We studied the outcome of the surgical treatments, mainly on the walking ability, of the 113 femoral neck fractures of 113 limbs in the elderly, 70 and over, who were admitted in our hospital during the period between Nov. 1992 and Nov. 1996.
Sixty-six of the 113 cases (60.0%) regained the pre-traumatic walking abilities. The rest of the cases, particularly patients over age 85, failed to make good recoveries because of advanced age aging, presence of various complications, types of fractures, and/or poor pre-traumatic walking abilities.
Among various types of complications, dementia appeared as the number one factor in the poor recuperation. We, therefore, recommend that speech therapy as well as occupational therapy be used in the elderly with dementia to arrest further deterioration, and those without to prevent the occurrence of dementia during the perioperative periods with particular emphasis on the preoperative period while patients are still in bed with their legs under traction.
The cases with inside neck fractures of Garden classification type III/IV recovered excellently, for which we applied bipolar arthroplasty (bipolar prosthesis with femoral stem). This is because the bipolar arthroplasty technique ensured much firmer fixation at the fracture site, earlier rising from bed, and earlier weight bearing than in the case of other operative techniques.
The cases with the unstable lateral type of fractures, that are to be cured in osteosynthesis, and so treated by the Ender technique, did not recover well, because of infirm fixation at the fracture site, late rising and bearing times, and eventual concurrence and/or worsening of dementia.
We, therefore, inclined to think that bipolar arthroplasty surgery would be more appropriate for the case of an unstable, complex type of fracture than the Ender fixation maneuver would be, because the former ensures the better outcome.

In our department, we use Jinnaka's Rehabilitation method as a means of aftertreatment of patients who underwent surgery to repair fresh Achilles tendon ruptures. In this paper, we compared the results of tendon ruptures in farmers with those in other occupational workers, who visited our hospital for surgical treatment from April 1990 to December 1996. The data required in this study were collected by interviewing each patient by telephone.
We repaired 22 tendons in farmers, another 22 tendons in manual, laborers, and 36 tendons in non-manual laborers (office workers, 32 tendons and housewives, 4 tendons.) The average period of follow-up was 4 years and 3 months. Re-rupture was observed in only one of the non-manual laborers. The average age of the farmer group was 50.4 years, which was higher than those of the other two groups-43.0 years for the manual laborer group, and 38.4 years for the non-manual laborer group. 83.3% of the patients in the non-mnual laborer group could return to engaging in sports. However, a smaller number of patients, 50.4%, look part in sports in either the farmer group or the manual laborer group respectively.
This low rate of comeback to sports in the farmer group may reflect their belief that physical exercise is unnecessary in light of the farmer's life style.
There are some reports that claim that farmers should engage in some kinds of sport, repeatedly and at regular intervals, to promote and maintain their health, because physical activity in farming is not necessarily sufficient or appropriate from the view point of health preservation.
It is good to promote the idea that farmers, who perform physical labor, should also take part in some kind of sport.