Session 5: Poster med foredrag II
Onsdag 26. oktober
11:00 – 12:00
Lokale: Stockholm / Copenhagen
Chairmen: Maiken Stilling / Michael Mørk Petersen
hristian Kastenskov, Jeppe Vejlgaard Rasmussen , Janne Ovesen, Bo Sanderhoff Olsen
Ortopædisk afdeling, Herlev hospital; Ortopædisk afdeling, Herlev hospital; Ortopædisk afdeling, Århus hospital; Ortopædisk afdeling, Herlev hospital
Background: Recurrent Posterolateral Elbow Instability (PLI) is the most common type of chronic elbow joint instability. Recurrent elbow dislocations is caused by insufficiency of the lateral ligaments. Different surgical procedures has been described to reconstruct the LCL. The studies reports almost the same results. None of the studies have a mean follow up time more than 6 years.
Purpose / Aim of Study: The aim of the present study was to report the long-term clinical outcome following surgical LCL reconstruction.
Materials and Methods: We included 18 consecutive patients prior treated for posterolateral elbow instability in the period 1993- 1999 and prior in 2003 evaluated for clinical result. 12 of 18 patients were reexamined in 2015 at a clinical follow-up. The mean follow-up of 230 months. We performed the clinical follow-up with clinical examination of stability, ROM, Pain VAS score, Mayo elbow performance score, functional elbow score and Danish version of Oxford elbow score. Furthermore a conventional x-ray of the elbow was performed to evaluate osteoarthritis.
Findings / Results: None of the patients reported pain during rest. During activity the patients had a VAS mean of 2,8. Few patients had a reduction in ROM. All the patients had a stable elbow. 2 patients had apprehension to the pivot-shift stress test. None had apprehension during ”chair stand up” test. Functional elbow score gave unchanged results. The mean Mayo elbow score was 86 ( 9 point decrease). The mean Oxford Elbow score was 45 (“satisfying elbow function”). Osteoarthritis was seen on X-ray in 41%.
Conclusions: In conclusion we observed a high percentage of patients with radiographic arthrosis but without clinical symptoms. The results reported in 2003 seem durable over time. The technique reported by Olsen & Søjbjerg in 2003 gives good long-term results.
Ortopædisk afdeling, Herlev hospital; Ortopædisk afdeling, Herlev hospital; Ortopædisk afdeling, Århus hospital; Ortopædisk afdeling, Herlev hospital
Background: Recurrent Posterolateral Elbow Instability (PLI) is the most common type of chronic elbow joint instability. Recurrent elbow dislocations is caused by insufficiency of the lateral ligaments. Different surgical procedures has been described to reconstruct the LCL. The studies reports almost the same results. None of the studies have a mean follow up time more than 6 years.
Purpose / Aim of Study: The aim of the present study was to report the long-term clinical outcome following surgical LCL reconstruction.
Materials and Methods: We included 18 consecutive patients prior treated for posterolateral elbow instability in the period 1993- 1999 and prior in 2003 evaluated for clinical result. 12 of 18 patients were reexamined in 2015 at a clinical follow-up. The mean follow-up of 230 months. We performed the clinical follow-up with clinical examination of stability, ROM, Pain VAS score, Mayo elbow performance score, functional elbow score and Danish version of Oxford elbow score. Furthermore a conventional x-ray of the elbow was performed to evaluate osteoarthritis.
Findings / Results: None of the patients reported pain during rest. During activity the patients had a VAS mean of 2,8. Few patients had a reduction in ROM. All the patients had a stable elbow. 2 patients had apprehension to the pivot-shift stress test. None had apprehension during ”chair stand up” test. Functional elbow score gave unchanged results. The mean Mayo elbow score was 86 ( 9 point decrease). The mean Oxford Elbow score was 45 (“satisfying elbow function”). Osteoarthritis was seen on X-ray in 41%.
Conclusions: In conclusion we observed a high percentage of patients with radiographic arthrosis but without clinical symptoms. The results reported in 2003 seem durable over time. The technique reported by Olsen & Søjbjerg in 2003 gives good long-term results.
Laura Christoffersen, Gert Rahbek Andersen
stud. med., ; ort.kir., Rigshospitalet
Background: Congenital muscular torticollis can lead to face asymmetry and neck pain. Mild torticollis is often treated by positioning of the head of the infant and/or physiotherapy and Botullinum toxin. In cases with persisting torticollis, surgery can be necessary.
