P.T.P.W. Burgers

The epidemic of hip fractures: are we on the right track?

Background Hip fractures are a public health problem, leading to hospitalization, long-term rehabilitation, reduced quality of life, large healthcare expenses, and a high 1-year mortality. Especially older adults are at greater risk of fractures than the general population, due to the combination of an increased fall risk and osteoporosis. The aim of this study was to determine time trends in numbers and incidence rates of hip fracture-related hospitalizations and admission duration in the older Dutch population. Methods and Findings Secular trend analysis of all hospitalizations in the older Dutch population (≥65 years) from 1981 throughout 2008, using the National Hospital Discharge Registry. Numbers, age-specific and age-adjusted incidence rates (per 10,000 persons) of hospital admissions and hospital days due to a hip fracture were used as outcome measures in each year of the study. Between 1981 and 2008, the absolute number of hip fractures doubled in the older Dutch population. Incidence rates of hip fracture-related hospital admissions increased with age, and were higher in women than in men. The age-adjusted incidence rate increased from 52.0 to 67.6 per 10,000 older persons. However, since 1994 the incidence rate decreased (percentage annual change −0.5%, 95% CI: −0.7; −0.3), compared with the period 1981–1993 (percentage annual change 2.3%, 95% CI: 2.0; 2.7). The total number of hospital days was reduced by a fifth, due to a reduced admission duration in all age groups. A possible limitation was that data were obtained from a linked administrative database, which did not include information on medication use or co-morbidities. Conclusions A trend break in the incidence rates of hip fracture-related hospitalizations was observed in the Netherlands around 1994, possibly as a first result of efforts to prevent falls and fractures. However, the true cause of the observation is unknown.

Reliability, Validity, and Responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for Elderly Patients with a Femoral Neck Fracture

BACKGROUND The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. METHODS Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older. RESULTS The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%). CONCLUSIONS The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations. CLINICAL RELEVANCE The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.

Rigidity of unilateral external fixators--a biomechanical study.

INTRODUCTION External fixation is the primary choice of temporary fracture stabilisation for specific polytrauma patients. Adequate initial fracture healing requires sufficient stability at the fracture site. The purpose of this study was to compare the rigidity of the Dynafix DFS(®) Standard Fixator (4 joints) with the Orthofix ProCallus Fixator(®) (2 joints), which differ in possibilities for adapting the configuration for clinical needs. MATERIALS AND METHODS Both devices were tested 10 times in a standardised model. In steps of 10N, loading was increased to a maximum of 160N in parallel, transversal and axial direction (distraction and compression). Translation resultant and rotation resultant were calculated. RESULTS With a force of 100N in parallel direction the mean translation resultant (Tr(mean)) of the Dynafix DFS(®) Standard Fixator (6.65±1.43mm) was significantly higher than the ProCallus Fixator(®) (3.29±0.83mm, p<0.001; Students t-test). With a maximum load of 60N in transverse direction the Tr(mean) of the Dynafix DFS(®) Standard Fixator was significantly lower (8.14±1.20mm versus 9.83±0.63mm, p<0.005). Translation was significantly higher with the Dynafix DFS(®) Standard Fixator, for both distraction (2.13±0.32mm versus 1.69±0.44mm, p<0.05) and compression (1.55±1.08mm versus 0.15±0.33mm, p<0.005). The mean rotation resultant (Rr(mean)) at 160N distraction was lower for the Dynafix DFS(®) Standard Fixator (0.70±0.17° versus 0.97±0.21°, p<0.005). CONCLUSIONS Both fixators were most sensitive to transverse forces. The Dynafix DFS(®) Standard Fixator was less rigid with parallel and axial forces, whereas transverse forces and rotation at distraction forces favoured the Dynafix DFS(®) Standard Fixator. Repeated heavy loading did not influence the rigidity of both devices.

Een pijnlijke knie tijdens voetballen

SamenvattingWij zagen een gezonde 16-jarige jongen met een pijnlijke linkerknie, opgelopen tijdens een voetbalwedstrijd. Na de bal geschoten te hebben, was hij bij de landing door de knie gezakt.