prosthesis. The outcome variables assessed included the occurrence of a postoperative complication, length and cost of hospitalization, and function in various quality of life measurements. Patients who underwent bipolar hemiarthroplasty with either a cemented or a press fit prosthesis had better pain relief and function than patients who had a noncemented unipolar prosthesis at a minimum of 24 months after surgery. However, the mean hospitalization cost for patients who had a bipolar prosthesis was

Eight-year outcome associated with clinical options in the management of femoral neck fractures.

12,290 compared with

Outcomes of surgical management of total HIP replacement in patients aged 65 years and older: cemented versus cementless femoral components and lateral or anterolateral versus posterior anatomical approach

8876 for a unipolar prosthesis.

THE DIABETIC NEUROPATHIC FOOT: A TRIPLE CRUSH SYNDROME-MEASUREMENT OF COMPARTMENTAL PRESSURES OF NORMAL AND DIABETIC FEET

This study involved a review of the medical records of 367 patients treated surgically after femoral neck fracture. Linkage of these records with claims files from the Health Care Financing Administration allowed as many as 8 years of followup to analyze the rates of hospital readmission rates for revision, other postoperative complications and mortality. The results revealed: (1) a significantly higher revision rate was associated with internal fixation for the treatment of displaced femoral neck fractures in patients older than 80 years of age; no differences in revision rates were seen between internal fixation or hemiarthroplasty for the treatment of nondisplaced femoral neck fractures in this patient age group; (2) no differences in revision rates were found between internal fixation or hemiarthroplasty for the treatment of displaced femoral neck fractures in patients between the ages of 65 to 80 years; (3) a significantly higher mortality rate was associated with internal fixation than hemiarthroplasty for patients who were between the ages of 65 and 80 years; and (4) no differences in medical or surgical complications, revision rates, or other outcomes were found between unipolar and bipolar prostheses, or between anterior and posterior surgical approaches for hemiarthroplasty in patients who were age 65 years or older.

The role of renal bone disease in the production of transplant osteonecrosis.

This observational study compared the outcomes of 271 cases of hip osteoarthritis receiving primary total hip replacement (patients 65 years of age and older) from numerous surgeons in 12 Baltimore region hospitals from 1991–1993. The independent variables studied were: (a) totally non‐cemented prostheses (non‐cemented femoral component, non‐cemented acetabular component) versus hybrid prostheses (cemented femoral component, non‐cemented acetabular component), and (b) lateral or anterolateral surgical approach versus posterior surgical approach. Outcomes included complications during the initial hospitalization, hospital length of stay, hospital cost, readmission, and reported and/or observed physical, instrumental, neuromuscular and affective functioning and pain at 2, 6, and 12 months post surgery.

Recovery From Hip Fracture in Eight Areas of Function

The role of chronic swelling in the feet of diabetic patients with severe neuropathy is unclear. It was hypothesized that swelling might raise the compartment pressures of the foot high enough above normal to produce nerve and soft tissue injury, ie, the triple crush syndrome. Four compartment measurements were recorded in 30 feet of 15 normal patients and in 34 feet of 20 patients with severe diabetic neuropathy and normal large vessel arterial blood flow. The lateral compartments produced unreliable results and were discarded from statistical evaluation. The mean medial compartment pressure was 7.8 mm Hg (SD 2.55) in the normal feet and 9.4 mm Hg (SD 4.08) in the diabetic feet. This was not a statistically significant difference. Highly significant differences were recorded in the interosseous and central compartments where the mean pressures were 6.4 mm Hg (SD 2.72) and 5.7 mm Hg (SD 2.89), respectively, in the normal feet and 9.3 mm Hg (SD 4.75) and 8.9 mm Hg (SD 5.0) in the diabetic feet (P < .05 for each group). Furthermore, within the diabetic group, 9 of 9 patients (100%) with clinically swollen feet had at least one compartment pressure measure two standard deviations (12 mm Hg) or greater compared with 5 of 11 (45%) in those without clinical swelling. This difference is significant (P < .01). We could not correlate elevated compartment pressures directly with soft tissue pathology.(ABSTRACT TRUNCATED AT 250 WORDS)