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Hip fractures in the elderly are a worldwide epidemic, and aging of the populations is increasing the burden of these fractures on the health care systems. To improve the knowledge of whether the number of hip fractures is increasing even more rapidly than can be accounted for by the demographic changes only, all patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first hip fracture were selected from the National Hospital Discharge Register. There was a steady, average 7.7% annual increase in the total number of hip fractures in Finland during this period so that the number of fractures was 2239 in 1970 and 6071 in 1991. The proportion of patients aged 60 years or more increased steadily from 75% in 1970 to 91% in 1991. In 1991, 74% of the patients were women. Across the study period, the age-adjusted total incidence of hip fractures also increased in both women and men 50 years of age and over. This increase was more pronounced in men. Thus, the increasing incidence of hip fractures in Finland was not only due to the fact that the population was aging but also due to the increasing age-adjusted incidence. We conclude that the number of hip fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and this will seriously challenge the Finnish health care system in the future.

The incidence of hip fracture in Finland was studied for the year 1988. During 1988, 6139 patients were treated for a fresh hip fracture. Three out of four hip fracture patients were women, and the occurrence of cervical fractures was 2.8 times and that of trochanteric fractures 2.5 times more common in women than in men. The incidence rates of hip fractures per 100,000 were 174 in women, 70 in men and 123 in the whole population. The mean hospitalization time for fresh hip fractures was 33 days for cervical fractures and 38 days for trochanteric fractures. The costs of primary hospitalizations due to fresh hip fractures in 1988 were estimated at US $66 million.

A population sample of 27,000 Finnish women and 30,000 men was studied for the presence of a thoracic vertebral fracture. In both sexes, the prevalence of such fractures increased with age: after 40 years of age in the men and after 55 years of age in the women. The interaction of sex and age was significant, and even when the other determinants were adjusted for. In the women aged 35-44, 55-64, and 75 years or more, the prevalence per 1,000 was respectively 2.4, 5.1, and 29, and in the men in the corresponding age groups 5.2, 15, and 28. A previous history of trauma was a fracture determinant in both sexes. In the men, but not in the women, there was an increased risk of fracture when there was a history of tuberculosis and/or peptic ulcer, and in current smokers. Thus, contrary to observations on extremity fractures, the men had an increased risk of sustaining a thoracic vertebral fracture compared with the women. This may reflect differences in the development of osteoporosis in the axial skeleton versus the appendicular skeleton.

We studied prospectively the demographic data, fracture types and modes of treatment in 390 patients with acute traumatic hip fractures in two health care regions in Finland, the Middle Finland region and the Kymenlaakso region in 1989. In Middle Finland population (251,203 inhabitants) 199 patients with a hip fracture were admitted to two acute care hospitals, while 191 patients were admitted in Kymenlaakso (population 189,726) to four acute hospitals. There were no significant differences in the sex- and age-specific incidences between the two regions. In Middle Finland, 70% of the fractures were of the femoral neck, 28% were trochanteric and 2% subtrochanteric. The corresponding figures in Kymenlaakso were 57%, 38% and 5% (P < 0.05). In Middle Finland, 73% of the femoral neck fractures were treated primarily with a hemiendoprosthesis, 2% with primary total hip replacement and 25% by osteosynthesis. The corresponding figures in Kymenlaakso were 81%, 7% and 12% (P < 0.001). The mean duration of hospital stay was 14 days in Middle Finland and 21 days in Kymenlaakso (P < 0.01).

We studied prospectively the occurrence of hip fractures among the over 49-year-old urban populations (n = 88,206) in the cities Tampere, Jyväskylä and Kotka in 1989 and compared the results with a parallel Scandinavian multicentre study. During 1989, there were 266 inhabitants who were treated for a hip fracture, 213 of them were women. Women had in 132 cases a femoral neck fracture and in 81 cases a trochanteric fracture, and the corresponding numbers for men were 22 and 31. Among women, the total hip fracture incidence in Jyväskylä (n = 22) was the lowest when compared with the ones in Tampere (n = 47) and Kotka (n = 36). These incidences were on average lower than in the other Scandinavian cities studied in parallel. The all over ratio of femoral neck/trochanteric fractures was 1.1 in Tampere, 3.0 in Jyväskylä and 2.2 in Kotka and in Tampere, women had 9.3 times more femoral neck fractures than men. Our study showed that in Finland in three major cities the hip fracture incidence was lower than what has been similarly registered in corresponding urban populations in other Scandinavian countries. We also point out that the relative part of trochanteric fractures appears to be increasing.

During 1985, 4,490 patients with a hip fracture were treated in Finland. From 1970 to 1985, the number almost doubled. The predicted annual number of patients with a hip fracture by the year 2000 will rise to 5,800 if the calculations are based on available demographic data, and to 7,100 if the trend observed during the period 1970 to 1985 continues.

Fifty-five patients who underwent lower spine surgery were preoperatively evaluated with myelography and postmyelography CT. ENMG was done on 23 patients. CT had the highest accuracy in finding the affected level (F = 75,5; p less than 0,0005) as compared to myelography (F = 46,5; p less than 0,0005) or to ENMG (F = 11,4; p greater than 0,15). We did not find statistical differences in diagnostic accuracy in different disc spaces nor was there a difference between primary and recurrent low-back disease.

