Harris Criteria Research Articles

Functional and Radiological Outcome of Revision Total Hip Arthroplasty in the Indonesian National Referral Hospital

Background: Revision total hip arthroplasty (rTHA) rate has increased until 12-20% in the past few decades, despite the 95% success rate of THA approach in 10 years and 80% in 20 years. The most common causes of rTHA are dislocation, periprosthetic fracture, aseptic loosening, and periprosthetic joint infection. This study is aimed to describe the outcome of rTHA in Indonesia where there are limited types of revision implant and funding. Material and Methods: An analytic cross-sectional study was conducted on 31 rTHA in the Indonesian national referral hospital from January 2014 to December 2019. Data on the causes of rTHA was extracted. All subjects met the criteria underwent examination for functional outcome (Harris hip score) and radiological outcome (Harris or Engh criteria). All complications and outcomes after rTHA were identified. Results: Sixteen subjects met the criteria with the mean age of 48.13 (18.74). The most common causes of rTHA were dislocation, aseptic loosening, and perirosthetic joint infection (five cases each, 31.25%). The Harris hip score after complete rTHA was 79.42 (SD 6.14, range 70.50 – 91) with the mean follow up of 29.50 (SD 16.88, range 7 – 70 months). Only one possible loosening was identified in hybrid prosthesis (femoral component) from radiological exam. Three complications were observed, i.e. drop foot, recurrent dislocation, and extension knee contracture. Conclusion: Revision THA produces fair to good results in terms of functional outcome and no loosening in radiological exam. Revision THA is still a reliable technique to manage complications of THA.

Application of bone-retaining femoral stem prosthesis in young patients with Dorr C femoral medullary cavity

To assess the clinical efficacy of Tri-Lock bio-short prosthesis in artificial total hip arthroplasty(THA) in young patients with Dorr type C femoral medullary cavity. From January 2010 to January 2014, 35 young patients(37 hips) with in the chimney-like femoral medullary cavity received Tri-Lock BPS prosthesis of THA, including 18 males(20 hips) and 17 females with an average age of (32.2±3.0) years old ranging from 21.2 to 38.5 years old. There were 16 cases of rheumatoid hip arthritis (17 hips), 8 cases of rheumatoid arthritis (9 hips), and 11 cases of aseptic necrosis of femoral head (11 hips). All cases were complicated with different degrees of osteoporosis. According to Singh index, 26 cases were classified as Grade III and 9 cases as Grade II. Biological prostheses were used for the acetabulum, with ceramic lining and full ceramic femoral head. The proximal femoral medullary cavity was Dorr type C on anteroposterior X-ray. After replacement, X-ray examination was performed to locate the prosthesis stem. Engh and Harris criteria were used to evaluate the stability of bone-prosthesis interface and hip function, respectively. Changes of hip movement pre-operation and at last follow-up were compared. All patients were followed up for 18 to 45 months(means 33.8 months). Harris hip scores in 35 cases (37 hips) increased significantly from preoperative 61.8±3.0 (51.2 to 73.5) to 93.3±6.5 (92.5 to 98.8) points at last follow-up (t=54.745, P<0.01). The hip mobility increased from (46.5±8.0)°(0° to 55°) before surgery to(101.2±10.5)°(85° to 130°) at the last follow-up, the difference was statistically significant(t=133.091, P<0.01). Immediately after surgery, the prostheses were tightly packed with the medullary cavity. At the final follow-up, 17 hips had significant femur cortical bone thickening;12 hips had varying degrees of stress occlusal bone resorption at proximal femoral, including 9 degree I(low femur density, round and blunt) and 3 degree II(involving small rotor) hips. Meanwhile, 15 hips had significant femur cortical bone thickening without thigh pain. The cone-shaped short Tri-lock biological short-stem can fill Dorr C chimney-like medullary cavity and effectively retain good proximal femoral bone mass. Titanium microporous coating on the surface can effectively increase the friction of the prosthesis. The short-stem end in the medullary cavity can effectively avoid the occurrence of coxa varus.

