Background

The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still an ongoing process and osteoporosis has been suggested as a predictor.

Introduction: Recently there has been increasing interest in postoperative pain treatment by use of wound infil-tration with local anaesthetics. The technique has been reported effective following hip and knee arthroplasty. We hypothesized that repeated installations of intraar-ticular local anaesthetic in patients with femoral neck fracture would give pain relief without side effects and reduced opioid usage.

Material and Methods: 33 patients undergoing osteo-synthesis with two Hook Pins were randomized into 2 groups in a double-blinded study (Clinical Trials.gov id: NCT00529425). In group A (Active) 19 patients received 1 peroperative (30 ml=200 mg) and 6 postoperative (10 ml=100 mg) bolus instillations of ropivacaine through an intraarticular catheter which was removed after 48 hours. In group B (placebo) 14 patients were injected with the same volume of saline water. The need for opioid rescue analgesia standardized to mg equivalent of oxyco-done and pain measured on a 5 point scale were recorded during the intervention period of two days after surgery.

Results: No significant difference in consumption of rescue analgesia was found between the groups on day one and two: Group A (16.7 mg and 15 mg, both median values) opposed to group B (10 mg and 7.5 mg, both median values), (P=0.51 and P=0.36 Mann-Whitney). Testing for insufficient use of rescue analgesia by comparing the number of pain scores exceeding a defined limit of tolerable pain showed no difference between the groups on day 1 and 2 (P=0.31 and P=0.45). Comparing the maximum pain score we found no significant difference between the groups on day 1 (P=0.41). Although not significant, the maximum pain score was higher in group A on day 2 (P=0.051). There was no difference between the median pain score on day 1 (P=0,78) but on day 2 the median pain score was significantly higher in group A (P=0,03).

Conclusion: Repeated intraarticular application of ropi-vacaine provides no reduction in opioid requirements or pain after osteosynthesis of femoral neck fracture. This suggests that the technique has no clinically relevant analgesic effect in this category of patients.

Background: Dysplasia of the hip is associated with hip pain and development of secondary osteoarthrosis. An early intervention by a PAO is both a pain relieving treatment and it prolongs or eliminates the development of osteoarthrosis. Different surgical approaches have been used to perform the PAO. We have compared a modified iliofemoral (MI) approach and the ilioinguinal (II) approach on acetabular reorientation, perioperative variables and clinical outcome.

Patients and Method: We included 90 PAO’s performed on 75 patients with symptomatic hip dysplasia operated between February 2003 and July 2006 at Odense University Hospital. The variables in this study are center edge (CE) and acetabular roof angle (AA), Harris Hip score (HHS), WOMAC, pain (VAS), satisfaction with surgery, level of activity, quality of life (EQ5D), peri-operative blood loss, operating time and neurovascular complications.

Results: The MI approach was used in 71 PAO’s and the II in 19 PAO’s. Overall, patients had a significantly better result after the PAO compared to before with regard to HHS, pain and WOMAC, EQ5D. Reorientation measured on pre- and post-operative CE- and AA-angles showed no significant difference between the two groups. Operating time proved the MI approach significantly faster then the II-approach (p< 0.05). The intraoperative blood loss and pre-operative Hb-conc. was equal in the two groups. However, there was a significant lower postoperative Hb-conc. using the II-approach. The II group had one case of arterial thrombosis and none in the MI group. In both groups, half the patients had dysaesthesia related to the lateral cutaneous femoral nerve.

There were no significant differences between the two approaches with regard to pre- and post-operative HHS, WOMAC, patient satisfaction, level of activity and EQ5D

Conclusion: Although the II approach offers better access to the pubic bone, we did not find any difference in reorientation of the acetabular fragment. Both groups improved significantly in clinical outcome and quality of life. We find the MI approach safer than the II, as no arterial thrombosis was seen in that group.

Introduction: Among numerous international studies on hip fractures only few were dealing with the occurrence and risk of a subsequent hip fracture. Some studies contain information identifying patients at risk of subsequent hip fractures as well as the risk of a hip fracture following another osteoporotic fracture, others on outcome following the subsequent fracture.

Material and methods: The Funen County Hip Fracture Register contains information on every consecutive hip fracture in the county of Funen since January 1st 996. The register contains general information about the patient i.e.: type of fracture, operative treatment, complications, living conditions, ADL, as well as information from 4 and 12 month out-patient visit and if necessary re-surgery. A maximum of 155 variables can be recorded about every patient. The register has been subjected to a complete revision and validation (4.660 patient files was checked) and contained a total number of 7.457 hip fractures from January 1st 1996 to December 31st 2003. Incidence numbers were calculated based on risk of fracture from the first fracture since January 1st 1996 to death or December 31st 2003.

Results: In the period January 1st 1996 to December 31st 2003, 7,457 fractures were registered. Of these, 261 patients were registered with a second fracture, the primary fracture occurring before the period and thus excluded. Within the period 6,676 primary fractures were registered, and of these 520 patients (7.5 %) experienced a subsequent fracture. The median time from primary to subsequent fracture was 8 months (range 0–75 months) in males and 14 months (range 0–82 months) in females, the overall median was 13.5 months (range 0–82 months). In males the risk of dying after the primary hip fracture was 10 times higher than the risk of sustaining a subsequent hip fracture, in females it was five times higher.

Conclusion: Only few patients with a hip fracture will experience a subsequent hip fracture and with the short time frame presented, any intervention should have immediate impact.