Purpose/Introduction: The number of hip fractures is rising, due to increases in life expectancy. In such cases, patients are at risk from post-operative complications and subsequently the average length of hospitalization may be extended. In 2011, we established a clinical pathway (CP), a specific model of care for patient-care management, to improve the clinical and economic outcomes of proximal femoral fracture management in elderly patients. The goal was to evaluate the CP using clinical, process, and financial indicators.Methods: We included all surgical patients aged 65 and over, admitted to the emergency department with a fracture of the proximal femur following a fall. Assessment parameters included three performance indicators: clinical, process, and financial. The clinical indicators were the presence or absence of acute delirium on the third post-operative day, diagnosis of nosocomial pneumonia, and the number of patients fulfilling at least 75% of their nutritional requirements at the end of the hospitalization period. The process indicator was the time interval between arrival at the emergency department and surgery. The financial indicator was based on the number of days spent in hospital.Results: From 2011 to 2013, 669 patients were included in the CP. We observed that the average length of stay in hospital decreased as soon as the CP was implemented and stabilized afterwards. The goal of 90% of patients undergoing surgery within 48 h of arrival in the emergency department was surpassed in 2013 (93.1%). Furthermore, we observed an improvement in the clinical indicators.Conclusion: The application of a CP allowed an improvement in the qualitative and quantitative efficiency of proximal femoral fracture management in elderly patients, in terms of clinical, process, and financial factors.

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Purpose There is a paucity of data available on total knee prostheses combining dual-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert. This prospective cohort study aimed to assess the clinical evolution of the FIRST® prosthesis (Symbios Orthopédie, Yverdon, CH), the earliest prosthesis with this particular design. It was hypothesized that the primary outcomes, evaluating pain, stiffness, function and stability, would improve following arthroplasty and remain improved during the follow-up period of 10 years. Methods All patients programmed for a total knee arthroplasty using a FIRST® prosthesis at our university hospital between 2006 and 2008 were invited to participate. Study knees were evaluated pre-operatively as well as one, five and ten years post-operatively. Patients filled out questionnaires at each evaluation point and had a radiographic assessment at the five-year and ten-year follow-ups. Primary outcomes were the total, pain, stiffness and function measures of the Western Ontario and McMaster Universities Osteoarthritis questionnaire (WOMAC) and the knee and function measures of the Knee Society Score (KSS). Friedman and Wilcoxon’s rank-sum tests were used to compare measures across time points. Results Hundred and twenty four prostheses were included (baseline demographics: 69.9 ± 8.3 years old, 28.1 ± 4.3 kg/m2, 54% male) and 68 could be followed during ten years. Five prostheses underwent a revision. All other prostheses lost at follow-up were lost for reasons unrelated to the prosthesis. All primary measures reported statistically and clinically significant improvements between baseline and the three follow-up evaluations. Statistically significant improvements at the three follow-up evaluations were also observed for most secondary measures. There was no implant loosening. At ten-year follow-up, radiolucent lines were observed in 2.9% femoral implants and 1.5% tibial implants. Conclusion The positive results observed in all domains of assessment and the small revision rate demonstrated an effective functioning of the FIRST® prosthesis during the ten-year follow-up period. The results, globally similar to those previously published for other prosthesis designs, encourage the development of assistive methods to select the most appropriate designs on an individual basis. Level of evidence IV, prospective cohort study.

Natural gas in the world, by Nicole Fleury. This article presents an overview of the natural gas situation in the world since the beginning of the seventies. The gas situation is compared with that of oil when comparison axe seemed appropriate. This is the case for some specific indicators such as the geographical distribution of the resources. Eastern Europe's preeminent role with regard to gas resources is compare with the paucity of its oil resources. The Middle East holds first place for oil resources and second place for gas resources. The numbers underline the lack of gas resources in western countries which are the greatest consumer in the world. Their consumption had been going down quite quickly since 1979 The decline was very sharp in the United States which was still the largest consumer in the world in 1983 just before the Ussr, the european consumption on the contrary was growing. The price factor is mentioned without being full developed. The control of internal prices in Usa, together with the timing of the increase which it implied, had in particular a fundamental role in the fall of consumption. The recent developments in the spot market for gas could reverse the situation in the future. Trends in gas production, taking account its geographic distribution, remain very close to trends in consumption. This underlines however the development of a world trade in gas, in particular for pipelines, a less costly means of transport. The growth of european imports, starting with the Ussr is the most pertinent example. Beginning with these elements, an outline of evolution of the future gas market to the end of the century can be discerned. The three most important points are: the increasing western european dépendance on the countries of eastern europe who will have more than 40% of world gas production, the continuing decline of the north amencan share in world gas production notwithstanding the progress achieved in Canada, the improvement of the production in Latin America and in Africa, these regions reinforcing their efforts for a better utilization of associated gas. This global trend conceals in the industrialised countries a different sectoral distribution underlining, the stability of gas utilization in the residential and services sector, where there is competition from electricity, the sharp decline of gas utilization in the electric sector, an increasing penetration in the industrial sector. These trends will be heavily dependent on the prices of competing energy sources, -in particular petroleum products and electricity.