Proximal femoral nail antirotation for Evans-Jensen III intertrochanter fracture without fixation of the femoral lesser trochanterlc fragment: a finite element analysis and clinical study

Objective To analyse the biomechanical stability of Evans-Jensen Ⅲ intertrochanteric fracture fixed by proximal femoral nail antirotation (PFNA) without fixation of the femoral lesser trochanteric fragment through the finite element and clinical effects of this method. Methods Three three-dimensional finite element models of the Evans-Jensen Ⅲ intertrochanteric fracture fixed with PFNA with or without fixation of the femoral lesser trochanteric fragment was established. Von Mises stress distribution of points was observed to analyze the biomechanical stability.115 patients with Evans-Jensen Ⅲ intertrochanteric fracture were treated by PFNA without fixation of the femoral lesser trochanterlc fragment, Fractures heal and internal fixations were evaluated by radiograph postoperatively and hip joint function were done by Harris criteria. Results Whether femoral lesser trochanterlc fragment fixed, the maximum Von Mises stress of femur is located on distal and meidal femur and that of inter fixation on main screw or medial connection. But peak von Mises stress of No fixed femoral lesser trochanterlc fragment was lower than that of fixed. The mean follow-up was 32 months for 115 cases, Fracture union occurred in all patients with a mean healing time of 3 months, Two cases were found with varus deformity of hip because of early weight. The hip function was rated as excellent in 91, good in 15, fare in 7 and poor in 2 case according to Harris functional evaluation system. Conclusion PFNA fixation for Evans-Jensen Ⅲ intertrochanteric fracture without fixation of the femoral lesser trochanteric fragment can effectively maintain the stability of the fractures and seems simple, safe and also can achieve satisfactory clinical effect. Key words: Intertrochanteric fracture; Lesser trochanteric fragment; Proximal femoral nail antirotation; Finite element; Clinical effect

Treatment of displaced femoral neck fracture in young adults with close reduction and femoral neck locking plate fixation

To investigate the clinical effects of close reduction and proximal femoral locking plate fixation for the treatment of femoral neck fractures in young adults. From August 2010 to 2014 August, 54 patients with displaced femoral neck fracture were treated with closed reduction and proximal cannulated screw locking plate fixation. There were 34 males and 20 females, aged from 18 to 55 years with an average of 39.8 years. The informations of fracture healing and complications were recorded after operation. According to Harris criteria, the function of hip joint was evaluated. All patients were followed up from 4 to 24 months with an average of 11.3 months. Three cases occurred fracture nonunion, fracture union rate was 94.4%(51/54), union time was from 3 to 6 months with an average of 4.1 months. Among the healed 51 cases, the median of femoral neck shorten was 0.8 mm with the mean of (0.48±0.46) mm. No complications such as infection, internal fixation displacement were found during follow up. According to Harris criteria, 40 cases obtained excellent results, 9 good, 2 fair, 3 poor. Close reduction and proximal femoral locking plate fixation is an effective method in treating femoral neck fracture in young adults, it has advantages of avoiding the femoral neck crispation, reliable fixation, high rate of fracture union and good functional recovery.

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle-C1 interval.

Atlantooccipital dislocation (AOD) in adults cannot be diagnosed with adequate specificity and sensitivity using only CT or plain radiography, and the spine literature offers no guidelines. In children, the most sensitive and specific radiographic measurement for the diagnosis of AOD is the CT-based occipital condyle-C1 interval (CCI). The goal of the current study was to identify the normal CCI in healthy adults and compare it with the CCI in adults with AOD to establish a highly sensitive and specific cutoff value for the neuroimaging diagnosis of AOD. A total of 81 patients, 59 without AOD and 22 with AOD, were included in this study. Measurements obtained from thin-slice CT scans of the craniovertebral joint to assess atlantooccipital dislocation included the CCI, condylar sum, the Wholey and Harris intervals, Powers and Sun ratios, Wackenheim line, and Lee X-lines. The group of patients without AOD included 30 men (50.8%) and 29 women (49.2%) with a mean age of 42.4 ± 16 years (range 19-87 years). The group of patients with AOD included 10 men (45.5%) and 12 women (54.5%) with a mean age of 38.2 ± 9.7 years (range 20-56 years). Interrater reliabilities within a 95% CI were all greater than 0.98 for CCI measurements. A total of 1296 measurements of the CCI were made in 81 patients. The mean CCI for non-AOD patients was 0.89 ± 0.12 mm, the single largest CCI measurement was 1.4 mm, and the largest mean for either right or left CCI was 1.2 mm. The mean condylar sum was 1.8 ± 0.2 mm, and the largest condylar sum value was 2.2 mm. Linear regression with age predicted an increase in CCI of 0.001 mm/year (p < 0.05). The mean CCI in AOD patients was 3.35 ± 0.18 mm (range 1.5 mm-6.4 mm). The shortest single CCI measurements in the AOD patients were 1.1 mm and 1.2 mm. The mean condylar sum for all 22 AOD patients was 6.7 ± 2.7 mm and the shortest condylar sums were 3.0 mm. Cutoff values for AOD were set at 1.5 mm for the CCI and 3.0 mm for the condylar sum, both with a sensitivity of 1 and false-negative rate of 0. Sensitivity for the Powers, Wholey, Harris, Sun, Wackenheim, and Lee criteria were determined to be 0.55, 0.46, 0.27, 0.23, 0.41, and 0.41, respectively. The CCI is shorter in adult patients as opposed to the pediatric population. The revised CCI (1.5 mm) and condylar sum (3.0 mm) cutoff values have the highest sensitivity and specificity for the diagnosis of AOD in the adult population.

