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Background: Surgery of proximal femur fractures can give rise to a high rate of postoperative complications and morbidity. In order to evaluate the results of proximal femoral surgery and to improve treatment in the elderly, we performed a prospective study between 1996 and 1998, scoring complications according to a special system used at our institute. Patients: 268 patients (220 women; 82%), mean age 81 years (range 24-97 years), underwent surgery for proximal femoral fractures during a 2-year period. Results: 172 complications (64%) occurred in 116 patients. Complications included pressure sore (13.4%), urinary tract infection (8.5%), problems due to implantation of the osteosynthesis (8.5%), pneumonia (7.8%), minor wound infection (4.9%), urine retention (3.3%), deep venous thrombosis (0.7%), and myocardial infarction (0.4%). Mean hospital stay was 31 days (range 3-196 days). During this time, eleven of 268 patients died (mortality 4.1%). An error in management was seen in 30% of all complications, and technical errors in 21%. In 49% the complication was due to the patient's general health. Conclusions: Surgery for proximal femur fractures is accompanied by complications in many patients, and especially in the elderly. Indeed, the patients in our study were elderly, and their poor general health accounted for nearly half of the complications encountered. The registration of complications may lead to new management/surgical protocols to prevent such complications in the near future.

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European Journal of TraumaAb stract Background and Purpose: Knee injuries are frequently seen in the accident and emergency (A&E) department. A prospective study was carried out to investigate the reliability of the initial diagnosis of knee injuries made in the A&E department. Patients and Methods: All patients (n = 425) who presented at the A&E Department of the Red Cross Hospital in the Hague, the Netherlands, in 1996 with a knee injury were clinically examined and an X-ray was obtained. The patients were reviewed in the outpatient clinic after 4 days and then at 6 weeks. At these times, patients were referred to the orthopedic outpatient clinic for further investigation and treatment as indicated. After 5 years, a final evaluation was undertaken. Results: After 6 weeks, the subsequent diagnosis was found to differ from the initial one in 6% of cases. This finding had no further consequences with regard to prognosis. After 5 years, all patients were approached by telephone. In total, 94% of the patients were contacted and of these, three patients (1%) had been re-referred to the orthopedic outpatient clinic. The final diagnosis of these three patients was different to the initial diagnosis. Of these patients, one needed an arthroscopy, the other two received conservative treatment. Conclusion: The study found that 1% of knee injuries were misdiagnosed at the A&E department. It is therefore beneficial to review patients with knee injuries in the outpatient clinic after 4 days.