Almost one fourth of older hip fracture patients in this unit died within a year. The most important predictor was admittance from nursing home, which was associated with comorbidity and frailty. More attention to patients from nursing homes is needed in the health care system.

BackgroundNorway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric units where orthopaedic care is combined with interdisciplinary geriatric care. The characteristics and needs of older hip fracture patients are poorly described. The aim of this paper is to describe the characteristics of these patients in order to better understand their need for care and rehabilitation.MethodsThis is an observational study based on a quality register for all patients 65+ years in an orthogeriatric unit who are operated for a hip fracture. The unit covers 250,000 inhabitants in Oslo. Patient data were collected in the aim of quality control. The quality database includes demographic, medical, and functional data collected from routine assessment by the interdisciplinary team.ResultsFrom January 2007 to September 2009, 1010 patients, included 241 (24%) from long-term care institutions, were enrolled in the database. Mean age was 85.1 years (SD 7.1), 76% were female, and 83% had experienced an indoor fall. Chronic diseases were registered in 88%, and 38% of the community-dwelling patients had pre-fracture cognitive impairment defined as IQCODE-SF > 3.6. Complications were observed in 51% of the patients, of which the most common were a need for blood transfusion, delirium, and urinary tract infections. Post-operative orthopaedic infections were rare (3.1%). Patients from long-term care were older, (87 vs. 84 years, p < 0.001), more had American Society of Anaesthesiologists (ASA) score >/= 3 (67% vs. 48%, p < 0.001) and a higher number of chronic medical conditions (mean 2.2 vs. 1.6, p < 0.001). Among community-dwelling patients, those who had fallen indoors were older, more often female, had ASA score >/= 3, chronic medical conditions, impairment in pre-fracture ADL and cognitive function, and more complications during hospital stay.ConclusionsOlder hip fracture patients in this orthogeriatric unit may be divided into three groups; patients who are relatively fit and have experienced outdoors falls (17%), frail community-dwelling patients who have fallen indoors (59%), and patients from long-term care institutions (24%). Different caring pathways are needed for these groups.

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Hip fracture patients who are using warfarin experience a longer waiting time for surgery, most likely due to more comorbidities. A more active approach to better management of comorbidities may reduce waiting time for surgery in warfarin users.

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A 32-year-old man with a fracture of the scapular notch associated with a lesion of the suprascapular nerve is reported. A nerve decompression operation was performed 20 months after the injury with relief of pain. The possibility that residual disability following a fracture of the scapula can be due to a lesion of the suprascapular nerve is underlined. The value of X-ray examination with projections visualizing the notch and diagnostic local anaesthetic block of the nerve passing through the notch are emphasized. Primary wide resection of the scapular notch is a preferable procedure preventing recurrence of nerve compression symptoms.

Bone changes 6-12 weeks after castration have been studied in 25 female and 27 male middle-aged rats. Castrated female rats gained more weight than their controls, but had decreased bone density and calcium and hydroxyproline content per cm3 bone volume of tibia. Castrated male rats did not differ from controls regarding body weight and the bone parameters. No influence of castration on the mechanical strength of the femora could be detected in either sex. At 2 weeks after castration, the circulating levels of immunoreactive calcitonin (iCT) were decreased in female rats compared to controls. In contrast, iCT was increased both in castrated male and female rats 10 weeks later. We conclude that castration of 6-month-old female rats causes osteoporosis, and therefore represents a promising experimental model for studying postmenopausal bone loss.

Bone ingrowth into weight-bearing porous fiber Ti-6Al-4V implants in rat tibias was assessed for the amount, composition, and mineralization rate 3, 12, and 26 weeks after implantation. The data were compared with the ipsi- and contralateral metaphyseal controls and related to the ultimate bending stresses of the distal bone/implant interfaces. From the 3rd to the 12th week there was rapid bone ingrowth and also marked decline in mineralization rate of the ingrowing bone. After 12 weeks the implants were macroscopically pervaded by bone. The ultimate bending stresses increased from the 3rd to the 12th week and reached 45% of that of controls after 26 weeks. There was a linear proportionality between the amount of bone ingrowth and interfacial strength but a curvilinear relationship between bone maturity in terms of calcium/hydroxyproline and calcium/phosphorous ratios and interfacial strength. Stepwise multiple regression analysis showed that the interfacial strength depends on the amount and the maturity of the ingrown bone. Compared with the calcium/hydroxyproline ratio, the calcium/phosphorous ratio was an unreliable predictor of interfacial strength.