Treatment of Middle‐up Part Long‐segment Femoral Fracture with Long Proximal Femoral Nail Antirotation

To investigate the outcomes of treating middle-up part long-segment fractures of the femur by long proximal femoral nail antirotation (PFNA-long). From June 2006 to December 2013, 139 cases (35 women, 104 men; mean age 48.8, range, 18-86 years) of long-segment femoral fracture in middle-up part were treated with long proximal femoral nail antirotation (PFNA, 320-380 mm) by minimally invasive percutaneous fixation and autogenous iliac bone graft. Fifty-eight cases were graded as type IA long-segment femoral fractures (41.73%), 25 type IB (17.99%), four type IC (2.88%), 28 type II (20.14%), 12 type IIIA (8.63%), five type IIIB (3.60%), and seven type IV (5.04%). Clinical efficacy was evaluated with Harris hip function scores and postoperative pain with visual analogue scale. The operative time was 35-90 min (mean, 45 min) and mean intraoperative blood loss 78.6 mL (range 30-200 mL). Most patients were walking with assistance 4-10 days postoperatively. All patients were followed up for 3-37 months (mean, 19 months). There were no serious complications. All fractures healed after 2.8-6.8 months (mean, 3.9 months). According to Harris criteria, the clinical results were excellent in 108 patients, good in 22, fair in eight and poor in one. Ninety-three cases had no pain, 33 mild pain, 13 moderate pain and 25 occasionally needed non-steroidal analgesics. Closed reduction or limited open reduction with PFNA-long is an effective treatment for long-segment femoral fracture in middle-up part, with good strength in fixation, high rate of fracture union, early functional recovery and low rate of complications.

Treatment of long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation

Objective To investigate the effects of long proximal femoral nail antirotation （PFNA-long） in treating long-segment fracture in middle-up part of femoral. Methods From June 2006 to December 2013, we treated 139 cases long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation （PFNA, 320-380 mm） by minimally invasive per-cutaneous fixation and autogenous iliac bone graft. Data of 139 patients （104 male and female 35;ages 18 to 86 years, with an aver-age age of 48.8 years）. Type IA 58 cases （41.73%, 58/139）, type IB 25 cases （17.99%, 25/139）, type IC 4 cases （2.88%, 4/139）, type II 28 cases （20.14%, 28/139）, type IIIA 12 cases （8.63%, 12/139）, type IIIB in 5 cases （3.60%, 5/139）, type IV 7 cases （5.04%, 7/139）. The duration from injury to surgery was 3 hours to 12 days, with an average of 4.2 days. The postoperative follow-up was at 1, 2, 3, 6, 9, 12 months, and annually at least. The clinical efficacy was evaluated with Harris hip function score. The postoperative pain was evaluated with visual analogue scale （VAS）. Results The operative time of 139 cases was from 35 to 90 minutes, averaged 45 minutes and the blood loss during surgery averaged 78.6 ml （ranged from 30 to 200 ml）. All patients walked by walking aid appliance after 4 to 10 days postoperatively, apart from 16 cases with serious long grinding fracture. All patients had been followed up for 3 to 37 months （mean 19 months）. No complications, such as infection, lower limb vein infarction, cut-out and breakage of the implants, occurred. However, there were 4 patients with nail broken and 6 patients with hip internal rotation who were treated by secondary operation. There were 5 cases with slight hip external rotation and 8 cases with hip internal reverse-lamb shortening malformation. All fractures healed after 2.8-6.8 months （mean 3.9 months）. According to Harris criteria, the clini-cal results were best in 108 cases, better in 22 cases, good in 8 cases, and bad in 1 case. The excellent and good rate was 93.53%（130/139）. The score for VAS was 0-6 （mean 0.8）, 93 cases in which no pain, mild pain in 33 cases, moderate pain in 13 cases, 25 cases occasionally need to take non-steroidal analgesics. Conclusion Closed reduction or limited open reduction with PFNA-long is an effective treatment for long-segment fracture in middle-up part of femoral, with higher strength in fixation, higher rate of fracture union, early functional recovery and lower rate of complications. Key words: Femoral fractures Fracture fixation; intramedullary Internal fixators

