OTA 2002 - Session 6 Session VI - Geriatrics Sat., 10/12/02 Geriatrics, Paper #39, 11:37 AM Early Mortality after Hip Fracture: Is Delay to Surgery Important? Christopher G. Moran, MD ; Andrew M. Taylor, MD; University Hospital, Nottingham, United Kingdom

OTA 2002 - Session 6 Session VI - Geriatrics Sat., 10/12/02 Geriatrics, Paper #37, 11:15 AM How to Prevent Fixation Failure in Patients with an Osteoporotic Trochanteric Fracture Treated with Dynamic Hip Screw: A Prospective Randomized Study Antonio Moroni, MD ; Cesare Faldini, MD; Francesco Pegreffi, MD; Sandro Giannini, MD; Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy Purpose: Dynamic hip screw (DHS) fixation is widely used for patients with trochanteric fractures. Significant failure rates have been reported among osteoporotic patients because of lag screw cutout resulting >from inadequate fixation. Recently, studies have shown that fixation can be improved with use of hydroxyapatite- (HA) coated AO/ASIF screws. Our purpose was to determine whether similar results could be achieved for patients with osteoporotic trochanteric fractures. Methods: One hundred and twenty patients with trochanteric fractures were selected. Patients were divided into two groups and randomized to receive 135° 4-hole DHS with either standard lag and cortical AO/ASIF screws (group A) or HA-coated lag and cortical AO/ASIF screws (group B). Included were women age 65 or older, with AO type A1 or A2, and bone mineral density (BMD) lower than -2.5 T score. Patients were excluded if the lag screw extended into the proximal third of the femoral head. Results: Patient age, BMD, and lag screw position in the femoral head did not differ between groups. In group A there were four patients with cutout and none in group B ( P <0.05;_ _ = 0.8). Three patients with cutout underwent revision with a bipolar prosthesis; the fourth patient with a lag screw cutout refused revision. Fracture impaction was 13 ± 15 mm in group A and 10 ± 7 mm in group B, and the average tip apex distance (TAD) was 22 ± 4 mm in group A and 23 ± 5 mm in group B, which were not significant. No differences in the percentages indicating "at risk" (TAD _ 25 mm) or "not at risk" (TAD _ 25 mm) for cutout were found between the two groups. In both the standard and HA-coated group, no patient with a TAD _ 25 mm experienced cutout. In the standard group, patients experiencing cutout all had a TAD greater than 25 mm. However, no patients in the HA-coated screw group with a TAD greater than 25 mm experienced cutout. At 6 months, the Harris Hip Score was 63 ± 22 (group A) and 71 ± 18 (group B) ( P = 0.02); The SF-36 score was 56 ± 24 (group A) and 62 ± 19 (group B), which was not significantly different. Postoperative neck-shaft angle was 134 ± 5° in group A and 134 ± 7° in group B, but, at the 6-month follow-up, it was 129 ± 7° (group A) and 133 ± 7° (group B) ( P = 0.008). Discussion: HA-coated AO/ASIF screws optimize DHS fixation and clinical outcome of patients with osteoporotic trochanteric fractures. These superior clinical results suggest that HA-coated implants could be the key to improving fixation in mechanically weak bone.

Is a fat stitch required when closing a hip emiarthroplasty wound without a drain? Injury Volume 37, Issue 2 , February 2006, Pages 190-193 M. Lemon, , S.L. Bali, N. Ibery, D.S. Elliott and A. Khaleel Rowley Bristow Orthopaedic Centre, St. Peter's Hospital, Guildford Road, Chertsey KT16 0PZ, UK Accepted 18 July 2005. Studies have shown no benefit of a subcutaneous fat stitch when closing hip wounds, but all have been in the presence of a drain. Our aim was to determine whether, in the absence of a drain, suturing or not of the subcutaneous fat layer in hip hemiarthroplasty wounds had any significant effect on wound complication rate. We performed a prospective cohort study of 45 hip hemiarthroplasty patients who had a fat stitch and 40 who did not. No drains were used in either group. There were 44 patients in the fat stitch group and 35 in the no fat stitch group after six patients were excluded. The infection rate was 2% for the fat stitch group, and 20% for the no fat stitch group (p = 0.02). There were no cases of deep dehiscence in the fat stitch group, but four cases (11%) in the no fat stitch group (p = 0.035). The overall complication rate in the fat stitch group was 6.8% compared to 33% in the no fat stitch group (p = 0.007). In the absence of a drain, we have found a significant increase in hip hemiarthroplasty wound complications when the subcutaneous fat is not sutured.

