Posterudstilling
Fra onsdag den 26. oktober
lokale: Capital Foyer
Postere med foredrag er listet under Session 4, Session 5, Session 6
Morten Lykke Olesen, Natasja Leth Jørgensen, Bjørn Borsøe Christensen, Helle Lysdahl, Martin Lind, Casper Bindzus Foldager
Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Sports Trauma Clinic, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital
Background: Cellular outgrowth and formation of cartilaginous tissue around articular cartilage explants has been described in a number of recent experimental studies.
Purpose / Aim of Study: We aimed to investigate the effect of platelet-rich plasma (PRP) on new tissue formation around articular cartilage chips in vitro.
Materials and Methods: Full thickness cartilage biopsies were isolated from the femoral condyles of three skeletally mature Göttingen minipigs. The biopsies were prepared into 1mm3 cartilage chips. Cartilage chips were embedded in fibrin glue and cultured in cell culture inserts up to 21 days in 1) control media (Dulbecco’s Modified Eagle’s Media/F12, 10% fetal calf serum and 1% penicillin- streptomycin), 2) control media with 10% autologous PRP or 3) 10% autologous platelet- poor plasma (PPP) supplementation. Toluidine blue pH 4, alcian blue pH 1 and hematoxylin & eosin (H&E) stainings were performed to characterize newly formed matrix.
Findings / Results: Cartilage chips were viable in all groups after 21 days of tissue culturing. No pericellular clearing in H&E slides were observed. There were no definite signs of chondrocytes from the chips in any of the groups. Histologic evaluation revealed formation of negatively charged aggregates at the wound edges of the cartilage chips in the PRP group compared with the control and PPP groups. The majority of the cells found in these aggregates had a rounded shape. The highly acidic alcian blue stain of the extracellular matrix indicated the presence of glycosaminoglycans.
Conclusions: The addition of PRP to fibrin glue-embedded cartilage explants in vitro leads to formation of a glycosaminoclycan-rich and cell containing aggregate surrounding the cartilage surfaces. This suggests a potential role of PRP in new tissue formation when using cartilage explants embedded in fibrin glue.
Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Sports Trauma Clinic, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital
Background: Cellular outgrowth and formation of cartilaginous tissue around articular cartilage explants has been described in a number of recent experimental studies.
Purpose / Aim of Study: We aimed to investigate the effect of platelet-rich plasma (PRP) on new tissue formation around articular cartilage chips in vitro.
Materials and Methods: Full thickness cartilage biopsies were isolated from the femoral condyles of three skeletally mature Göttingen minipigs. The biopsies were prepared into 1mm3 cartilage chips. Cartilage chips were embedded in fibrin glue and cultured in cell culture inserts up to 21 days in 1) control media (Dulbecco’s Modified Eagle’s Media/F12, 10% fetal calf serum and 1% penicillin- streptomycin), 2) control media with 10% autologous PRP or 3) 10% autologous platelet- poor plasma (PPP) supplementation. Toluidine blue pH 4, alcian blue pH 1 and hematoxylin & eosin (H&E) stainings were performed to characterize newly formed matrix.
Findings / Results: Cartilage chips were viable in all groups after 21 days of tissue culturing. No pericellular clearing in H&E slides were observed. There were no definite signs of chondrocytes from the chips in any of the groups. Histologic evaluation revealed formation of negatively charged aggregates at the wound edges of the cartilage chips in the PRP group compared with the control and PPP groups. The majority of the cells found in these aggregates had a rounded shape. The highly acidic alcian blue stain of the extracellular matrix indicated the presence of glycosaminoglycans.
Conclusions: The addition of PRP to fibrin glue-embedded cartilage explants in vitro leads to formation of a glycosaminoclycan-rich and cell containing aggregate surrounding the cartilage surfaces. This suggests a potential role of PRP in new tissue formation when using cartilage explants embedded in fibrin glue.
Mostafa Almadareb, Martin Lindberg-Larsen, Thomas Giver Jensen, Susanne van der Mark
Orthopaedic department, Bispebjerg Hospital, BBH; Orthopaedic department, BBH; Orthopaedic department, BBH; Orthopaedic department, BBH
Background: The conventional treatment for femoral neck fractures is screw fixation in patients ¡Ü 70 years regardless of fracture classification and in patients > 70 years with fractures classified as Garden 1-2.
Purpose / Aim of Study: To determine the re-operation rate of patients with femoral neck fractures treated with 3 cannulated screws. Furthermore, to investigate whether national guidelines were followed.
Materials and Methods: A descriptive retrospective single center study on patients with femoral neck fractures treated with cannulated screws from Jan 1, 2014 to Dec 31, 2015. Fractures are classified according to Gardens Classification (1-4). Information about re-operations are found from The Danish National Patient Register.
Findings / Results: 148 patients were included. The re- operation rate of the total cohort was 27.7 % (n=41). Causes of re- operations were caput necrosis (16), non-healing (7), pain (3), osteosynthesis failure (6), fall-related (4) and removal of the screws (5). 76 patients were ¡Ü 70 years and 27 (35.5%) were later re-operated compared to 14 (19.4%) re-operations in patients > 70 years (n=72). 10 patients (6.7%) were not treated according to national guidelines (>70 years and Garden 3-4) and were treated with cannulated screws due to co-morbidities. 4 (40.0%) of these were later re-operated. The remaining 138 patients (93.3%) were treated according to the national guidelines and 37 (26.8%) were later re-operated. Final poster will present data on patient characteristics.
Conclusions: The re-operation rate after femoral neck fracture treated with cannulated screws was 27.7 %. Higher re- operation rates were found in patients ¡Ü 70 years and in the few patients (6.7%) not treated according to national guidelines.
Orthopaedic department, Bispebjerg Hospital, BBH; Orthopaedic department, BBH; Orthopaedic department, BBH; Orthopaedic department, BBH
Background: The conventional treatment for femoral neck fractures is screw fixation in patients ¡Ü 70 years regardless of fracture classification and in patients > 70 years with fractures classified as Garden 1-2.
Purpose / Aim of Study: To determine the re-operation rate of patients with femoral neck fractures treated with 3 cannulated screws. Furthermore, to investigate whether national guidelines were followed.
Materials and Methods: A descriptive retrospective single center study on patients with femoral neck fractures treated with cannulated screws from Jan 1, 2014 to Dec 31, 2015. Fractures are classified according to Gardens Classification (1-4). Information about re-operations are found from The Danish National Patient Register.
Findings / Results: 148 patients were included. The re- operation rate of the total cohort was 27.7 % (n=41). Causes of re- operations were caput necrosis (16), non-healing (7), pain (3), osteosynthesis failure (6), fall-related (4) and removal of the screws (5). 76 patients were ¡Ü 70 years and 27 (35.5%) were later re-operated compared to 14 (19.4%) re-operations in patients > 70 years (n=72). 10 patients (6.7%) were not treated according to national guidelines (>70 years and Garden 3-4) and were treated with cannulated screws due to co-morbidities. 4 (40.0%) of these were later re-operated. The remaining 138 patients (93.3%) were treated according to the national guidelines and 37 (26.8%) were later re-operated. Final poster will present data on patient characteristics.
Conclusions: The re-operation rate after femoral neck fracture treated with cannulated screws was 27.7 %. Higher re- operation rates were found in patients ¡Ü 70 years and in the few patients (6.7%) not treated according to national guidelines.
Carsten M. Mølgaard, Sinan Said
dept. of Occupational & Physiotherapy, Aalborg University Hospital; Orthopaedic dept., Aalborg University Hospital
Background: There is a wide range of different techniques in the treatment of patella luxation. The Elmslie-Trillat procedure is one of the methods, which have earlier been used to stabilize the patella by correcting the mechanical axis. There is however, a lack of knowledge in how this works for patients in the long run.
Purpose / Aim of Study: The purpose is to investigate the level of knee function and satisfaction among patients after the Elmslie-Trillat- procedure.
Materials and Methods: 100 patients were treated with the Elmslie-Trillat procedure at Aalborg University Hospital in the period 2000 to 2012. Data retrieval by systematically going through all charts with the procedure codes KNGE09, KNLG89, KNGH72, KNGK79 and KNGK59. 27 patients were present at follow up in 2015. A physical examination was performed and questionnaires were answered. The applied score-systems were: Kujala, IKCD, Tegner, Lysholm, SANE.
Findings / Results: 27 patients were present at the time of follow up; 20 females and 7 males. Average age at the time of the procedure was 20,2 years, and average age at follow up was 29,9 years. The Kujala-score showed “excellent” or “good” results with 18,5% of the patients, The Lysholm-score showed “excellent” or “good” results with 22,2% of the patients. The IKDC-average-score was 54,4. The Tegner-score was 6,34 before the procedure and 8,04 after the procedure, hereby 1,70 points higher, meaning a reduced level of function. The SANE-average-score was 6,23. 74,1% had a satisfaction- score above 5 and would go through the same procedure again. 37,0% had experienced reluxation by the time of the follow up.