Endoscopic axillary lymphadenectomy combined with laparoscopically harvested pedicled omentum for immediate breast reconstruction.

To determine the therapeutic and cosmetic outcomes of patients with breast cancer treated with endoscopic axillary lymphadenectomy (EAL) combined with laparoscopically harvested pedicled omentum (LHPO) for immediate breast reconstruction. Forty patients with early breast cancer underwent EAL, followed by quadrantectomy and LHPO for immediate breast reconstruction. All patients were evaluated for operating time, blood loss, postoperative hospital stay, complications, etc. The cosmetic outcomes were evaluated 6 months after the surgery, according to the Harris criteria. The average operating time was 308 min, including 39 min for EAL, 63 min for quadrantectomy, and 58 min for LHPO. The average blood loss was 70 ml, and was mainly incurred during breast resection. On average, the patients were discharged 9.5 days after the surgery. Partial graft necrosis and omental fat liquefaction occurred in one patient each. No other complications occurred after the surgery. No local recurrence or distant metastasis was found during the follow-up. The cosmetic results were mostly satisfactory. No size reduction of the reconstructed breast occurred after radiation therapy. Esthetic evaluation of the reconstructed breast showed that the cosmetic outcome was "excellent" in 35 patients, "good" in 4 patients, and "fair" in 1 patient. EAL combined with LHPO for breast reconstruction is a viable, safe procedure that causes minimal surgical trauma and results in a soft, shapely breast postoperatively.

AB0827 Painful Periprosthetic Resorption of Total Hip Arthroplasty Treated with Risedronate: an Observational Study

BackgroundTotal hip arthroplasty (THA) is the treatment for severe hip osteoarthritis. It improves the quality of life, pain and patient autonomy. However, a periprosthetic resorption may occur, in 3% to...

Surgical outcome and complications of posterior hip dislocation combined with femoral head fractures

Objective To investigate the short-term surgical effect and complications of posterior dislocation of the hip with femoral head fractures.Methods Twenty-two patients with posterior dislocation of the hip with femoral head fractures treated surgically from December 1999 to December 2008 were reviewed retrospectively.All the patients were males aged from 23-52 years (mean 39.2 years).According to Pipkin classification,fractures were type Ⅰ in nine cases (41％),type Ⅱ in seven (32％),type Ⅲ in two (9％) and type Ⅳ in four (18％).Different surgical approaches and treatment methods were employed together with a periodic follow-up.Harris score and Thompson & Epstein score were used as measurement standard in postoperative clinical and radiological follow-up.Postoperative complications were analyzed as well.Results All the patients were followed up for mean 36 months.Clinical outcome as assessed by Harris criteria was excellent in 10 cases,good in seven,fair in two and poor in three,with excellent-good rate of 77％.Complications included femoral head avascular necrosis in four cases and traumatic arthritis in six.Heterotopic ossification of the hip did not occur.One case complicated with idiopathic injury of sciatic nerve was recovered at one year after operation.Conclusions Posterior dislocation of the hip with femoral head fractures should be operated as soon as possible.Operational modalities should depend on the type of fractures for the sake of reducing complications. Key words: Femoral fractures ; Hip dislocation ; Complications

Total hip arthroplasty with the MS-30 polished surface cemented stem: a single surgeon consecutive series study at 10 year follow-up