Purpose / Aim of Study: The present study describes the outcome of a cohort of patients treated surgically for congenital muscular torticollis.
Materials and Methods: Thirty-two patients operated for congenital muscular torticollis at Rigshospitalet 2008- 2015 were included. Retrospectively data from charts, including complications or need for additional surgery were used.
Findings / Results: No complications were found. Nine patients needed additional surgery. Mean age at initial surgery for patients who later needed additional surgery were 12 years.
Conclusions: Other authors found that surgery should be performed before the age of 5, to prevent need for additional surgery. The present study shows a need for early referral of the patients.
stud. med., ; ort.kir., Rigshospitalet
Background: Congenital muscular torticollis can lead to face asymmetry and neck pain. Mild torticollis is often treated by positioning of the head of the infant and/or physiotherapy and Botullinum toxin. In cases with persisting torticollis, surgery can be necessary.
Purpose / Aim of Study: The present study describes the outcome of a cohort of patients treated surgically for congenital muscular torticollis.
Materials and Methods: Thirty-two patients operated for congenital muscular torticollis at Rigshospitalet 2008- 2015 were included. Retrospectively data from charts, including complications or need for additional surgery were used.
Findings / Results: No complications were found. Nine patients needed additional surgery. Mean age at initial surgery for patients who later needed additional surgery were 12 years.
Conclusions: Other authors found that surgery should be performed before the age of 5, to prevent need for additional surgery. The present study shows a need for early referral of the patients.
Thomas Petersen, Hans Tromborg
Ortopaedic Dept., Odense University Hospital; Ortopaedic Dept., Odense University Hospital
Background: Cerebral palsy of the hand can be a seriously debilitating illness, especially hand activities demanding the use of two hands can be affected. Being able to extend the wrist allows for better visual apprehension, when manipulating objects. Increased tension of finger flexors permits improved grip strength.
Purpose / Aim of Study: To evaluate the long-term effect of tendon transfer with flexor carpi ulnaris (FCU) transferal to the extensor carpi radialis brevis (ECRB)
Materials and Methods: Twenty-five patients with cerebral p palsy was surgically reconstructed with f flexor carpi ulnaris (FCU) transferal to t the extensor carpi radialis brevis ( (ECRB) and other surgery as needed, i including correction of thumb and p pronation. Age 15,3(9,8-29,2) years. Wrist extension was classified using Zancolis classification of wrist and f finger deformity pre- postoperatively. In a addition, DASH and grip strength, was a also measured pre- postoperatively.
Findings / Results: On follow up after 588 days (512-680) eleve eleven of Twenty-five patient showed impro improvement in Zancolli classification. Anoth Another 11 remained unchanged and 3 patie patients degraded one level. Zancolli befor befor 2,4(0,3) (avg(sem)), on followup 1,6(0,2) (0,2) (p<0,05). DASH was improved 10 points (-21-40). From From 57(3) to 47(3) (p< 0.01) on followup. All but 3 patients showed improved grip str strength on average 2,9, from 5.4(1.4) to 8.2 8.2(1.6) (p< 0.01).
Conclusions: In carefully selected adolescent children with cerebral palsy wrist function and grip strength can be improved with tendon transfer with flexor carpi ulnaris (FCU) transferal to the extensor carpi radialis brevis (ECRB). DASH score shows improvement, although statistical significant, improvement of 10 point is not consider clinical relevant.
Ortopaedic Dept., Odense University Hospital; Ortopaedic Dept., Odense University Hospital
Background: Cerebral palsy of the hand can be a seriously debilitating illness, especially hand activities demanding the use of two hands can be affected. Being able to extend the wrist allows for better visual apprehension, when manipulating objects. Increased tension of finger flexors permits improved grip strength.
Purpose / Aim of Study: To evaluate the long-term effect of tendon transfer with flexor carpi ulnaris (FCU) transferal to the extensor carpi radialis brevis (ECRB)
Materials and Methods: Twenty-five patients with cerebral p palsy was surgically reconstructed with f flexor carpi ulnaris (FCU) transferal to t the extensor carpi radialis brevis ( (ECRB) and other surgery as needed, i including correction of thumb and p pronation. Age 15,3(9,8-29,2) years. Wrist extension was classified using Zancolis classification of wrist and f finger deformity pre- postoperatively. In a addition, DASH and grip strength, was a also measured pre- postoperatively.