Conclusions: The Elmslie-Trillat procedure has a relatively high satisfaction level according to the patients. Clinical outcome and knee function were however lower than expected.
dept. of Occupational & Physiotherapy, Aalborg University Hospital; Orthopaedic dept., Aalborg University Hospital
Background: There is a wide range of different techniques in the treatment of patella luxation. The Elmslie-Trillat procedure is one of the methods, which have earlier been used to stabilize the patella by correcting the mechanical axis. There is however, a lack of knowledge in how this works for patients in the long run.
Purpose / Aim of Study: The purpose is to investigate the level of knee function and satisfaction among patients after the Elmslie-Trillat- procedure.
Materials and Methods: 100 patients were treated with the Elmslie-Trillat procedure at Aalborg University Hospital in the period 2000 to 2012. Data retrieval by systematically going through all charts with the procedure codes KNGE09, KNLG89, KNGH72, KNGK79 and KNGK59. 27 patients were present at follow up in 2015. A physical examination was performed and questionnaires were answered. The applied score-systems were: Kujala, IKCD, Tegner, Lysholm, SANE.
Findings / Results: 27 patients were present at the time of follow up; 20 females and 7 males. Average age at the time of the procedure was 20,2 years, and average age at follow up was 29,9 years. The Kujala-score showed “excellent” or “good” results with 18,5% of the patients, The Lysholm-score showed “excellent” or “good” results with 22,2% of the patients. The IKDC-average-score was 54,4. The Tegner-score was 6,34 before the procedure and 8,04 after the procedure, hereby 1,70 points higher, meaning a reduced level of function. The SANE-average-score was 6,23. 74,1% had a satisfaction- score above 5 and would go through the same procedure again. 37,0% had experienced reluxation by the time of the follow up.
Conclusions: The Elmslie-Trillat procedure has a relatively high satisfaction level according to the patients. Clinical outcome and knee function were however lower than expected.
Niels Jørgen Thomsen, Kim Lyngby Mikkelsen, Christian Wong
Ortopædkirurgisk afd., Hvidovre Hospital; , Patienterstatningen; Ortopædkirurgisk afd., Hvidovre Hospital
Background: Proximal femoral fractures are one of the most common type of fractures worldwide, and are also a large portion of claims in the Patient Compensation Association (PCA)
Purpose / Aim of Study: The purpose of the study was to investigate the claims an desicions on proximal femoral fractures made to the PCA from 2006-13. We wanted to examine whether there were an association between types of fractures, severity of the complications, experience level of the physician and the awarded compensation.
Materials and Methods: The PCA database of was searched for ICD-10 diagnoses DS70.0, DS72.0, DS72.1 and DS72.2. All age groups were included. A root cause analysis was performed on the data.
Findings / Results: The number of claims was 723 with a male:female ratio of 1:3. The average age was 65.9 years. The distribution was 3.5:1.5:1:1 for Collum (CF), pertrochanteric (PF) , subtrochanteric (SF) and ‘contusion’ fractures. The main complications were improper or insufficient treatment or missed diagnosis. Pseudoarthrosis was overrepresented for fractures initially diagnosed as contusion, infection for PF, and CF had cases of nerve and vessel injury. Based on DPA data, the level of competence was distributed between staff members and junior residents in the ratio 5:1. One third of all claims were acknowledged with a distribution of Lex Maria into two almost equal groups; no or light to moderate damage. 7% suffered severe damage or death. A total of 3,94 mio EUR was awarded with an avaerage of 12.300 EU .
Conclusions: The acknowledged claims indicate a need for education on all levels of competence, as the highest level of experience was over represented. One should have: Special attention for the STF, as missed diagnosis was largely over represented, and increased attention in surgical technique for CF due to severe iatrogenic damage.
Ortopædkirurgisk afd., Hvidovre Hospital; , Patienterstatningen; Ortopædkirurgisk afd., Hvidovre Hospital
Background: Proximal femoral fractures are one of the most common type of fractures worldwide, and are also a large portion of claims in the Patient Compensation Association (PCA)
Purpose / Aim of Study: The purpose of the study was to investigate the claims an desicions on proximal femoral fractures made to the PCA from 2006-13. We wanted to examine whether there were an association between types of fractures, severity of the complications, experience level of the physician and the awarded compensation.
Materials and Methods: The PCA database of was searched for ICD-10 diagnoses DS70.0, DS72.0, DS72.1 and DS72.2. All age groups were included. A root cause analysis was performed on the data.
Findings / Results: The number of claims was 723 with a male:female ratio of 1:3. The average age was 65.9 years. The distribution was 3.5:1.5:1:1 for Collum (CF), pertrochanteric (PF) , subtrochanteric (SF) and ‘contusion’ fractures. The main complications were improper or insufficient treatment or missed diagnosis. Pseudoarthrosis was overrepresented for fractures initially diagnosed as contusion, infection for PF, and CF had cases of nerve and vessel injury. Based on DPA data, the level of competence was distributed between staff members and junior residents in the ratio 5:1. One third of all claims were acknowledged with a distribution of Lex Maria into two almost equal groups; no or light to moderate damage. 7% suffered severe damage or death. A total of 3,94 mio EUR was awarded with an avaerage of 12.300 EU .
Conclusions: The acknowledged claims indicate a need for education on all levels of competence, as the highest level of experience was over represented. One should have: Special attention for the STF, as missed diagnosis was largely over represented, and increased attention in surgical technique for CF due to severe iatrogenic damage.
Casper Bindzus Foldager, Morten Lykke Olesen, Bjørn Borsøe Christensen, Kris Hede, Martin Lind, Johan Palmfeldt
Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Sports Trauma Clinic, Aarhus University Hospital; Research Unit for Molecular Medicine, Aarhus University
Background: The early regenerative processes are believed to be important determinants for cartilage repair outcome.
Purpose / Aim of Study: The aim was to investigate the mechanisms in early cartilage repair using microfracture with and without platelet-rich plasma (PRP) in a chronic cartilage defect model in minipig knees.
Materials and Methods: Six skeletally mature Göttingen minipigs received two cylindrical full-thickness cartilage defects (Ø=6mm) in the trochlea in each knee. The defects were allowed to become chronic for 5 weeks before they were treated with microfracture with autologous 2mL PRP supplementation (Zimmer Biomet) or saline. Animals were followed for 3 (n=3) and 12 (n=3) days. Normal cartilage, debrided cartilage from chronic defects, and repair tissue at sacrifice were collected for histological, immunohistochemical, and protein mass spectrometry (MS) analyses. Peptides were analyzed by liquid chromatography (LC) tandem MS. Cluster 3.0, Java Tree View and Panther were used for clustering, visualization and analysis.
Findings / Results: Four days post-treatment a blood clot was formed with red blood cells, loose matrix, and very few nucleated cells. Twelve days post-treatment a vascularized, denser extracellular matrix with high cellularity had replaced the blood clot. Of the 1213 proteins identified, 475 were expressed in all samples. Protein clustering grouped samples from the same time-points to highest degree (higher expression similarity). Proteins selectively expressed in the PRP group were predominantly involved in metabolic processes. The collagen composition in early cartilage repair (day 12) included types 1A1, 3A1, 6A1-3, 12A1 and 18A1 (endostatin) compared with types 2A1, 9A1 and 11A1 in normal cartilage.
Conclusions: Complex processes in early cartilage repair can be identified and visualized using repair tissue proteome analyses.
Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Sports Trauma Clinic, Aarhus University Hospital; Research Unit for Molecular Medicine, Aarhus University
Background: The early regenerative processes are believed to be important determinants for cartilage repair outcome.
Purpose / Aim of Study: The aim was to investigate the mechanisms in early cartilage repair using microfracture with and without platelet-rich plasma (PRP) in a chronic cartilage defect model in minipig knees.
Materials and Methods: Six skeletally mature Göttingen minipigs received two cylindrical full-thickness cartilage defects (Ø=6mm) in the trochlea in each knee. The defects were allowed to become chronic for 5 weeks before they were treated with microfracture with autologous 2mL PRP supplementation (Zimmer Biomet) or saline. Animals were followed for 3 (n=3) and 12 (n=3) days. Normal cartilage, debrided cartilage from chronic defects, and repair tissue at sacrifice were collected for histological, immunohistochemical, and protein mass spectrometry (MS) analyses. Peptides were analyzed by liquid chromatography (LC) tandem MS. Cluster 3.0, Java Tree View and Panther were used for clustering, visualization and analysis.