The Morscher-Sportorno femoral stem is a stainless steel, straight, three-dimensionally tapered, collarless implant for cemented fixation in total hip replacement. The clinical and radiographic results of this implant at a minimum of 5-year follow-up have been extremely encouraging. However, the results at 10years have yet to be reported. Therefore, we wished to establish the clinical performance and survival of the polished surface MS-30 femoral stem at a minimum of 10-year follow-up. We report the results at a minimum follow-up of 10years of a single surgeon series of 55 total hip replacements with the polished surface MS-30 cemented femoral component in 48 consecutive patients aged between 50 and 64. The median period of observation was 12years (inter-quartile range, 10-13). Six patients died with their implant in situ, and one patient was unable to attend for follow-up. All the remaining 41 patients with 47 total hip replacements were reviewed. All patients were assessed clinically with the use of the Oxford hip score, and radiographs taken at the latest follow-up were evaluated by an independent specialist hip surgeon. To date, none of the implants have been revised. The median Oxford hip score was 13 (inter-quartile range, 12-14). Radiologically, no stems had evidence of loosening on assessment by the Harris criteria, and only 4 hips (8.5%) had osteolysis adjacent to the stem, mostly in Gruen zone 7. The results of the polished surface MS-30 femoral stem were satisfactory with survivorship at a minimum of 10years of 100%. These findings support the continued use of this femoral component.

Estudo prospectivo de 76 casos de fratura do acetábulo tratados cirurgicamente

OBJETIVO: Fazer estudo prospectivo sobre fratura instável e incongruente do acetábulo, comparativo com a literatura, abordando o tipo de acesso, material de fixação, grau de redução, tipo de fratura e seus resultados após cirurgia. MÉTODOS: Os autores avaliaram 76 pacientes com fratura instável e incongruente do acetábulo entre janeiro de 1999 e dezembro de 2009. A classificação utilizada foi a de Marvin Tile e todos foram tratados cirurgicamente segundo a técnica preconizada pelo grupo AO-ASIF. RESULTADOS: A avaliação radiológica foi feita segundo os critérios de Ruesch; foram obtidos resultados bons, ótimos e perfeitos em 64 pacientes (84,2%). Quanto à avaliação clínica, segundo os critérios de Harris, os resultados foram bons e ótimos em 62 pacientes (81,6%). As complicações foram avaliadas e, quando comparadas com a literatura, mostraram-se compatíveis mesmo após a análise estatística. CONCLUSÃO: Os autores concluem que a redução anatômica e a fixação estável são importantes para um bom resultado.

PROSPECTIVE STUDY ON SEVENTY-SIX CASES OF FRACTURED ACETABULUM WITH SURGICAL TREATMENT

Objective: To conduct a prospective study on unstable and incongruent fractures of the acetabulum, in comparison with the literature, covering the type of access, fixation materials, degree of reduction, type of fracture and results after surgery. Methods: The authors evaluated 76 patients with unstable and incongruent fracture of the acetabulum between January 1999 and December 2009. The Marvin Tile classification was used, and all cases were treated surgically using the technique recommended by the AO-ASIF group. Results: The radiological evaluation was done in accordance with the Ruesch criteria, and good, excellent or perfect results were obtained for 64 patients (84.2%). The clinical evaluation was done in accordance with the Harris criteria, and good or excellent results were obtained for 62 patients (81.6%). The complications were assessed and, in comparison with the literature, were shown to be compatible with previous reports even after the statistical analysis. Conclusion: It was concluded that anatomical reduction and stable fixation are important for good results.

Treatment of long-segment fracture in middle-up part of femoral shaft with long proximal femoral nail antirotation of AO/ASIF

Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail ant-rotation(PFNA-long)in treating long-segment fracture in middle-up part of femoral bone.Methods From June 2006 to December 2009,32 cases of long-segment fracture in middleup part of femoral shaft were treated by closed reduction or limited open reduction and fixation with PFNA-long,including 30 males and 2 females with an average age of 3.8.8 years(range,20-69).All patients had closed fractures in shaft of femur.The average time from injury to operation was 4.2 days(range,3 hours to 12 days).All fractures were fixed with the PFNA-long.The patients were followed at 1,2,3,6,9,12 month after surgery,respectively,and next time at least once per year.The clinical outcomes were evaluated according to Harris criteria and radiological examinations.Results The mean operating time of all cases was 55 minutes(range,35-90),and the mean blood loss during surgery was 75.6 ml(ranged,30-150 ml).All patients walked with walking aid 4-7 days after surgery.They were followed up for 9-37 months.All fractures healed after 3.1-5.4 months(mean 3.7 months).No complications such as infection,lower limb vein infarction,cut-out or breakage of the implants occurred.But 2 cases had hip internal reverse-lamb shortening malformation,According to Harris criteria,the clinical results were excellent in 23 cases,good in 7,and moderate in 2,and the excellent and good rate was 93.75%(30/32).Conclusion PFNA-long is an effective and minimally invasive method for long-segment fracture in middle-up part of femoral shaft,with minimally invasive,high fixation-strength and accord with biomechanics characteristics;and with a high rate of bone union,early functional recovery and less complications. Key words: Femoral fractures; Fracture fixation,intramedullary; Internal fixators