OTA 2002 - Session 2 Session II - Post-Traumatic Reconstruction Fri., 10/11/02 Post Traumatic Reconstruction, Paper #9, 3:00 PM Outcome after Arthrolysis of the Hip for Severe Heterotopic Ossification and Ankylosis Michael Skutek, MD ; Stefan Hanning; Ulrich Bosch, MD; Christian Krettek, MD, FRACS; Department of Trauma Surgery, Hannover Medical School, Hannover, Germany Purpose: The aim of this clinical study was to determine and evaluate the outcome after arthrolysis of the hip for severe heterotopic ossification (HO) and ankylosis. Methods: Twenty-seven hips in 20 patients (5 women and 15 men with an average age of 43.25 ± 15.07 years) with HO Brooker grade 3 ( N = 10 ) and 4 ( N = 17) were included. All patients underwent open surgical arthrolysis between 1990 and 1997 at our institution. Arthrolysis was performed 21.3 ± 16.6 months (range, 6 to 60) after diagnosis of HO. Postoperatively, all patients received prophylaxis with Indomethacin for 6 weeks. Additionally, two patients were radiated. Outcome evaluation comprised clinical outcome and evaluation with use of the Merle d'Aubigne, Harris Hip, and the Lower Limb scores to cover all effects caused by this severe complication. Results: The overall scores at the latest follow-up (5 ± 3 years) were 6.8 ± 3.5 (Merle-d'Aubigne), 60.7 ± 20.7 (Harris Hip), and 77.2 ± 20.7 (Lower-Limb). There was a mean correlation between the interval (diagnosis to time of operation) and the score results (Merle-d'Aubigne and Harris-Hip Score) of r = ­0.54, respectively. The mean hip flexion was 55.5° ± 35.1° and correlated negatively with the interval ( r = ­0.66). Discussion/Conclusions: There were satisfying results after operative arthrolysis for heterotopic ossification and ankylosis. However, functional results deteriorated with an increasing interval (diagnosis to arthrolysis). After consideration of all contraindications, operative arthrolysis should be performed as early as possible after diagnosis of HO. The results of this study do not support the previous hypothesis that early arthrolysis results in recurrence of impaired hip function.

OTA 2002 - Session 6 Session VI - Geriatrics Sat., 10/12/02 Geriatrics, Paper #40, 11:44 AM Outcomes after Hip Fracture: The Results of a Prospective Multicenter Database Kenneth J. Koval, MD ; Andrew L. Chen, MD; Ethan A. Halm, MD; Sean R. Morrison, MD; Mary Ann McLaughlin, MD; Gretchen Orosz, MD; Jay Magaziner, PhD; Albert Siu, MD, Hospital for Joint Diseases-New York University, New York, New York, USA

OTA 2002 - Session 6 Session VI - Geriatrics Sat., 10/12/02 Geriatrics, Paper #41, 11:53 AM Randomized Trial of Reduction and Fixation versus Bipolar Hemiarthroplasty versus Total Hip Arthroplasty for Displaced Subcapital Fractures in the Fit Older Patient John F. Keating, FRCSEd (Orth) ; Moyra A. Masson, RGN; John F. Forbes, PhD; Neil W. Scott, PhD; Adrian Grant, PhD; Multicentre trial coordinated by Edinburgh Royal Infirmary, Edinburgh, United Kingdom

OTA 2002 - Session 6 Session VI - Geriatrics Sat., 10/12/02 Geriatrics, Paper #38, 11:21 AM Salvage of Failed Internal Fixation of Intertrochanteric Hip Fractures: Revision Internal Fixation or Hip Arthroplasty? George J. Haidukewych, MD ; Daniel J. Berry, MD; Mayo Clinic and Mayo Foundation; Rochester, Minnesota, USA