Findings / Results: Four days post-treatment a blood clot was formed with red blood cells, loose matrix, and very few nucleated cells. Twelve days post-treatment a vascularized, denser extracellular matrix with high cellularity had replaced the blood clot. Of the 1213 proteins identified, 475 were expressed in all samples. Protein clustering grouped samples from the same time-points to highest degree (higher expression similarity). Proteins selectively expressed in the PRP group were predominantly involved in metabolic processes. The collagen composition in early cartilage repair (day 12) included types 1A1, 3A1, 6A1-3, 12A1 and 18A1 (endostatin) compared with types 2A1, 9A1 and 11A1 in normal cartilage.
Conclusions: Complex processes in early cartilage repair can be identified and visualized using repair tissue proteome analyses.
Anette Enemark Larsen, Hanne Pedersen Hundsholdt, Ida-Marie Lykke Larsen, Julie Marie Eriksen, Maria Holse Jørgensen
Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol
Background: In Denmark 8,500 primary knee replacements (KR) are inserted annually for a total cost of 700 million dkr. Data is collected on these patients (ptt), but not on the patients self-perceived everyday life or their satisfaction with the level of functioning and well-being.
Purpose / Aim of Study: The aim of this study was to explore the well-being and self-perceived satisfaction on everyday life of KR ptt 5 years after a primary KR.
Materials and Methods: 34 KR ptt, av age 69.9 (55-85) were contacted from a hospital in region H, of which 28 participated, 14 men; 20 retired /7 working. Ptt were consecutively included based on operation dates from 1.feb. 2011 onwards. Ptt completed the WHO5 well-being index followed by an interview with the Canadian Occupational Performance Measure (COPM). WHO5 well-being index scores the general well-being and the degree of positive experiences over the past two weeks. COPM is an interview-based measurement, where ptt identify occupational problems (OP) in their everyday live within Self-care, Productivity and Leisure. The ptt score the OP on 1-10 point scales regarding importance, performance and satisfaction with performance.
Findings / Results: 24 of the included ptt had a satisfactory daily life and high well- being.15 scored both the performance and satisfaction of their OP low, while their WHO5 score was on indicating a good well-being. More than ½ of the 109 reported OP were in the category of self-care with 24% within Functional mobility, whereas the sub-category with fewest identified OP was Work. The av. score of performance and satisfaction on Functional mobility was low, however, rated as the least important while Work was rated as the most important. 2 ptt rated low or very low well-being as well as very low performance and satisfaction.
Conclusions: In order to understand the effect of KR, COPM is effective.
Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol; Institut for Fysioterapi og Ergoterapi, Professionshøjskolen Metropol
Background: In Denmark 8,500 primary knee replacements (KR) are inserted annually for a total cost of 700 million dkr. Data is collected on these patients (ptt), but not on the patients self-perceived everyday life or their satisfaction with the level of functioning and well-being.
Purpose / Aim of Study: The aim of this study was to explore the well-being and self-perceived satisfaction on everyday life of KR ptt 5 years after a primary KR.
Materials and Methods: 34 KR ptt, av age 69.9 (55-85) were contacted from a hospital in region H, of which 28 participated, 14 men; 20 retired /7 working. Ptt were consecutively included based on operation dates from 1.feb. 2011 onwards. Ptt completed the WHO5 well-being index followed by an interview with the Canadian Occupational Performance Measure (COPM). WHO5 well-being index scores the general well-being and the degree of positive experiences over the past two weeks. COPM is an interview-based measurement, where ptt identify occupational problems (OP) in their everyday live within Self-care, Productivity and Leisure. The ptt score the OP on 1-10 point scales regarding importance, performance and satisfaction with performance.
Findings / Results: 24 of the included ptt had a satisfactory daily life and high well- being.15 scored both the performance and satisfaction of their OP low, while their WHO5 score was on indicating a good well-being. More than ½ of the 109 reported OP were in the category of self-care with 24% within Functional mobility, whereas the sub-category with fewest identified OP was Work. The av. score of performance and satisfaction on Functional mobility was low, however, rated as the least important while Work was rated as the most important. 2 ptt rated low or very low well-being as well as very low performance and satisfaction.
Conclusions: In order to understand the effect of KR, COPM is effective.
Charlotte Packroff Stenqvist, Susanne van der Mark
Department of Orthopedic Surgery, Bispebjerg Hospital; Department of Orthopedic Surgery, Bispebjerg Hospital
Background: Important predictors for death in frail hip fracture patients are anemia, cognitive impairment, prolonged delirium, post- operative infections and age ≥ 85 years. Admittance from a nursing home, a high- ASA score, and frailty have also been shown to be independent predictors of mortality.
Purpose / Aim of Study: The purpose of this study is to evaluate the effect of Orthogeriatrics at nursing home residents admitted with a hip fracture. Primary outcome is mortality in-hospital and after one, three and 12 months.
Materials and Methods: This is a retrospective clinical cohort study. The intervention group consists of all patients admitted from December 1, 2009 to December 1, 2011 (n= 993). The historic control group was admitted from June 1, 2007 to June 1, 2009 before the implementation of orthogeriatrics (n=989). If patients were admitted twice during the study period due to bilateral fractures, second admission was not included. There were no other exclusion criteria or any randomization.
Findings / Results: Our data show significantly increasing ASA scores over time reflecting increasing frailty and comorbidity among the hip fracture patients. In our intervention group, a multivariate analysis correcting for age, gender, and ASA score shows significantly reduced mortality as well in-hospital (OR 0.35), as after 30 (OR 0.66) and 90 days (OR 0.72) and 1-year (OR 0.79) despite only 50% of the group having received geriatric assessment. Patients from nursing homes had no significant decreasing mortality at any time. Our intervention population consists of 23% (218/928) nursing home residents.
Conclusions: There has been a tradition to discharge nursing home residents early, but the increasing comorbidity among these patients and decreasing skills at the step down facilities call for a change in management for these weak patients.
Department of Orthopedic Surgery, Bispebjerg Hospital; Department of Orthopedic Surgery, Bispebjerg Hospital
Background: Important predictors for death in frail hip fracture patients are anemia, cognitive impairment, prolonged delirium, post- operative infections and age ≥ 85 years. Admittance from a nursing home, a high- ASA score, and frailty have also been shown to be independent predictors of mortality.
Purpose / Aim of Study: The purpose of this study is to evaluate the effect of Orthogeriatrics at nursing home residents admitted with a hip fracture. Primary outcome is mortality in-hospital and after one, three and 12 months.
Materials and Methods: This is a retrospective clinical cohort study. The intervention group consists of all patients admitted from December 1, 2009 to December 1, 2011 (n= 993). The historic control group was admitted from June 1, 2007 to June 1, 2009 before the implementation of orthogeriatrics (n=989). If patients were admitted twice during the study period due to bilateral fractures, second admission was not included. There were no other exclusion criteria or any randomization.
Findings / Results: Our data show significantly increasing ASA scores over time reflecting increasing frailty and comorbidity among the hip fracture patients. In our intervention group, a multivariate analysis correcting for age, gender, and ASA score shows significantly reduced mortality as well in-hospital (OR 0.35), as after 30 (OR 0.66) and 90 days (OR 0.72) and 1-year (OR 0.79) despite only 50% of the group having received geriatric assessment. Patients from nursing homes had no significant decreasing mortality at any time. Our intervention population consists of 23% (218/928) nursing home residents.
Conclusions: There has been a tradition to discharge nursing home residents early, but the increasing comorbidity among these patients and decreasing skills at the step down facilities call for a change in management for these weak patients.
Julie W. M. Egholm, Bolette Pedersen, Kristian Oppedal, Jes Bruun Lauritzen, Bjørn Madsen, Hanne Tønnesen
Orthopedic Dept, Hospital of Southern Jutland, University of Southern Denmark; WHO-CC, Clin Health Promotion Centre, Bispebjerg-Frederiksberg Hospita, University of Copenhagen; Alcohol and Drug Research Western Norway, Stavanger University Hospital, Norway; Dept Orthopaedic Surgery, Bispebjerg-Frederiksberg Hospital, University of Copenhagen; Dept Orthopaedic Surgery, Hvidovre Hospital, University of Copenhagen; Clin Health Promotion Centre, Dept Health Sciences, Lund University, Sweden
Background: Patients with high alcohol consumption have increased risk of postoperative complications. Preoperative alcohol cessation intervention has been shown to halve the frequency of postoperative complications. However, it still remains unexplored whether alcohol cessation during and after surgery has an impact on the prevalence of postoperative complications.
Purpose / Aim of Study: The aim of this study was to evaluate the effect of a new gold standard program for alcohol cessation intervention in the peri- and postoperative period.
