Lumbar spondylolysis is a stress fracture of the pars interarticularis. We have evaluated the site of origin of the fracture clinically and biomechanically.

Ten adolescents with incomplete stress fractures of the pars (four bilateral) were included in our study. There were seven boys and three girls aged between 11 and 17 years. The site of the fracture was confirmed by axial and sagittal reconstructed CT. The maximum principal tensile stresses and their locations in the L5 pars during lumbar movement were calculated using a three-dimensional finite-element model of the L3-S1 segment.

In all ten patients the fracture line was seen only at the caudal-ventral aspect of the pars and did not spread completely to the craniodorsal aspect. According to the finite-element analysis, the higher stresses were found at the caudal-ventral aspect in all loading modes. In extension, the stress was twofold higher in the ventral than in the dorsal aspect.

Our radiological and biomechanical results were in agreement with our clinical observations.

Objective: The objective was to evaluate mortality and ambulatory ability for elderly patients over 80 years with a femoral neck fracture treated surgically. A strategy for managing elderly patients with various problems is proposed.

Materials and Methods: From January 1, 1998 to March 31, 1999, 122 patients with femoral neck fractures were treated in our hospital. Sixty patients aged over 80 years were chosen from this series for the present study. The 60 patients included 50 women and 10 men with a mean age of 87.1years (range 80–97years). The fractures included 26 intracapsular and 34 extracapsular fractures. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80–84 years old), group B (85–89 years old) and group C (over 90 years old). The following parameters were evaluated: duration between injury and operative treatment, duration of hospital stay, senile dementia, prefracture and postoperative walking abilities, and mortality. Walking ability was graded on a scale of 0–4: 0, free gait; 1, gait with a walking stick; 2, gait with a wheelchair; 3, ability only to walk a few steps; and 4, bedridden.

Results: The rates of regained postoperative walking ability to better than grade 2 were 72.2% (13/18) in group A, 65.2% (15/23) in group B and 84.2% (16/19) in group C. These patients were followed until death or for at least one year. The overall mortality rates were 11.1% (2/18) in group A, 17.4% (4/23) in group B and 10.5% (2/19) in group C.

Conclusion: In cooperation with internists, medical staff and family members, we were able to overcome various problems and achieve good clinical outcomes. Cooperation of family members was needed for the elderly patients to return to where they had lived before the trauma and to improve their quality of life.

Objective: To compare the functional results with the anatomical results of treatment for fractures of the distal end of radius in patients aged over 60 years.

Methods: The results of treatment for fractures of the distal end of radius in 25 elderly patients were evaluated retrospectively. The average age of the patients was 70 years and the average follow-up period was 24 months. Twenty-one fractures were treated by percutaneous pinning, two were treated with plates, and two were treated conservatively. All patients were right-handed. The functional results were evaluated according to the sum of demerit points (Saito, 1983), and the following three parameters were used for evaluation of anatomical results: radial tilt, ulnar variance, and palmar tilt.

Results: The latest follow-up functional end results were excellent in 52 % of the fractures and good in 48%. In the final radiographs, the average radial tilt was 20.5 degrees, ulnar variance was 3.7 mm, and palmar tilt was 2.5 degrees. The values of ulnar variance and palmar tilt were often found to be out of the normal range. Most of the patients had a satisfactory outcome, and the functional results were not correlated with the magnitude of residual deformities. Grip power was the most significant factor related to subjective evaluation. Grip power recovered 75.2 % of uninjured side grip power in patients fractured left hands and 103.4 per cent in patients fractured right hands. This difference was significant (p< 0.05).

Conclusions: A good functional outcome of treatment for fractures of the distal end of radius in elderly patients can be expected irrespective of radiographic evidence of minor deformities.