Outcome in Patients with Trochanteric and Subtrochanteric Femoral Fractures Aspects on Surgical Methods, Quality of Life and Cognitive Function

...............................................................................................................3 List of papers........................................................................................................4 List of abbreviations ............................................................................................5 Introduction..........................................................................................................6 Historical background ..................................................................................6 History of hip fracture research at Södersjukhuset......................................7 Epidemiology................................................................................................7 Classification ................................................................................................8 Evolution of internal fixation .....................................................................12 Assessment of outcome..............................................................................19 Cognitive function ......................................................................................20 Stating the problem.....................................................................................20 Aims of the studies.............................................................................................22 Patients ...............................................................................................................23 Ethics...........................................................................................................23 Inclusion criteria and follow-up.................................................................23 Methods..............................................................................................................25 Age and gender...........................................................................................25 Fracture classification.................................................................................25 Co-morbidity...............................................................................................25 Randomisation............................................................................................26 Cognitive function ......................................................................................26 ADL ............................................................................................................26 Preoperative walking ability.......................................................................26 Living conditions........................................................................................26 Treatment modalities ..................................................................................27 Perioperative data .......................................................................................27 Complications.............................................................................................28 Radiological assessment.............................................................................28 Assessment of clinical outcome.................................................................29 Statistical methods......................................................................................32 Results ................................................................................................................33 Study I.........................................................................................................33 Study II .......................................................................................................37 Study III ......................................................................................................40 Study IV......................................................................................................44 Study V .......................................................................................................47 General discussion .............................................................................................51 Failure rates and reoperation rates .............................................................51 Fracture healing complications ..................................................................53 Wound infections........................................................................................54 Femoral shaft fractures...............................................................................55 Salvage procedures.....................................................................................56 Surgical technique ......................................................................................56 Hip function ................................................................................................57