INTRODUCTION Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures. MATERIAL AND METHODS We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6 +/- 11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification). RESULTS AND DISCUSSION The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p = 0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2 +/- 7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6 +/- 5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p = 0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p = 0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p = 0.0001). CONCLUSION PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient.

BACKGROUND Previous studies have documented ethnic differences in the utilization of total hip arthroplasty. Less is known if this operation is performed at the same stage of symptoms and has equal effects in patients with different ethnicity. AIM We investigated whether patients born outside Sweden report equal effects of operation with the insertion of a total hip replacement in terms of EQ-5D, pain and overall satisfaction as those born in Sweden. METHOD Preoperative and 1-year postoperative data from Swedish Hip Arthroplasty Register, (1216 patients,1216 hips) with primary osteoarthritis of the hip operated between years 2002 and 2006, were analysed. All patients completed the EQ-5D form, filled in a VAS about pain preoperatively and at 1 year postoperatively, when a VAS about overall satisfaction was added. FINDINGS Before the operation and after adjustment for confounders, patients born abroad reported more problems (dichotomized into no or moderate/severe problems), with self-care (p = 0.01) and anxiety/depression (p = 0.02) in the EQ-5D form than those born in Sweden. They also had more pain (VAS, p = 0.04). One year after the operation and after statistical adjustments, patients born outside Sweden reported lower scores for self-care (p = 0.008) and usual activities (p = 0.001) in the EQ-5D form. They still reported more pain (VAS, p = 0.02), but no significant difference concerning degree of satisfaction (p = 0.3). CONCLUSIONS Our finding of more preoperative disability and pain (VAS) before the operation in patients born abroad might depend on cultural differences, communication problems and differences in indications. Even if the effect of the total hip replacement was good, patients born abroad scored less for some of the items at 1 year. We think that this patient group could benefit from improved pre- and postoperative information and other measures to facilitate and improve their rehabilitation.

Background and purpose Total Hip Replacement (THA) is one of the most successful and cost-effective operations. Despite its benefits, marked ethnic differences in the utilization of THA are well documented. However, very little has been published on the influence of ethnicity on outcome. We investigate whether the outcome—in terms of reoperation within 2 years or revision up to 14 years after the primary operation—varies depending on ethnic background. Methods Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthropalsty Registry and integrated with data on ethnicity of patients from 2 demographical databases (i.e. Patient Register and Statistics Sweden). The first operated side in patients with THA recorded in the Swedish Hip Arthroplasty Register (SHAR) between 1992 and 2007 were generally included. We excluded patients with 1 Swedish and 1 non-Swedish parent and patients born abroad with 2 Swedish parents. After these exclusions 151,838 patients were left for analysis. There were 11,539 Swedish patients born outside Sweden. We used a Cox regression model including age, sex, diagnosis, type of fixation, whether or not there was comorbidity according to Elixhauser or not, marital status and educational level. Results The mean age was lowest in the group of patient coming from outside Europe including the former Soviet Union (61 years), and highest in the Swedish population (70 years). Before adjustment, for covariates, patients born in Europe outside the Nordic countries showed a lower risk to undergo early reoperation (HR = 0.73, 95% CI: 0.56–0.97), which increased after adjustment to (HR = 0.76, 95% CI: 0.58–1.01). Before adjustment, patients born in the Nordic countries outside Sweden and those born outside Europe (including the former Soviet Union) showed a higher risk to undergo revision than patients born in Sweden (HR = 1.14, 95% CI: 1.02–1.27; HR = 1.49, 95% CI: 1.2–1.9), but this difference disappeared after adjustment for covariates. Conclusion We did not find any certain differences in reoperation within 2 years, or revision within 14 years, between patients born in Sweden and immigrants. Further studies are needed to determine whether our observations are biased by the attitude of health providers regarding performance of these procedures, or by a reluctance of certain patient groups to seek medical attention should any complications requiring reoperation or revision occur.

Ferid Krupic 1,3, Sylvia Määttä2, Göran Garellick 1,3, Elisabeth Dahlborg Lyckhage2,4, Johan Kärrholm 1,3 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden1 The Centre for Gender Equal Care, Västra Götalandsregionen, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden2 The Swedish Hip Arthroplasty Register, Registercentrum VGR, SE-413 43, Gothenburg, Sweden3 Institute of Nursing, University of West, Trollhatatan, Sweden4

BACKGROUND Total hip replacement is an operation that usually leads to pain relief and improved health related quality of life (HRQoL). Previous studies have demonstrated the importance of information about upcoming surgery. Therefore, it was of interest to study how both immigrants, whose first language was not Swedish, and Swedish patients described pre-operative information. MATERIAL AND METHODS Individual interviews were conducted with 10 immigrants and 10 Swedish participants. The data were analysed using qualitative content analysis. The study was carried out in western Sweden from March to November 2010. RESULTS The findings revealed that pre-operative information for all patients undergoing elective total hip replacement was limited. Patients from both groups expressed concern about inadequate preoperative information pertaining to the surgery, implant selection, pain relief, choice of anaesthesia, no or too short a time to put questions to the surgeon and an overall stressful situation. CONCLUSIONS Adequate preoperative information is important for optimising pain relief and shortening the hospital stay. The fact that the patients overwhelmingly rated the preoperative information as inadequate may be due to several reasons. Mental distress and the two-week interval between the time when the patient received the information and the operation might have contributed to the low degree of retention.