Materials and Methods: The present study is designed as a randomized clinical multi-center study. A total number of 70 patients with an ankle fracture witch requires osteosynthesis and a excessive alcohol intake were included and randomly allocated to either standard care or a 6-weeks gold standard program with the aim of alcohol abstinence peri- and postoperatively. The structured patient education program involved weekly intervention at the orthopedic outpatient clinic. Furthermore, patients were provided with thiamine and B-vitamins, prophylaxis and treatment for alcohol withdrawal symptom and disulfiram to support abstinence. Biochemical validation of alcohol intake was done at the weekly intervention meetings and follow-up visits after 6 weeks and 3, 6, 9 and 12 months. The main outcome measures were postoperative complications, alcohol intake and cost-effectiveness.
Findings / Results: The results on postoperative complications, alcohol consumption and cost-effectiveness will be presented at the conference.
Conclusions: The study will show if the 6-weeks gold standard program can reduce postoperative complications after emergency surgery. The results will be of relevance for the individual patient as well as for the society at large.
Orthopedic Dept, Hospital of Southern Jutland, University of Southern Denmark; WHO-CC, Clin Health Promotion Centre, Bispebjerg-Frederiksberg Hospita, University of Copenhagen; Alcohol and Drug Research Western Norway, Stavanger University Hospital, Norway; Dept Orthopaedic Surgery, Bispebjerg-Frederiksberg Hospital, University of Copenhagen; Dept Orthopaedic Surgery, Hvidovre Hospital, University of Copenhagen; Clin Health Promotion Centre, Dept Health Sciences, Lund University, Sweden
Background: Patients with high alcohol consumption have increased risk of postoperative complications. Preoperative alcohol cessation intervention has been shown to halve the frequency of postoperative complications. However, it still remains unexplored whether alcohol cessation during and after surgery has an impact on the prevalence of postoperative complications.
Purpose / Aim of Study: The aim of this study was to evaluate the effect of a new gold standard program for alcohol cessation intervention in the peri- and postoperative period.
Materials and Methods: The present study is designed as a randomized clinical multi-center study. A total number of 70 patients with an ankle fracture witch requires osteosynthesis and a excessive alcohol intake were included and randomly allocated to either standard care or a 6-weeks gold standard program with the aim of alcohol abstinence peri- and postoperatively. The structured patient education program involved weekly intervention at the orthopedic outpatient clinic. Furthermore, patients were provided with thiamine and B-vitamins, prophylaxis and treatment for alcohol withdrawal symptom and disulfiram to support abstinence. Biochemical validation of alcohol intake was done at the weekly intervention meetings and follow-up visits after 6 weeks and 3, 6, 9 and 12 months. The main outcome measures were postoperative complications, alcohol intake and cost-effectiveness.
Findings / Results: The results on postoperative complications, alcohol consumption and cost-effectiveness will be presented at the conference.
Conclusions: The study will show if the 6-weeks gold standard program can reduce postoperative complications after emergency surgery. The results will be of relevance for the individual patient as well as for the society at large.
Kristine Husum Münter, Christopher Clemmesen , Nicolai Bang Foss, Henrik Palm, Morten Tange Kristensen
Anaesthesiology, Hvidovre Hospital; Anaesthesiology, Hvidovre Hospital; Anaesthesiology, Hvidovre Hospital; Orthopaedic Surgery, Hvidovre Hospital; Physiotherapy, Hvidovre Hospital
Background: The patient’s ability to complete their planned physiotherapy session after hip fracture (HF) surgery has been proposed as an independent predictor for achieving basic mobility independency upon hospital discharge. However, knowledge of factors limiting is sparse.
Purpose / Aim of Study: To examine patient reported factors limiting ability to complete planned physiotherapy sessions as well as limitations for not achieving independency in basic mobility early after HF surgery.
Materials and Methods: 204 consecutive patients with a HF (47 admitted from a nursing home); mean age of 80 years, and treated in accordance with a multimodal enhanced program. The Cumulated Ambulation Score (CAS) was used to evaluate the patient’s independency in three basic mobility activities: getting in and out of bed, sit-to-stand-to-sit from a chair with arms and indoor walking with an aid. Limitations for patients not achieving a full CAS score or inability to complete their planned physiotherapy sessions were noted by physiotherapists on postoperative day 1-3.
Findings / Results: More than 85% and 42% of patients, respectively, did not achieve an independent CAS level and did not fully complete their planned physiotherapy on all three days, and with fatigue and hip fracture-related pain as the most frequent reported reasons. At hospital discharge (median [IQR] day 10 [6-14]), only 54% of patients had regained their pre-fracture CAS level.
Conclusions: Based on the patient’s perception, fatigue and pain are the most frequent limitations for patients not achieving independent basic mobility and not completing physiotherapy, early after hip fracture surgery, despite following an enhanced recovery program. This raises questions whether multimodal perioperative hip fracture programs can be further optimized to enhance the early recovery of these frail patients.
Anaesthesiology, Hvidovre Hospital; Anaesthesiology, Hvidovre Hospital; Anaesthesiology, Hvidovre Hospital; Orthopaedic Surgery, Hvidovre Hospital; Physiotherapy, Hvidovre Hospital
Background: The patient’s ability to complete their planned physiotherapy session after hip fracture (HF) surgery has been proposed as an independent predictor for achieving basic mobility independency upon hospital discharge. However, knowledge of factors limiting is sparse.
Purpose / Aim of Study: To examine patient reported factors limiting ability to complete planned physiotherapy sessions as well as limitations for not achieving independency in basic mobility early after HF surgery.
Materials and Methods: 204 consecutive patients with a HF (47 admitted from a nursing home); mean age of 80 years, and treated in accordance with a multimodal enhanced program. The Cumulated Ambulation Score (CAS) was used to evaluate the patient’s independency in three basic mobility activities: getting in and out of bed, sit-to-stand-to-sit from a chair with arms and indoor walking with an aid. Limitations for patients not achieving a full CAS score or inability to complete their planned physiotherapy sessions were noted by physiotherapists on postoperative day 1-3.
Findings / Results: More than 85% and 42% of patients, respectively, did not achieve an independent CAS level and did not fully complete their planned physiotherapy on all three days, and with fatigue and hip fracture-related pain as the most frequent reported reasons. At hospital discharge (median [IQR] day 10 [6-14]), only 54% of patients had regained their pre-fracture CAS level.
Conclusions: Based on the patient’s perception, fatigue and pain are the most frequent limitations for patients not achieving independent basic mobility and not completing physiotherapy, early after hip fracture surgery, despite following an enhanced recovery program. This raises questions whether multimodal perioperative hip fracture programs can be further optimized to enhance the early recovery of these frail patients.
Morten Torrild Schmiegelow, Nikolaj Sode, Troels Riis, Jes Bruun Lauritzen, Lindberg-Larsen Martin
Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital
Background: Re-operation rates after below-knee (BKA), through-knee and above-knee amputations (AKA) within 90 days has been reported to be 30%, 34% and 9% respectively in our institution (feb.2009-feb.2013) (Sode 2013). 90 days mortality rates were 36% and 40% after through knee and AKA (Buch 2013).These results led to change in practice, with restricted indications for the through-knee amputation procedure.
Purpose / Aim of Study: To investigate re-operation rates and mortality of the major lower extremity amputations performed in our institution after change of practice.
Materials and Methods: Cases were included in the period Jan 1, 2014 to Dec 31, 2015. Mortality and re-operations within 90 days of the index amputation were registered through examination of medical records.
Findings / Results: 116 amputations in 115 patients were performed. 95 AKA and 21 BKA and no through-knee amputations. Mean age was 69 years for BKA and 78 years for AKA. 85.7% of the BKA and 59% of the AKA were male. 52% of the BKA patients and 67% of the AKA patients were current or previous smokers. Mean Charlson comorbidity score was 4.8 in the BKA patients and 4.2 in the AKA patients. The re-operation rate after BKA was 33.3% (CI 17-55) (6 soft tissue revisions and 1 re-amputation) caused by necrosis (n=4) and infection (n=3). The re-operation rate after AKA was 6.3% (CI 3-13) (2 re-amputations, 4 soft tissue revisions) caused by necrosis (n=2) and infection (n=4). The 90-days mortality rate was 0% after BKA and 44% (CI 35-54) after AKA.
Conclusions: The re-operation rate of 33% after BKA is at the same level as before change of practice and the re-operation rate of 6.3% after AKA is slightly lower. Most of patients previously offered a through-knee amputation are now offered an AKA with a lower re-operation rate. However, the mortality rate of 44% after AKA is the major challenge.
Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital; Orthopedic, Bispebjerg Hospital
Background: Re-operation rates after below-knee (BKA), through-knee and above-knee amputations (AKA) within 90 days has been reported to be 30%, 34% and 9% respectively in our institution (feb.2009-feb.2013) (Sode 2013). 90 days mortality rates were 36% and 40% after through knee and AKA (Buch 2013).These results led to change in practice, with restricted indications for the through-knee amputation procedure.