Complications des fractures–décollements épiphysaires de l’extrémité inférieure du tibia et de la fibula. Étude d’une série de 81 cas

Distal tibial and fibular epiphyseal fractures are common in children. Those lesions, usually benign, could produce damage to the growth plate with angular deformities and leg-length discrepancies. Patients and methods We report a series of 81 epiphyseal fractures observed in the lower tibia and fibula. Traumas were classified according to the Salter and Harris (SH) criteria. Epiphysiodesis, angular deformity, leg-length discrepancy and articular incongruity were searched. Those complications were analyzed according to age, sex, SH type, displacement and treatment modality. Results were evaluated according to the Gleizes criteria. Results Mean age was 13 years. SH classification of their injuries was SH I in nine children, SH II in 45, SH III in 13 and SH IV in 11 children. Three injuries were complex. The patients were given orthopedic treatment alone in 56 cases, in combination with percutaneous pin in ten cases and underwent open surgery in 15 cases. Six patients (7.4%) had a total of 11 complications (five physeal bares, two ankle varus, two leg-length discrepancy and two articular incongruity). The complications succeed constantly to SH IV and complex fractures. Overall results were good in 90% of cases, average in 2.5% and poor in 7.5%. Conclusion Complications appeared to be favored by high energy trauma, SH IV type of fracture and complex lesion.

Application of dynamic condylar screw in treatment of intertrochanteric fractures of the femur

Objective To observe the application and efficacy of dynamic condylar screw (DCS) in treating intertrochanteric fractures of the femur and discuss the fixation principle, feasibility, advanta-ges and related issues. Methods A retrospective analysis was done on 23 patients with intertrochanter-ic fractures of the femur treated with DCS from January 2000 to December 2006. Of all, there were 10 elderly patients with different levels of various kinds of internal diseases and 13 young patients injuried by high-energy such as traffic accidents. According to Boyd' s classfication, there was one patient with type Ⅰ fracture, five with type Ⅱ , nine with type Ⅲ and eight with type Ⅳ. After a detailed pre-operative physical examination and targeted treatment, DCS fixation was employed for intertrochanteric fractures of the femur. Results A follow-up for average 18 months showed no death. Early complications occurred in three patients including two with pulmonary infection and one with urinary tract infection, who got cured after proper treatment. There was one patient with long-term complication, post-traumatic arthritis. All 23 patients got bone healing, with excellenee rate of 96% according to Harris criteria. There were no complications like breakage of nails, nonunion, eoxa yarn deformity, shortening or external rotation of the lower limb. Conclusions DCS has advantages of simple operation, reliable fixation and coincidence with biomechanical characteristics and hence is one of ideal methods for treatment of intertrochanteric frac-ture of the femur, especially for subtrochanteric fracture, contrary chanteric fractur, fracture involving large pyriform troehanteric and comminuted fractures of sub-trochanteric lateral os integumentale. Key words: Femoral fractures; Fracture fixation,internal; Dynamic condylar screw

Clinical effective analysis of surgical methods on elderly intertrochanterie fracture

Objective To study the clinical efficacy in treatment of elderly patients with intertrochanteric fracture by the hollow nail plus DHS, or Gamma nail, or PFNA. Methods 150 cases of elderly patients with intertrochanteric fracture, according to three kinds of different fixation methods, were randomly divided into the hollow nail plus DHS group (54 cases), Gamma nail group (51 cases), and PFNA group (45 cases). Results According to Harris criteria scores, the rate of excellent and good effects in PFNA and Gamma nail groups are superior to that in hollow nail plus DHS group, the anterior postoperative functional recovery is also good; and the rate of excellent and good effects in PFNA group and Gamma nail group was no significant difference (P> 0.05). The bleeding volume, postoperation pain and failure ratio of internal fixation in Gamma nail and PFNA groups are less than that in hollow nail plus DHS group (P<0.05). Conclusion The methods of Gamma nail and PFNA fixation are simple, fixed firmly, less bleeding and excellent efficacy in treatment of elderly patients with intertrochanteric fracture, especially the unstable fracture of the intertrochanteric fracture. Key words: Intertrochanteric fracture; Internal fixation