Findings / Results: On follow up after 588 days (512-680) eleve eleven of Twenty-five patient showed impro improvement in Zancolli classification. Anoth Another 11 remained unchanged and 3 patie patients degraded one level. Zancolli befor befor 2,4(0,3) (avg(sem)), on followup 1,6(0,2) (0,2) (p<0,05). DASH was improved 10 points (-21-40). From From 57(3) to 47(3) (p< 0.01) on followup. All but 3 patients showed improved grip str strength on average 2,9, from 5.4(1.4) to 8.2 8.2(1.6) (p< 0.01).
Conclusions: In carefully selected adolescent children with cerebral palsy wrist function and grip strength can be improved with tendon transfer with flexor carpi ulnaris (FCU) transferal to the extensor carpi radialis brevis (ECRB). DASH score shows improvement, although statistical significant, improvement of 10 point is not consider clinical relevant.
Pelle Baggesgaard Petersen, Jes Bruun Lauritzen, Michael Rindom Krogsgaard
Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Sports Traumatology M51, Bispebjerg Hospital
Background: Complex regional pain syndrome is a challenging condition including a broad spectrum of sensory, autonomic and motor features predominantly in extremities recovering a trauma. Surgical and non- surgical treatments are known risk-factors. Few large-scale studies have addressed occurrence of and factors associated with CRPS following orthopedic treatment.
Purpose / Aim of Study: The present study aimed to identify factors associated to post-treatment development of CRPS.
Materials and Methods: Using the Danish Patient Compensation Association’s database (DPCA), we identified 647 patients with post-treatment CRPS (DM89.0), between January 1, 1992 and March 5, 2015. Age, gender, initial diagnosis, treatment, debut date of CRPS, severity of CRPS and size of compensation were extracted. A multiple logistic regression was performed to assess variables with association to approval of the claim made to DPCA. In the cases of CRPS in patients with carpal tunnel syndrome we analyzed bilateral vs. unilateral symptoms and whether neurophysiological changes prior to treatment were seen.
Findings / Results: The following variables were excessively represented; woman gender 4:1, primary diagnosis to the upper limb 2½:1 and surgical treatment 3:1. Mean age was 47.5±13.7, no difference between gender. Colles’ fracture (12%) and carpal tunnel syndrome (9%) were the most common diagnoses. Conservative treatment was negatively associated with approval of the claim (OR 0.29). Among CTS patients with unilateral symptoms 71.4% had normal neurophysiology prior to surgery.
Conclusions: Female gender, surgical treatment and treatment to the upper limb were risk factors. Elective surgery accounted for a large amount of patients with post- treatment CRPS. Among CTS patients with carpal tunnel syndrome, a normal neurophysiological examination is common.
Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Sports Traumatology M51, Bispebjerg Hospital
Background: Complex regional pain syndrome is a challenging condition including a broad spectrum of sensory, autonomic and motor features predominantly in extremities recovering a trauma. Surgical and non- surgical treatments are known risk-factors. Few large-scale studies have addressed occurrence of and factors associated with CRPS following orthopedic treatment.
Purpose / Aim of Study: The present study aimed to identify factors associated to post-treatment development of CRPS.
Materials and Methods: Using the Danish Patient Compensation Association’s database (DPCA), we identified 647 patients with post-treatment CRPS (DM89.0), between January 1, 1992 and March 5, 2015. Age, gender, initial diagnosis, treatment, debut date of CRPS, severity of CRPS and size of compensation were extracted. A multiple logistic regression was performed to assess variables with association to approval of the claim made to DPCA. In the cases of CRPS in patients with carpal tunnel syndrome we analyzed bilateral vs. unilateral symptoms and whether neurophysiological changes prior to treatment were seen.
Findings / Results: The following variables were excessively represented; woman gender 4:1, primary diagnosis to the upper limb 2½:1 and surgical treatment 3:1. Mean age was 47.5±13.7, no difference between gender. Colles’ fracture (12%) and carpal tunnel syndrome (9%) were the most common diagnoses. Conservative treatment was negatively associated with approval of the claim (OR 0.29). Among CTS patients with unilateral symptoms 71.4% had normal neurophysiology prior to surgery.