Purpose / Aim of Study: To investigate re-operation rates and mortality of the major lower extremity amputations performed in our institution after change of practice.
Materials and Methods: Cases were included in the period Jan 1, 2014 to Dec 31, 2015. Mortality and re-operations within 90 days of the index amputation were registered through examination of medical records.
Findings / Results: 116 amputations in 115 patients were performed. 95 AKA and 21 BKA and no through-knee amputations. Mean age was 69 years for BKA and 78 years for AKA. 85.7% of the BKA and 59% of the AKA were male. 52% of the BKA patients and 67% of the AKA patients were current or previous smokers. Mean Charlson comorbidity score was 4.8 in the BKA patients and 4.2 in the AKA patients. The re-operation rate after BKA was 33.3% (CI 17-55) (6 soft tissue revisions and 1 re-amputation) caused by necrosis (n=4) and infection (n=3). The re-operation rate after AKA was 6.3% (CI 3-13) (2 re-amputations, 4 soft tissue revisions) caused by necrosis (n=2) and infection (n=4). The 90-days mortality rate was 0% after BKA and 44% (CI 35-54) after AKA.
Conclusions: The re-operation rate of 33% after BKA is at the same level as before change of practice and the re-operation rate of 6.3% after AKA is slightly lower. Most of patients previously offered a through-knee amputation are now offered an AKA with a lower re-operation rate. However, the mortality rate of 44% after AKA is the major challenge.
Kristine Andersen, Kamille Fogh, Henrik Eshøj, Klaus Bak
Sports Clininc, Aleris-Hamlet Parken, Copenhagen; Sports Clinic, Aleris-Hamlet Parken, Copenhagen; Department of Sports Science and Clinical Biomechanics,, University of Southern Denmark; Sport Clinic, Aleris-Hamlet Parken, Copenhagen
Background: With increasing evolution of techniques, implant strength, suture quality, and proper patient selection, the results of arthroscopic Bankart repair are more promising. In a previous study on the same cohort with a median follow-up of 20 months the recurrence rate was 5.4 %. It is known from other studies that there is an increase in failure rate with time.
Purpose / Aim of Study: The aim of this study was to evaluate the results of primary and revision arthroscopic Bankart repairs in an active population with minimum 3 years follow-up.
Materials and Methods: Sixty-five consecutive patients underwent arthroscopic Bankart repair from 2008-2014. Of these 36 (55%) were available for a follow-up evaluation at a median of 75 months (38-92) follow-up. There were 23 males and 13 females (median age 31 (14-58) years). Duration of symptoms was median 26 (1-144) months. 29 were primary repairs while 7 were revision cases (median 3 previous procedures (1-4)). There were 23 athletes and 13 non-athletes. A knotless anchor (Pushlock, Arthrex) was used together with a FibreWire #2 (Arthrex). The median number of anchors used was 2 (1-3). One surgeon performed all operations. Follow-up evaluation was performed by registration of recurrent instability besides use of the patient reported outcomes Western Ontario Instability Score (WOSI) and Oxford Shoulder Score (OSS).
Findings / Results: 36 patients were available at a median of 75 months (38-92) follow-up. There were 23 males and 13 females (median age 31 (14-58) years) of which 23 were athletic active. Duration of symptoms was median 26 (1-144) months. 29 patients had primary repairs while 7 were revision cases (median 3 previous procedures (1-4)). Six patients (16.7 %) had an experience of recurrent instability. Four of these (13.8 %) occurred in primary repairs and two in revision cases (28.6 %). One patient(2.8 %) had a poor result due to chondrolysis. Moreover, the follow-up scores of WOSI and OSS was median 84 (28-99.8) % and 16 (12- 28), respectively.
Conclusions: The rate of failure after arthroscopic Bankart repair with a knotless anchor increases with time, but the results of primary arthroscopic Bankart repair is acceptable at a median of 6.5 years follow-up in a relative active population. Though, as expected, the risk of recurrence is greater in revision cases.
Sports Clininc, Aleris-Hamlet Parken, Copenhagen; Sports Clinic, Aleris-Hamlet Parken, Copenhagen; Department of Sports Science and Clinical Biomechanics,, University of Southern Denmark; Sport Clinic, Aleris-Hamlet Parken, Copenhagen
Background: With increasing evolution of techniques, implant strength, suture quality, and proper patient selection, the results of arthroscopic Bankart repair are more promising. In a previous study on the same cohort with a median follow-up of 20 months the recurrence rate was 5.4 %. It is known from other studies that there is an increase in failure rate with time.
Purpose / Aim of Study: The aim of this study was to evaluate the results of primary and revision arthroscopic Bankart repairs in an active population with minimum 3 years follow-up.
Materials and Methods: Sixty-five consecutive patients underwent arthroscopic Bankart repair from 2008-2014. Of these 36 (55%) were available for a follow-up evaluation at a median of 75 months (38-92) follow-up. There were 23 males and 13 females (median age 31 (14-58) years). Duration of symptoms was median 26 (1-144) months. 29 were primary repairs while 7 were revision cases (median 3 previous procedures (1-4)). There were 23 athletes and 13 non-athletes. A knotless anchor (Pushlock, Arthrex) was used together with a FibreWire #2 (Arthrex). The median number of anchors used was 2 (1-3). One surgeon performed all operations. Follow-up evaluation was performed by registration of recurrent instability besides use of the patient reported outcomes Western Ontario Instability Score (WOSI) and Oxford Shoulder Score (OSS).
Findings / Results: 36 patients were available at a median of 75 months (38-92) follow-up. There were 23 males and 13 females (median age 31 (14-58) years) of which 23 were athletic active. Duration of symptoms was median 26 (1-144) months. 29 patients had primary repairs while 7 were revision cases (median 3 previous procedures (1-4)). Six patients (16.7 %) had an experience of recurrent instability. Four of these (13.8 %) occurred in primary repairs and two in revision cases (28.6 %). One patient(2.8 %) had a poor result due to chondrolysis. Moreover, the follow-up scores of WOSI and OSS was median 84 (28-99.8) % and 16 (12- 28), respectively.
Conclusions: The rate of failure after arthroscopic Bankart repair with a knotless anchor increases with time, but the results of primary arthroscopic Bankart repair is acceptable at a median of 6.5 years follow-up in a relative active population. Though, as expected, the risk of recurrence is greater in revision cases.
Anders Kjærsgaard Valen, Karen Toftdahl Bjørnholdt, Bent Lund
Department of Orthopedic Surgery, Regional Hospital of Horsens; Department of Orthopedic Surgery, Regional Hospital of Horsens; Department of Orthopedic Surgery, Regional Hospital of Horsens
Background: Traumatic head injuries account for frequent visits in Danish Emergency Departments (ER) with more than 20.000 visits yearly and 25 daily hospital admissions. An estimated 90 per cent have mild head injury (MHI) with GCS 14-15. The diagnostic approach has been notoriously challenging especially regarding the use of CT-C. In 2013 the blood test S-100b was introduced in the revised guidelines regarding management of these patients. S- 100b is designed to rule out intracranial haemorrhage in selected adult patients with MHI thereby possibly avoiding excessive use of CT-scans. The test is widely used in many European countries. However, it remains unclear to what extent it is being used in Danish ERs.
Purpose / Aim of Study: An observational study was conducted to quantify the number of Danish ERs using S- 100b. In addition, the yearly number of requested tests was found.
Materials and Methods: During March 2016 the major ERs in Denmark (n=30) were contacted regarding their ability to use S-100b. The departments that were able to use S-100b were subsequently contacted concerning how many tests were made during 2015.
Findings / Results: Response rate was 100 per cent. 20 per cent (6/30) of the ERs were able to do in- house analysis of blood work for S-100b. Some 16,7 per cent (5/30) were able to request the test and have it transported to larger nearby hospitals for analysis. However, this opportunity was not used. On average the six ERs that were able to use S-100b requested 335 tests during 2015.
Conclusions: The results indicate that Danish ERs do not routinely use S-100b despite recent recommendations. The ERs able to request the test use it to a limited extent. The reasons for this reluctance should be further investigated. More studies are yet to be made to clarify whether the use of S-100b results in less CT-scans and admissions in a Danish setting.
Department of Orthopedic Surgery, Regional Hospital of Horsens; Department of Orthopedic Surgery, Regional Hospital of Horsens; Department of Orthopedic Surgery, Regional Hospital of Horsens
Background: Traumatic head injuries account for frequent visits in Danish Emergency Departments (ER) with more than 20.000 visits yearly and 25 daily hospital admissions. An estimated 90 per cent have mild head injury (MHI) with GCS 14-15. The diagnostic approach has been notoriously challenging especially regarding the use of CT-C. In 2013 the blood test S-100b was introduced in the revised guidelines regarding management of these patients. S- 100b is designed to rule out intracranial haemorrhage in selected adult patients with MHI thereby possibly avoiding excessive use of CT-scans. The test is widely used in many European countries. However, it remains unclear to what extent it is being used in Danish ERs.
