PhD defence G.R. (Gert) Roukema

Dissertation in short:

This thesis investigated multiple aspects of the clinical practice relating to the patient with a
hip fracture.

Part A deals with the reliability of the Pauwels classification for intracapsular hip fractures and the reliability of the predictors for cut-out of the lag screw in a hip fracture.
Chapter 2; There is low agreement for the Pauwels classification based on the preoperative X-ray, and, therefore, the Pauwels classification should no longer be used.
Chapter 3; The tip-apex distance is reliable predictor for lag screw cutout in intertrochanteric hip fractures. By maintaining a tip-apex distance of < 25 mm the expectation is that cutout of the screw in the femoral head will be minimized. 

Part B discusses perioperative challenges related to femur and hip fractures. It addresses the following questions: can the contralateral femur be used as a rotation reference for the fractured subtrochanteric hip/femur, and can we reduce perioperative radiation exposure?
Chapter 4; The non-fractured femur can be used as a rotation template for the fractured femur. In addition, CT measurement of femoral rotation is reliable. 
Chapter 5; A randomized controlled trial showed a statistically significantly lower radiation time for the total group and for the pertrochanteric fracture subgroup with indirect fluoroscopy but no significant effect on the radiation dose and dose area product was found.

Part C. The third part of this thesis concentrates on clinical outcome after hip surgery.
Chapter 6; No significant differences in mortality rates and postoperative complications were found between the minimally invasive anterolateral approach and the traditional anterolateral approach for the treatment of femoral neck fractures with a hemi-arthroplasty. But a decreased operation time and a smaller incision was found in the minimally invasive anterolateral approach.
Chapter 7; Patients admitted during weekends and holidays had shorter waiting time for surgery and shorter hospital stay. Because there is no elective surgical program on weekends and holidays, patients can be operated on earlier.