QUANTITATIVE ASSESSMENT OF FRACTURE HEALING OF LONG BONES USING THE IMPULSE RESPONSE METHOD
Y. Nakatsuchi, A. Tsuchikane (Shinshu University, Matsumoto, Japan)
Judgments with respect to the amount of load the fractured limb can bear, and when joint movement may be allowed, have historically been made based on empirical assessments. A rehabilitation regimen should be based on the quantifiable data regarding the degree of fracture healing. The resonant frequency of a long bone as measured using the impulse response method (IRM) can reflect the bending rigidity of the bone. A study was performed using IRM to quantitatively assess fracture healing in long bone fractures consisting of 75 tibias, 7 femurs, 3 humeri and 2 ulnas. The vibrations were generated by the impact of an impulse-hammer on the end of the bone. The output of the vibrational response was recorded on the other end of the bone with an accelerometer.
A temporary decrease in resonant frequency early in the treatment course was found in 56% of tibias, most frequently in the cases treated by external fixation and the AO plate. The resonant frequency also decreased temporarily following the removal of the fixation devices in 78% of the tibias where they were removed. The resonant frequency of the fractured tibia at the final follow-up exceeded that of the contralateral side. The decision whether or not to remove fixation devices should be made based on the change in resonant frequency. In order to prevent re-fracture following hardware removal, the resonant frequency should be allowed to reach a high enough value. It took a longer time for the fractured tibia to obtain the same level of bending rigidity as the sound tibia than would be predicted by plain radiographs. IRM examinations are most helpful when they are able to detect the change in bending rigidity early in the treatment of fractures of long bones.
FUNCTIONAL PROGNOSIS AFTER SURGICAL TREATMENT OF HIP FRACTURE IN THE ELDERLY
Kimihiko Nakata*, Haruki Takagi*, Shigeyuki Tamaki*, Shigeko Takayama**, Masayuki Iki***, Yukinori Kusaka*** (Fukui Red Cross Hospital*, Fukui Prefectural University**, Fukui Medical School***, Fukui, Japan)
Purpose: To determine the factors affecting functional prognosis in elderly patients who have undergone surgical treatment for fractures of the femoral neck and trochanteric region.
Method: The clinical study involved 263 patients, aged 60 and over. They had suffered hip fracture and were primarily operated on in our hospital during 1988-1994. Clinical data was gathered from medical records, prognosis included activities of daily living (ADL) as well as medical condition after discharge, both which were surveyed by mail from patients or their relatives.
Result: Two hundred fifty-six fracture cases (61 males and 195 females) were traced. The average age of the patients was 79 years. The majority of injuries occurred indoors as a result of low energy trauma. The prevalence of injuries was lowest during the summer months. The ratio of trochanteric to femoral neck was 171:85 (2:1). The mean hospital stay was 60 days. From our analysis, age and duration of the hospital stay affected the ADL recovery. Two thirds of the patients returned home after discharge. Only few had home rehabilitation.
Conclusion: Although expected old age was the major factor associated with poor functional prognosis, it is inevitable. This study suggests the importance of home rehabilitation to reduce patients being bed-ridden due to hip fracture.