Purpose / Aim of Study: An observational study was conducted to quantify the number of Danish ERs using S- 100b. In addition, the yearly number of requested tests was found.
Materials and Methods: During March 2016 the major ERs in Denmark (n=30) were contacted regarding their ability to use S-100b. The departments that were able to use S-100b were subsequently contacted concerning how many tests were made during 2015.
Findings / Results: Response rate was 100 per cent. 20 per cent (6/30) of the ERs were able to do in- house analysis of blood work for S-100b. Some 16,7 per cent (5/30) were able to request the test and have it transported to larger nearby hospitals for analysis. However, this opportunity was not used. On average the six ERs that were able to use S-100b requested 335 tests during 2015.
Conclusions: The results indicate that Danish ERs do not routinely use S-100b despite recent recommendations. The ERs able to request the test use it to a limited extent. The reasons for this reluctance should be further investigated. More studies are yet to be made to clarify whether the use of S-100b results in less CT-scans and admissions in a Danish setting.
Niels Henrik Søe, David Eckerdal, Marianne Nygaard, Nina Venden-Jensen, Lars B.Dahlin
Handsection, Department of Orthopaedic T, Herlev and Gentofte University Hospital,Copenhagen,Denmark; Department of Hand Surgery, Skåne University Hospital,Malmø,Sweden; Department of Hand Surgery, Skåne University Hospital,Malmø,Sweden; Department of Operation, Anaesthesiology and Day Care Surgery Q, Herlev and Gentofte University Hospital ,Copenhagen,Denmark; Department of Translational Medicine – Hand Surgery, Lund University,Malmø,Sweden
Background: Pain from the wrist can have different causes, one of these being scapho- trapezio-trapezoid (STT) joint osteoarthritis. Treatment for this disorder is typically conservative, but a vast number of surgical treatments also exist. One of the available surgical options is the use of an implant as a spacer. Some of these implants are made of Pyrolytic carbon with the scaphoid trapeziodeum interposition implant (STPI) being one of these.
Purpose / Aim of Study: The aim was to evaluate the outcome of surgical treatment of STT osteoarthritis with the STPI implant.
Materials and Methods: In this prospective study, patients treated with the STPI between January 2003 and December 2009 were identified and followed over 72 months
Findings / Results: Most patients were satisfied with the results of the procedure. The VAS score at rest decreased, but not at activity, and the grip and pinch strengths increased. However the range of motion (ROM) as well as the modified Mayo wrist score did not improve after the procedure.
Conclusions: Surgical treatment of STT osteoarthritis with implantation with a STPI implant results in a high patient satisfaction and a reduction of pain at rest, but not at activity, as well as an increase in grip and pinch strength, without any change in ROM. Thus, our results suggest that the STPI should be considered as an option to treat STT osteoarthritis.
Handsection, Department of Orthopaedic T, Herlev and Gentofte University Hospital,Copenhagen,Denmark; Department of Hand Surgery, Skåne University Hospital,Malmø,Sweden; Department of Hand Surgery, Skåne University Hospital,Malmø,Sweden; Department of Operation, Anaesthesiology and Day Care Surgery Q, Herlev and Gentofte University Hospital ,Copenhagen,Denmark; Department of Translational Medicine – Hand Surgery, Lund University,Malmø,Sweden
Background: Pain from the wrist can have different causes, one of these being scapho- trapezio-trapezoid (STT) joint osteoarthritis. Treatment for this disorder is typically conservative, but a vast number of surgical treatments also exist. One of the available surgical options is the use of an implant as a spacer. Some of these implants are made of Pyrolytic carbon with the scaphoid trapeziodeum interposition implant (STPI) being one of these.
Purpose / Aim of Study: The aim was to evaluate the outcome of surgical treatment of STT osteoarthritis with the STPI implant.
Materials and Methods: In this prospective study, patients treated with the STPI between January 2003 and December 2009 were identified and followed over 72 months
Findings / Results: Most patients were satisfied with the results of the procedure. The VAS score at rest decreased, but not at activity, and the grip and pinch strengths increased. However the range of motion (ROM) as well as the modified Mayo wrist score did not improve after the procedure.
Conclusions: Surgical treatment of STT osteoarthritis with implantation with a STPI implant results in a high patient satisfaction and a reduction of pain at rest, but not at activity, as well as an increase in grip and pinch strength, without any change in ROM. Thus, our results suggest that the STPI should be considered as an option to treat STT osteoarthritis.
Nørgaard Sandra Lohne, Riber Sara Schødt, Danielsson Frederik Borup, Pedersen Niels Wisbech, Viberg Bjarke Løvbjerg
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: When using elastic stable intramedullary nailing (ESIN) in children’s forearm shaft fractures the surgical approach in the distal radius can either be lateral or dorsal.
Purpose / Aim of Study: The aim was to conduct a systematic review with meta-analysis to compare the lateral approach (LA) and dorsal approach (DA) in terms of complications when treating pediatric radius shaft fractures.
Materials and Methods: On October 14th 2015 an electronic search of PubMed, Embase and Cochrane databases was performed. Two authors independently screened 2234 articles by title, abstract and finally full text of 104 eligible articles was read. Data on demographics and complications was extracted by one author and checked by a second author. Complications were grouped into minor (temporary) or major (permanent or additional surgery) complications. The quality of studies was assessed according to Risk of Bias Assessment Tool for Nonrandomized Studies. Due to the lack of studies directly comparing the two approaches, a meta-analysis could not be performed.
Findings / Results: Sixteen studies (1502 patients) used LA while six studies (416 patients) used DA. There were four prospective studies, 18 retrospective, and the median follow-up ranged from 4.5-54. The quality of the included studies was in general low with high risk of bias and many studies lacked reporting of complications. Concerning major complications deep infection was 0.3% for LA and 6.3% (1 study) for DA, 0.3% permanent nerve palsy for LA, and 2.6% tendon rupture for DA. Concerning minor complications superficial infection was 2.6% for LA and 1.9% for DA, transient nerve palsy 2,9 % for LA and 5.3% for DA.
Conclusions: When deciding between LA and DA for radius shaft fractures treated with ESIN one should consider a 0.3% permanent nerve palsy for LA compared to 2.6% tendon rupture for DA.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: When using elastic stable intramedullary nailing (ESIN) in children’s forearm shaft fractures the surgical approach in the distal radius can either be lateral or dorsal.
Purpose / Aim of Study: The aim was to conduct a systematic review with meta-analysis to compare the lateral approach (LA) and dorsal approach (DA) in terms of complications when treating pediatric radius shaft fractures.
Materials and Methods: On October 14th 2015 an electronic search of PubMed, Embase and Cochrane databases was performed. Two authors independently screened 2234 articles by title, abstract and finally full text of 104 eligible articles was read. Data on demographics and complications was extracted by one author and checked by a second author. Complications were grouped into minor (temporary) or major (permanent or additional surgery) complications. The quality of studies was assessed according to Risk of Bias Assessment Tool for Nonrandomized Studies. Due to the lack of studies directly comparing the two approaches, a meta-analysis could not be performed.
Findings / Results: Sixteen studies (1502 patients) used LA while six studies (416 patients) used DA. There were four prospective studies, 18 retrospective, and the median follow-up ranged from 4.5-54. The quality of the included studies was in general low with high risk of bias and many studies lacked reporting of complications. Concerning major complications deep infection was 0.3% for LA and 6.3% (1 study) for DA, 0.3% permanent nerve palsy for LA, and 2.6% tendon rupture for DA. Concerning minor complications superficial infection was 2.6% for LA and 1.9% for DA, transient nerve palsy 2,9 % for LA and 5.3% for DA.
Conclusions: When deciding between LA and DA for radius shaft fractures treated with ESIN one should consider a 0.3% permanent nerve palsy for LA compared to 2.6% tendon rupture for DA.
Ameneh Mosayebi Marghoob, Karen Toftdahl Bjørnholdt, Mathias Bjerring Ho, Charlotte Hartig Andreasen
Orthopaedic surgery, Horsens Hospital; Orthopaedic surgery, Horsens Hospital; Orthopaedic surgery, Horsens Hospital; Orthopaedic surgery, Horsens Hospital
Background: Perioperative hypothermia, defined as body core temperature below 36 degrees, is associated with complications such as bleeding, wound infection, and myocardial ischaemia. Forced air warming during surgery is not always sufficient to avoid hypothermia in patients undergoing total hip replacement (THR).
Purpose / Aim of Study: To assess the effect of preoperative and postoperative use of active warming blankets on patient core temperature during and after surgery for primary THR.