Prospective evaluation of selected clinical criteria for cranial computed tomography in non‐trauma adult patients

To evaluate the usefulness of previously published criteria by Rothrock et al. and Harris et al. for urgent, cranial CT in non-trauma presentations. A prospective, observational study of consecutive adult patients with non-trauma presentations to Westmead Emergency Department, undergoing urgent cranial CT over a period of 2 years and 10 months. Clinical data were assessed to determine the presence of the proposed Rothrock and Harris criteria. Clinically significant findings defined by CT were intracerebral haemorrhage, acute infarction, intracranial infection, acute hydrocephalus, cerebral oedema and malignancy. A total of 1911 patients were studied. Among them, 21.7% (414/1911) of patients had clinically significant findings on CT. Application of the Harris criteria demonstrated a sensitivity of 93.5% (387/414, 95% CI 90.7-95.7) and a false negative rate of 6.5% (27/414, 95% CI 4.3-9.3) with a potential reduction in number of scans by 27.8%. With application of the Rothrock criteria, the possible scan reduction rate was 15% with a sensitivity of 98.8% (409/414, 95% CI 97.2-99.6) and a false negative rate of 1.2% (5/414, 95% CI 0.4-2.8). The Harris criteria were not validated by our study. The Rothrock criteria are also not confidently validated, but can be a useful guide for emergency physicians to help prioritize high-risk patients who might have clinically significant cranial CT findings. We have not replicated their very high sensitivity and very low false negative rates.

Manifestaciones clínicas y alteraciones inmunológicas en pacientes con síndrome antifosfolipídico. Presentación de 112 casos

We decided to describe the demographic, clinical and laboratory characteristics of a series of patients with antiphospholipid syndrome (APS) (Harris criteria) and review other Spanish published series. We describe 112 patients with APS, 50 primary (PAPS) and 62 secondary (SAPS) -56 (90%) to systemic lupus erythematosus (SLE)-, monitorized in two referral centers in Malaga (Spain) from 1989 to 2000. All data were obtained from the medical records by means of a protocol. The age was similar in both groups (42.3 [14.7] years for the whole series). Patients with SAPS had an earlier onset of the disease (29.6 [12.6] years, vs 37.0 [13.9] years in PAPS) and they had a longer evolution of the disease (143.3 [115.5] months, vs 83.5 [73.5] months in PAPS). There was a female predominance (84% and 60% in SAPS and PAPS, respectively). The prevalences of arterial (43%) and venous thrombosis (39%), fetal loss (40%), premature births (9%), anticardiolipin antibodies (88%) and lupus anticoagulant (54%) were similar in both groups. The prevalence of ANA-IFI, thrombocytopenia and autoimmune anemia was higher in SAPS. Patients with PAPS and SAPS did not present any differences in the clinical manifestations and immunological disorders of the syndrome. Those patients with SAPS were younger at the beginning of the disease and there was a female predominance. Our patients were different from those included in other Spanish published series, which could be explained by selection and classification bias.

Application of AO compressed hollow screws in treatment of femoral neck fracture in aged patients

目的 探讨老年人股骨颈骨折围手术期治疗的重要性及应用AO中空加压螺丝钉治疗老年人股骨颈骨折的可行性、优越性及相关注意事项.方法回顾分析应用AO中空加压螺丝钉治疗老年人股骨颈骨折43例的临床资料.其中Garden Ⅰ型6例,Ⅱ型13例,Ⅲ型17例,Ⅳ型7型,均有不同程度的并存症,进行治疗后用AO中空加压螺钉固定,术后均进行追踪随访.结果经平均4.8年的随访,无术中和住院期间死亡病例.近期并发症8例,发生率为18.6%;远期并发症4例,发生率为9.3%,除1例发生骨折不愈合及1例股骨头缺血性坏死外,余均一期愈合.骨折愈合率为95.12%.按Harris评分标准:优良率达90.24%.恢复伤前生活行走功能.结论老年人股骨颈骨折往往有并存症,应重视围手术期治疗及采用简单有效方法治疗,以减少并发症发生.AO中空加压螺丝钉治疗老年人股骨颈骨折操作简单、符合生物力学特点、固定牢固可靠、骨折愈合率高,是治疗老年人股骨颈骨折的理想方法之一。