***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Antibiotics given perioperatively are thought to decrease the occurrence of postoperative wound infection . The duration of treatment for hip fracture surgery is empirical . This r and omized , double-blind , single-hospital clinical study was carried out to assess the effect of both antibiotic use and duration of use on wound infections in hip fracture surgery .  Wound infection rates in three groups of patients were compared : those who received four doses of cefazolin ( 108 patients ) , those who received one dose of cefazolin and three doses of placebo ( 83 patients ) and those who received four placebo doses ( 121 patients ) . Results showed an infection rate of 1.6 % for the four-dose group , 2.4 % for the one-dose group and 3.7 % for the placebo group . These differences were not statistically significant , even when both treatment groups were combined and compared with the placebo group . The authors conclude that until more patients are added , empirical use of antibiotics should be continued in patients who undergo hip fracture surgery 22 patients with fractures of the femoral shaft were divided into 2 groups . One group ( 12 patients ) were given the st and ard postoperative physiotherapy and the remainder ( 10 patients ) received intensive physiotherapy .  Clinical examination of the knee joint was performed 2 , 4 and 9 weeks postoperatively . The patients ' mean age was 31 years ; 15 of them were men . The fractures in 18 patients were treated with intramedullary nailing , 2 with a long-shanked Jewett nail and 2 with AO-nailing .  Mobilisation and quadriceps atrophy of the injured limb of the patients given intensive physiotherapy appeared to improve faster than in the patients of the routine physiotherapy group . Nine weeks after the operation the range of knee movement had normalised in the cases given intensive physiotherapy . The flexion strength of the knee in the operated limb was close to the values for the normal limb after nine weeks , but the extension strength was still 40 - 66 % below the values for the healthy limb . The greatest increase in muscle power occurred during the first four postoperative weeks . Intensive physiotherapy seems to hasten the recovery of quadriceps strength of the patients with fractures of the femoral shaft , and to shorten the duration of sick leave of the patients operated on by closed intramedullary nailing A prospect i ve , r and omized , double-blind study was performed to evaluate the effects of antibiotic prophylaxis on the development of a wound infection in 239 patients who had immediate stabilization of a fracture of the proximal part of the femur with a dynamic hip screw . The effects of two perioperative doses of cefotiam , given twelve hours apart , were compared with those of two doses of a placebo .  Sixteen perioperative risk factors were evaluated to determine whether it was possible to identify patients who were at risk for a wound infection . All patients were followed for a minimum of six weeks . Antibiotic prophylaxis significantly reduced the prevalence of wound infection ( p < 0.05 ) : the rate of major wound infection decreased from 5 to 1 per cent and the rate of minor wound infection , from 11 to 4 per cent . The most powerful predictors of major wound infection were the duration of the operation , the interval between the accident and admission to the hospital , and the duration of postoperative urinary catheterization . The preoperative level of serum albumin and the absolute lymphocyte count were significant predictors ( p < 0.05 ) of minor wound infection and systemic infection , respectively We conducted a r and omized study of 100 patients to examine the efficacy and risks of two methods of urinary-bladder management  after total joint-replacement surgery . Patients who had hip or knee replacement were r and omly assigned either to Group I , in which indwelling catheters were placed during the operation and removed the next morning , or Group II , in which urinary retention was treated by intermittent catheterization as needed . After the removal of the indwelling catheter , the patients in Group I had a lower incidence of urinary retention than those in Group II ( 27 vs. 52 percent ; P less than 0.01 ) . Bladder distention ( volume above 700 ml ) was more common in Group II ( 45 percent as compared with 7 percent in Group I ; P less than 0.01 ) and was associated with an increased need for subsequent long-term catheterization . There was no significant difference between the groups in the rates of urinary tract infection ( 11 vs. 15 percent ) . We could not identify patients at high risk for retention or infection on the basis of preoperative urinary symptoms , previous urinary tract surgery , previous urinary tract infection or urinary retention , high-risk medical conditions , sex , type of anesthesia , or age ( in the absence of prophylactic treatment ) . We conclude that the short-term use of an indwelling catheter after extended surgery , such as joint replacement , reduces the incidence of urinary retention and bladder overdistention , without increasing the rate of urinary tract infection 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation A prospect i ve r and omized controlled study has been undertaken to evaluate two different prophylactic treatments against postoperative thromboembolic complications  after hip surgery . Patients with hip fracture ( 77 ) and patients undergoing elective hip arthroplasty ( 213 ) were separately r and omized into one of three groups : control , dextran 70 , or low-dose heparin . Deep vein thrombosis was diagnosed in both groups with the 125I-fibrinogen test and pulmonary perfusion defects in the arthroplasty group with a combination of pulmonary X-ray and perfusion scintigraphy . The frequency of thrombosis was significantly higher in untreated hip fracture patients than in untreated arthroplasty patients . In hip fracture patients both treatments significantly reduced the frequency of thrombosis . Only dextran reduced the frequency of major thrombosis and in the heparin group one fatal pulmonary embolism occurred . After elective hip surgery the overall frequency of thrombosis was not influenced by the two treatments , but with dextran 70 thigh thrombi were reduced and with low-dose heparin the frequency of bilateral thrombosis was reduced . Two patients in the control group died of pulmonary embolism , but the frequency of pulmonary perfusion defects was not influenced by the treatment . Bleeding and transfusions were the same in the three groups In a double-blind r and omized study of antibiotic prophylaxis in trochanteric fractures operated on with a nail and plate , a 24-hour intravenous administration of cefuroxime 0.75 grams thrice daily ( Group B ) was compared with the previous regimen of