Materials and Methods: Prospective study of twenty-seven patients undergoing primary THR surgery at Horsens Regional Hospital from April to June 2016. Body temperature was measured rectally on admittance and pre- and postoperatively. Patients receiving pre- and postoperative active warming blankets (Barrier® EasyWarm®) as a supplement to the intraoperative forced air warming (group 1) were compared to patients receiving intraoperative forced air warming only (group 2).
Findings / Results: Nineteen patients (group 1) and so far eight patients (group 2) were included. Preliminary data showed no differences in mean body core temperature or temperature changes pre- and postoperatively between the two groups. Both groups experienced a core temperature decrease from admittance to the immediate preoperative temperature recording. Four patients in each group fell below 36 degrees at the immediate postoperative recording.
Conclusions: The addition of active warming blankets did not contribute significantly to increase the preoperative temperature of these patients, and temperatures below 36 degrees postoperatively were not prevented. More aggressive use of passive and active warming devices should be tried to prevent hypothermia.
Orthopaedic surgery, Horsens Hospital; Orthopaedic surgery, Horsens Hospital; Orthopaedic surgery, Horsens Hospital; Orthopaedic surgery, Horsens Hospital
Background: Perioperative hypothermia, defined as body core temperature below 36 degrees, is associated with complications such as bleeding, wound infection, and myocardial ischaemia. Forced air warming during surgery is not always sufficient to avoid hypothermia in patients undergoing total hip replacement (THR).
Purpose / Aim of Study: To assess the effect of preoperative and postoperative use of active warming blankets on patient core temperature during and after surgery for primary THR.
Materials and Methods: Prospective study of twenty-seven patients undergoing primary THR surgery at Horsens Regional Hospital from April to June 2016. Body temperature was measured rectally on admittance and pre- and postoperatively. Patients receiving pre- and postoperative active warming blankets (Barrier® EasyWarm®) as a supplement to the intraoperative forced air warming (group 1) were compared to patients receiving intraoperative forced air warming only (group 2).
Findings / Results: Nineteen patients (group 1) and so far eight patients (group 2) were included. Preliminary data showed no differences in mean body core temperature or temperature changes pre- and postoperatively between the two groups. Both groups experienced a core temperature decrease from admittance to the immediate preoperative temperature recording. Four patients in each group fell below 36 degrees at the immediate postoperative recording.
Conclusions: The addition of active warming blankets did not contribute significantly to increase the preoperative temperature of these patients, and temperatures below 36 degrees postoperatively were not prevented. More aggressive use of passive and active warming devices should be tried to prevent hypothermia.
Arnar Oskar Bjarnison, Thomas Juul Sørensen, Thomas Kallemose, Kristoffer W. Barfod
Department of Orthopedics, Zealand University Hospital; Department of Orthopedics, Zealand University Hospital; Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre ; Department of Orthopedics, Zealand University Hospital
Background: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of Rotator Cuff Tear (RCT) and Osteoarthritis of the shoulder (OA).
Purpose / Aim of Study: The purpose of the study was to test if the CSA was associated with RCT and OA. The study hypothesis being that people having a CSA > 35° were at increased risk of developing RCT and people with a CSA < 30° were at increased risk of developing OA.
Materials and Methods: The study was performed as a retrospective case- control study following the STROBE guidelines. 97 patients with RCT and 87 patients with OA constituted the two groups of cases. The controls were matched 3:1, by age and sex, from a population of 795 patients with humeral fractures. The CSA was measured as described by Moor et al. in 2013. Sample size calculation showed a need for 71 cases and 213 controls. Analysis of the relation with CSA for RCT and OA was done by logistic regression. Models were fitted separately for RCT and OA and used the controls matched to the respective cases.
Findings / Results: The mean CSA in the RCT group was 33.9° and in the matched control group 33.6°. The Odds Ratio for developing RCT for people with a CSA above 35° was 1.12 (p=.63). The mean CSA in the OA group was 31.1° and in the matched control group 33.3°. The Odds Ratio for developing OA for people with a CSA below 30° was 2.25 (p=.002).
Conclusions: This study did not find any association between CSA and RCT but did show association between CSA and OA with a 2.25 Odds Ratio of developing OA given the patient had a CSA below 30°. The results does not support the suggested praxis of shaving away the lateral border of the acromion in order to make the CSA smaller as it might increase the risk of developing OA without decreasing the risk of developing RCT.
Department of Orthopedics, Zealand University Hospital; Department of Orthopedics, Zealand University Hospital; Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre ; Department of Orthopedics, Zealand University Hospital
Background: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of Rotator Cuff Tear (RCT) and Osteoarthritis of the shoulder (OA).
Purpose / Aim of Study: The purpose of the study was to test if the CSA was associated with RCT and OA. The study hypothesis being that people having a CSA > 35° were at increased risk of developing RCT and people with a CSA < 30° were at increased risk of developing OA.
Materials and Methods: The study was performed as a retrospective case- control study following the STROBE guidelines. 97 patients with RCT and 87 patients with OA constituted the two groups of cases. The controls were matched 3:1, by age and sex, from a population of 795 patients with humeral fractures. The CSA was measured as described by Moor et al. in 2013. Sample size calculation showed a need for 71 cases and 213 controls. Analysis of the relation with CSA for RCT and OA was done by logistic regression. Models were fitted separately for RCT and OA and used the controls matched to the respective cases.
Findings / Results: The mean CSA in the RCT group was 33.9° and in the matched control group 33.6°. The Odds Ratio for developing RCT for people with a CSA above 35° was 1.12 (p=.63). The mean CSA in the OA group was 31.1° and in the matched control group 33.3°. The Odds Ratio for developing OA for people with a CSA below 30° was 2.25 (p=.002).
Conclusions: This study did not find any association between CSA and RCT but did show association between CSA and OA with a 2.25 Odds Ratio of developing OA given the patient had a CSA below 30°. The results does not support the suggested praxis of shaving away the lateral border of the acromion in order to make the CSA smaller as it might increase the risk of developing OA without decreasing the risk of developing RCT.
Nina Monrad, Ann Ganestam, Thomas Kallemose, Kristoffer W Barfod
Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre
Background: Degenerative shoulder lesions are common and a challenge to diagnose. They often result in significant disability for the patient and are an economic burden to society. From recent studies, an increasing incidence has been reported.
Purpose / Aim of Study: The purpose with this study was to investigate and map the incidence of degenerative shoulder lesions in Denmark from 1996 to 2013 with focus on sex, age and geographical area.
Materials and Methods: The National Patient Registry was retrospectively searched to find the number of degenerative shoulder lesions in Denmark during the period 1996– 2013. Regional population data were retrieved from the services of Statistics Denmark. Incidence rates were analyzed using poison regression models, all analysis was done in R 3.2.2, p-values of less than 0.05 were considered statistically significant.
Findings / Results: During the 18-year period, 244.519 individual contacts with a DM 75 diagnosis were registered. Male:female ratio was 51:49, median age was 51. Most frequent were impingement related lesions (DM 75.1-DM 75.5) with a mean incidence rate of 313.3 (CI 241.8-384.8) per 10^6 person years at risk (PYRS). A statistically significant increase in overall incidence rate from 149.4 per 10^6 PYRS in 1996 to 715.3 per 10^6 PYRS in 2013 was found (p<0.001). Incidence was highest for men aged 51-70 (1085.1 per 10^6 PYRS in 2013). Rural areas had a 1.3 fold higher mean incidence rate than urban areas. There was no significant difference in incidence between sexes.
Conclusions: The incidence of degenerative shoulder lesions rapidly increased mainly due to an increase in the older population +50. There were no significant differences in incidence between sexes. Rural areas had a 1.3 fold higher incidence rate than urban areas.
Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre; Department of Orthopedics, Copenhagen University Hospital Hvidovre
Background: Degenerative shoulder lesions are common and a challenge to diagnose. They often result in significant disability for the patient and are an economic burden to society. From recent studies, an increasing incidence has been reported.
Purpose / Aim of Study: The purpose with this study was to investigate and map the incidence of degenerative shoulder lesions in Denmark from 1996 to 2013 with focus on sex, age and geographical area.
Materials and Methods: The National Patient Registry was retrospectively searched to find the number of degenerative shoulder lesions in Denmark during the period 1996– 2013. Regional population data were retrieved from the services of Statistics Denmark. Incidence rates were analyzed using poison regression models, all analysis was done in R 3.2.2, p-values of less than 0.05 were considered statistically significant.
Findings / Results: During the 18-year period, 244.519 individual contacts with a DM 75 diagnosis were registered. Male:female ratio was 51:49, median age was 51. Most frequent were impingement related lesions (DM 75.1-DM 75.5) with a mean incidence rate of 313.3 (CI 241.8-384.8) per 10^6 person years at risk (PYRS). A statistically significant increase in overall incidence rate from 149.4 per 10^6 PYRS in 1996 to 715.3 per 10^6 PYRS in 2013 was found (p<0.001). Incidence was highest for men aged 51-70 (1085.1 per 10^6 PYRS in 2013). Rural areas had a 1.3 fold higher mean incidence rate than urban areas. There was no significant difference in incidence between sexes.