The author presents the long-term results of a proximal metatarsal osteotomy in hallux valgus. The results are based on clinical findings and radiographs.

Infection in total hip replacement, its definition, normal history and treatment are reviewed. A case with a two stage revision with the use of a cementless resection prosthesis is presented.

The social destiny of 54 patients with femoral neck and trochanteric fractures was analysed by interview three to five years after the operation and the results were compared with those of 48 control subjects of the same age. In addition to this 50 patients with a similar fracture not yet operated were asked the same questions and the results were compared with those of control subjects of the same age . The groups did not differ in terms of marital status, education and in state of health. The operated patients walked daily less than the control subjects. The capacity for self care of the not yet operated patients before the injury was more often reduced and they had to be helped in all daily activities more often than the control subjects. At follow up the ability to move of operated patients had deteriorated and every second patient had died. Of the operated patients, which were prior to the injury able to work, 40 per cent returned to work after the convalescent.

The number and type of reoperations after fractures of the proximal femur was studied in Jokilaakso Regional Hospital, Finland, from 1970 to 1981. Reoperations after fractures of the femoral neck occurred in 32% (24/74), in trochanteric fractures in 13% (6/48). In fractures of the femoral neck 38% (9/24) of the reoperations were performed during the first postoperative year, in trochanteric fractures half of the cases. The average time of hospital stay for reoperation was 19 days.

The results of 213 consecutive operatively treated patients with fractures of the femoral neck were evaluated. Especially the effects of improved operative technique, careful pre- and postoperative care and intensified rehabilitation were observed. The series consisted of 151 women and 62 men, 111 femoral neck fractures and 102 trochanteric fractures. Nailing was performed on 54 femoral neck fracture patients and endoprothesis operation on 57 patients. No statistically significant differences were proved when the two consecutive two years series were compared with one another concerning the nailing results and the frequence of thrombosis and infection. However, by means of early weight-bearing and improved pre- and postoperative care the 6 months mortality decreased statistically significantly (chi2 = 6.58, p less than 0.05).

The late results of 133 operatively treated patients with femoral neck and trochanteric fractures were evaluated. The series consisted of 86 women and 47 men, 72 femoral neck fractures and 61 trochanteric fractures. 99 patients were treated by A-O osteosynthesis and 34 by endoprosthesis. The average age of the group with osteosynthesis was 71 and of the group with endoprosthesis 76 years. From 3 to 5 years after the operation the nailing results of the patients with femoral neck fractures were poor in 7.1 and with trochanteric fractures in 15.4 per cent. During the same observation period the results of the patients treated with endoprosthesis were poor in 14.3 per cent. There were no statistically significant difference between the A-O group and the endoprosthesis group with femoral neck fractures. Between the mortality of the nailed patients with femoral neck fractures and the endoprosthesis group there was no statistically significant difference.

The results of 223 patients with fractures of the femoral neck treated by AO osteosynthes were evaluated. The series consisted of 140 women and 83 men, 114 femoral neck fractures and 109 trachanteric fractures. One year after the operation the nailing results were poor in 22.9 per cent of the femoral neck fractures and in 2.7 per cent of the trochanteric fractures. The reasons of the poor results were mainly the perforation of the nail. Pseudoarthrosis were founded in 3 cases and in one case the AO nail was broken. The mortality after 2 weeks was 3.1 per cent, after one month 6.3 per cent, after 6 months 15.7 per cent and after 12 months 20.6 per cent. Infection and thrombosis were founded both in 3.1 per cent.

In 1980 136 patients with fracture of the proximal part of the femur were treated in the Province of Middle Finland which has a population of 242 439. The total cost of these patients was analysed on the basis of hospital and travelling costs and loss of income. This amounted to 1 728 185 Finnmarks (FIM) ($ 367 066) and the cost per patient was 12 707 FIM ($ 2 700). The number of patients increased during the period 1970-1980 by 157%. If the incidence of fractures of the proximal femur continues to increase at the same rate, there will be about 350 patients with this kind of injury in the Province of Middle Finland in 1990. The number of treatment days will then amount to 5 850 and the total costs will be 4 447 450 FIM ($ 944 638).

In 1980 2449 patients with femoral neck and 1096 with trochanteric fractures were treated in Finland. The female--male ratio was 3:1 for femoral neck and 2:1 for trochanteric fractures. The age-specific incidence was higher for women than for men in both fracture types. About 3/4 of the patients were over 70 years old. The mean hospitalization time was 37 days for the patients with a femoral neck and 34 days for those with a trochanteric fracture. These patients accounted for 9% of all surgical hospitalization days in Finland during the year 1980. The injuries occurred evenly during every month. The number of femoral neck fractures will double during the period 1968 to 1985.

Functional recovery of the wrist and hand after a fracture of the distal forearm in 207 consecutive patients was analysed. A good or excellent result was achieved in 77 percent, fair in 22.5 percent and poor in 0.5 percent of cases. The result in 14 unstable fractures treated with external fixation was as good as that of the whole series. Good functional results were associated with extra-articular fractures, good anatomical results, male sex and low age. Comminuted intra-articular fractures of the radiocarpal joint, fracture line into the distal radio-ulnar joint, fracture of the ulnar styloid and a poor anatomical result in addition to high age contributed to a poor result.