cefuroxime for 24 hours plus 6 days of oral cephalexin ( Group A ) . In each group , 56 ( Group A ) and 65 ( Group B ) patients could be evaluated . One deep infection occurred in Group B with growth of Staphylococcus aureus , and another 4 patients had discharge and cultures of which 2 showed S. aureus . In Group A , 6 patients had signs of an infection , and in 3 patients cultures were taken but were negative . There were no differences between the groups . We concluded that the prophylaxis time need not be longer than 3 days In a prospect i ve trial of 278 patients aged over 65 years , treatment of displaced subcapital fractures was r and omly allocated to closed reduction and internal fixation with a sliding compression screwplate , Moore hemiarthroplasty , or total hip treatment with a Howse semicaptive prosthesis . One year after operation there was little difference between the three groups in mortality ( 25 per cent ) or general complications . The revision rate within the first year was highest for internal fixation ( 25 per cent ) , but many of the replacements also required a further anaesthetic for reduction of a dislocation ( Moore , 11 per cent ; Howse 12.5 per cent ) . Total hip replacement result ed in the least pain and most mobility at 1 year , while hemiarthroplasty was worst in these respects . We conclude that internal fixation and particularly primary total hip replacement should be given serious consideration in the management of the elderly patient with a displaced subcapital fracture Low-dose heparin , dipyridamole ( alone and in combination with aspirin ) , and flurbiprofen were evaluated as potential prophylactic agents against deep venous thrombosis in elderly patients with hip fractures . None of the agents that modify platelet behaviour could reduct the frequency of isotopically diagnosed venous thrombosis .  Low-dose heparin reduced the overall frequency of venous thrombosis and its extent as judged by the frequency of bilaterally abnormal scans , but this reduction did not achieve statistical significance A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission : group 1 , well nourished ; group 2 , thin ; group 3 , very thin . Group 1 ate well and had a low mortality and a short rehabilitation time . The thinner the patients the lower their voluntary food intake , the higher their mortality and the longer their rehabilitation time . A series of 122 patients from groups 2 and 3 were entered postoperatively into a r and omised controlled trial of overnight supplementary nasogastric tube feeding ( 4.2 MJ ( 1000 kcal ) , including 28 g protein ) in addition to their normal ward diet . This treatment was associated with improvements not only in anthropometric and plasma protein measurements but also in clinical outcome , especially in the very thin group 3 patients . Rehabilitation time and hospital stay were shortened . Mortality in group 3 was less in the tube fed patients ( 8 % ) than in the controls ( 22 % ) but this difference did not reach statistical significance . One in five patients could not tolerate the nasogastric tube , but in the remainder the treatment caused no side effects and did not seriously diminish voluntary oral food intake by day A r and omized trial was carried out with 194 patients to compare the effectiveness of sodium warfarin or aspirin with that of placebo in the prevention of  venous thromboembolism after surgery for fractured hip . Prophylaxis was commenced postoperatively and continued for 21 days or until patient discharge , whichever was earlier . All patients underwent surveillance with iodine 125-fibrinogen leg scanning and impedance plethysmography , with subsequent venography .  Venous thromboembolism occurred in 13 patients ( 20.0 % ) in the warfarin group , 27 patients ( 40.9 % ) in the aspirin group , and 29 patients ( 46.0 % ) in the placebo group . Proximal vein thrombosis or pulmonary embolism occurred in 6 patients ( 9.2 % ) in the warfarin group , 7 patients ( 10.6 % ) in the aspirin group , and 19 patients ( 30.2 % ) in the placebo group . The results of this study show that sodium warfarin therapy is safe and effective in preventing thromboembolic complications in patients undergoing surgery for fractured hip , and that aspirin therapy is an equally safe and effective method for preventing proximal vein thrombosis or pulmonary embolism Summary : A prospect i ve , r and omized clinical trial in 304 orthopaedic trauma patients with hip and pelvic fractures was conducted to investigate the effectiveness of pneumatic sequential leg compression devices ( PSLCDs ) for the prevention of thromboembolic disease . The control group received no specific form of prophylaxis . Patients were followed by venous Doppler , duplex scan , and ventilation perfusion lung scans . The study end-point was documented pulmonary embolism and /or deep vein thrombosis . The incidence of a venous thromboembolic event in the control group was 11 % and in the experimental group 4 % . This difference was statistically significant ( p=0.02 ) . These patients were also stratified into hip and pelvic fracture groups . In the hip fracture patients , the control group had a thromboembolic event incidence of 12 % and the experimental group 4 % . This difference was also statistically significant ( p=0.03 ) . In the pelvic fracture group there was a thromboembolic incidence of 11 % in the controls , demonstrating this patient population to be at significant risk . In this group , the PSLCDs were not statistically shown to be effective . Pneumatic leg compression devices are effective in reducing the incidence of thromboembolic events in patients with hip A r and omized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin ( 
    Output:
    
The results of these 11 studies suggest that early surgical repair ( within 24 to 48 hours ) is associated with a reduction in 1-year mortality .
Evidence from cohort studies indicates that for medically stable patients who do not have active comorbid illness ( such as unstable angina ) , surgical repair of hip fracture within the first 24 to 48 hours of admission is associated with a decrease in 1-year mortality .
Patients who would benefit from delay and further medical evaluation have not been well characterized .
In this study , wound infection rates were lowest when antibiotics were administered 0 to 2 hours before surgery .
Antibiotics seem to reduce the risk for deep-wound infections by approximately 44 % , and therapy should probably be continued for 24 hours ( that is , about 3 doses should be given ) .
Published data suggest that antibiotics should be administered 0 to 2 hours before surgery .
Efficacy of Thromboembolic Prophylaxis on Prevention of Deep Venous Thrombosis * The studies review ed strongly support the use of thromboembolic prophylaxis , but which agent is optimal is less clear .