Conclusions: The incidence of degenerative shoulder lesions rapidly increased mainly due to an increase in the older population +50. There were no significant differences in incidence between sexes. Rural areas had a 1.3 fold higher incidence rate than urban areas.
Niklas Tøndevold, Jamal Bouknaitir, Hassan Shakir
Ortopædkirurgisk afd, Sjællands Universitetshospital; Ortopædkirurgisk afd, Sjællands Universitetshospital; Ortopædkirurgisk afd, Sjællands Universitetshospital
Background: Surgical Treatment of lower back pain in the younger patients usually includes some kind of rigid fixation. Even some studies have shown a near 100% fusion rate there have only been reported an average of 70% satisfactory rates according to patient surveys. Fusion surgery has additionally some disadvantages including stress and degeneration of the adjacent segments. In our institution we have used semirigid dynamic fixation system (Dynesys®, Zimmer) in younger patients with lower back pain without olistesis. The goal is to offer pain relief without solid bone fusion.
Purpose / Aim of Study: Using SF-36, ODI and EQ-5D we monitored the patient satisfaction 1 and 2 years after surgery. Futhermore we examined the reoperation and complication rate.
Materials and Methods: From 2009 to 2013, 254 patients had a spinal fusion in our institution. 88 patients had dynamic stabilization, 46 men and 42 females with a mean age of 46 (20-72). None of the patients had any comorbidity. The patients received the SF-36, EQ-5D, Oswestry lower disability questionnaire and form asking about walking distance, usage of pain medication, work/pension status and pain evaluation back. The questionnaire where sent preoperatively, 1 and 2 years postoperatively.
Findings / Results: 67 of the 88 patients answered the questionnaires. In the 88 patients 9 had additional surgery. All patient reported outcomes improved significantly after surgery.
Conclusions: Patient satisfaction is at the same level as other studies. Complication rates are identical. Re operations are within actable levels. No major complications. 2 patients had adjacent level degeneration requiring surgery and 3 had a secondary rigid fixation of the same level. The method is less traumatic to the posterior joints and soft tissue, and gives satisfactory results in this young and healthy patient population.
Ortopædkirurgisk afd, Sjællands Universitetshospital; Ortopædkirurgisk afd, Sjællands Universitetshospital; Ortopædkirurgisk afd, Sjællands Universitetshospital
Background: Surgical Treatment of lower back pain in the younger patients usually includes some kind of rigid fixation. Even some studies have shown a near 100% fusion rate there have only been reported an average of 70% satisfactory rates according to patient surveys. Fusion surgery has additionally some disadvantages including stress and degeneration of the adjacent segments. In our institution we have used semirigid dynamic fixation system (Dynesys®, Zimmer) in younger patients with lower back pain without olistesis. The goal is to offer pain relief without solid bone fusion.
Purpose / Aim of Study: Using SF-36, ODI and EQ-5D we monitored the patient satisfaction 1 and 2 years after surgery. Futhermore we examined the reoperation and complication rate.
Materials and Methods: From 2009 to 2013, 254 patients had a spinal fusion in our institution. 88 patients had dynamic stabilization, 46 men and 42 females with a mean age of 46 (20-72). None of the patients had any comorbidity. The patients received the SF-36, EQ-5D, Oswestry lower disability questionnaire and form asking about walking distance, usage of pain medication, work/pension status and pain evaluation back. The questionnaire where sent preoperatively, 1 and 2 years postoperatively.
Findings / Results: 67 of the 88 patients answered the questionnaires. In the 88 patients 9 had additional surgery. All patient reported outcomes improved significantly after surgery.
Conclusions: Patient satisfaction is at the same level as other studies. Complication rates are identical. Re operations are within actable levels. No major complications. 2 patients had adjacent level degeneration requiring surgery and 3 had a secondary rigid fixation of the same level. The method is less traumatic to the posterior joints and soft tissue, and gives satisfactory results in this young and healthy patient population.
Peter Horstmann, Werner Hettwer, Michael Mørk Petersen
Department of Orthopedics, Muskuloskeletal Tumor Section, , Rigshospitalet, University of Copenhagen, Denmark ; Department of Orthopedics, Muskuloskeletal Tumor Section, , Rigshospitalet, University of Copenhagen, Denmark ; Department of Orthopedics, Muskuloskeletal Tumor Section, , Rigshospitalet, University of Copenhagen, Denmark
Background: Non-invasive evaluation of changes in mineralization after curettage is not always easy using conventional x-rays. Precise and quantitative measurements of bone mineral density (BMD) and bone mineral content (BMC) at various skeletal sites can be performed using DEXA.
Purpose / Aim of Study: To document early changes in BMD in patients receiving bone defect reconstruction with a biphasic (60% calcium sulfate/ 40% calcium phosphate) bone graft substitute (BGS) after intralesional curettage in benign bone tumors and cysts.
Materials and Methods: We prospectively reviewed 8 patients (F/M: 3/5, mean age 40 (18-68) years) who underwent intralesional curettage of 9 benign bone tumors or cysts with subsequent bone defect reconstruction with a biphasic BGS (CERAMENT™|BONE VOID FILLER) or a biphasic gentamicin eluting BGS (CERAMENT™|G) at our orthopedic oncology center with a minimum of 6 months follow-up.
Findings / Results: The most commonly treated lesions were uni- or multicameral bone cysts (n=3) and enchondromas (n=3) with an average size of 17 (6-33) mL. The most commonly affected regions were the proximal femur (n=3), and the proximal humerus (n=2). CERAMENT™|BVF was used in 6 cases and CERAMENT™|G was used in 3 cases with an average amount of 17 (4-56) mL. The mean postoperative BMD was 2.70 g/cm2 (CI95%: 2.11- 3.30), 1.44 g/cm2 (CI95%: 1.14-1.76) at 6 weeks, 1.28 g/cm2 (CI95%: 0.94- 1.61) at 3 months, and 1.21 g/cm2 (CI95%: 0.84-1.58) at 6 months.
Conclusions: In this small prospective series of 8 patients receiving bone defect reconstruction with a biphasic bone graft substitute (60% calcium sulfate/ 40% calcium phosphate), we found that the BMD at the defect site decreases in the first three months, probably corresponding to the resorption of calcium sulfate, without any further significant decrease from 3 to 6 months.
Department of Orthopedics, Muskuloskeletal Tumor Section, , Rigshospitalet, University of Copenhagen, Denmark ; Department of Orthopedics, Muskuloskeletal Tumor Section, , Rigshospitalet, University of Copenhagen, Denmark ; Department of Orthopedics, Muskuloskeletal Tumor Section, , Rigshospitalet, University of Copenhagen, Denmark
Background: Non-invasive evaluation of changes in mineralization after curettage is not always easy using conventional x-rays. Precise and quantitative measurements of bone mineral density (BMD) and bone mineral content (BMC) at various skeletal sites can be performed using DEXA.
Purpose / Aim of Study: To document early changes in BMD in patients receiving bone defect reconstruction with a biphasic (60% calcium sulfate/ 40% calcium phosphate) bone graft substitute (BGS) after intralesional curettage in benign bone tumors and cysts.
Materials and Methods: We prospectively reviewed 8 patients (F/M: 3/5, mean age 40 (18-68) years) who underwent intralesional curettage of 9 benign bone tumors or cysts with subsequent bone defect reconstruction with a biphasic BGS (CERAMENT™|BONE VOID FILLER) or a biphasic gentamicin eluting BGS (CERAMENT™|G) at our orthopedic oncology center with a minimum of 6 months follow-up.
Findings / Results: The most commonly treated lesions were uni- or multicameral bone cysts (n=3) and enchondromas (n=3) with an average size of 17 (6-33) mL. The most commonly affected regions were the proximal femur (n=3), and the proximal humerus (n=2). CERAMENT™|BVF was used in 6 cases and CERAMENT™|G was used in 3 cases with an average amount of 17 (4-56) mL. The mean postoperative BMD was 2.70 g/cm2 (CI95%: 2.11- 3.30), 1.44 g/cm2 (CI95%: 1.14-1.76) at 6 weeks, 1.28 g/cm2 (CI95%: 0.94- 1.61) at 3 months, and 1.21 g/cm2 (CI95%: 0.84-1.58) at 6 months.
Conclusions: In this small prospective series of 8 patients receiving bone defect reconstruction with a biphasic bone graft substitute (60% calcium sulfate/ 40% calcium phosphate), we found that the BMD at the defect site decreases in the first three months, probably corresponding to the resorption of calcium sulfate, without any further significant decrease from 3 to 6 months.