Conclusions: Female gender, surgical treatment and treatment to the upper limb were risk factors. Elective surgery accounted for a large amount of patients with post- treatment CRPS. Among CTS patients with carpal tunnel syndrome, a normal neurophysiological examination is common.
Johanne Lyhne, Jon Jacobsen, Søren Hansen, Carsten Jensen, Deutch Søren
Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers
Background: Frozen shoulder is a painful shoulder joint disease. Patients with diabetes seem to have worse clinical symptoms and surgery in this patient population is believed to be more common. Despite previous studies indicating, that operation is less effective in this patient population our experience is, that diabetic patients actually are quite satisfied after the procedure.
Purpose / Aim of Study: We wanted to clarify if diabetic patients are as equally satisfied as non-diabetics, and by that if we should differentiate our preoperative counseling or continue our current practice.
Materials and Methods: 93 patients were included. All had remained unresponsive to conservative treatment for at least 6 months. The patients were retrospectively divided in two groups based on diabetes status: Group 1 consisted of patients with type 1 or type 2 diabetes (18) and group 2 consisted of the remaining patients (75). Evaluation was performed prior to arthroscopic capsular release and at 6 months follow-up. The web-based questionnaire consisted of 2 different evaluation forms: An Oxford Shoulder Score (OSS) and a visual quality scale (VQS).
Findings / Results: Both groups had a statistically significant improvement in both evaluations. OSS in group 1 improved by 11.5 [95 % CI: 6.2 ; 16.4] and by 15.8 [95 % CI: 13.6 ; 17.9] in group 2. Although the improvement was larger in group 2, it was not statistically significant (p = 0.09). The VQS improved 39.6 in group 1 and 44.5 in group 2, (p = 0.50).
Conclusions: Our study indicates that diabetic and non- diabetic patients report equal symptom relieve after arthroscopic capsular release of frozen shoulder when patients are selected for operation with no regards of diabetic status. We will continue to select patients for arthroscopic release without differences in preoperative counseling between diabetics and non-diabetics.
Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers; Department of Orthopaedic Surgery, Regional Hospital Randers
Background: Frozen shoulder is a painful shoulder joint disease. Patients with diabetes seem to have worse clinical symptoms and surgery in this patient population is believed to be more common. Despite previous studies indicating, that operation is less effective in this patient population our experience is, that diabetic patients actually are quite satisfied after the procedure.
Purpose / Aim of Study: We wanted to clarify if diabetic patients are as equally satisfied as non-diabetics, and by that if we should differentiate our preoperative counseling or continue our current practice.
Materials and Methods: 93 patients were included. All had remained unresponsive to conservative treatment for at least 6 months. The patients were retrospectively divided in two groups based on diabetes status: Group 1 consisted of patients with type 1 or type 2 diabetes (18) and group 2 consisted of the remaining patients (75). Evaluation was performed prior to arthroscopic capsular release and at 6 months follow-up. The web-based questionnaire consisted of 2 different evaluation forms: An Oxford Shoulder Score (OSS) and a visual quality scale (VQS).
Findings / Results: Both groups had a statistically significant improvement in both evaluations. OSS in group 1 improved by 11.5 [95 % CI: 6.2 ; 16.4] and by 15.8 [95 % CI: 13.6 ; 17.9] in group 2. Although the improvement was larger in group 2, it was not statistically significant (p = 0.09). The VQS improved 39.6 in group 1 and 44.5 in group 2, (p = 0.50).
Conclusions: Our study indicates that diabetic and non- diabetic patients report equal symptom relieve after arthroscopic capsular release of frozen shoulder when patients are selected for operation with no regards of diabetic status. We will continue to select patients for arthroscopic release without differences in preoperative counseling between diabetics and non-diabetics.
Martin Bille Henriksen, Jensen Steen Lund
Ortopædkirurgisk afdeling, Aalborg Universitetshospital, Farsø; Ortopædkirurgisk afdeling, Aalborg Universitetshospital, Farsø
Background: Repair of distal biceps tendon ruptures include one- or two-incision techniques. Among various fixation techniques, biomechanical studies have shown that endobuttons have the highest load-to-failure strengths.
Purpose / Aim of Study: We hypothesize that the use of a single incision and endobutton would provide reliable fixation with good functional result and few complications. Accordingly, the aim of the study was to report our results using this technique.
Materials and Methods: Patients operated during 01.01.10 –01.11.15 were identified by ICD-10 & NOMESCO codes. Patient records were studied and questionnaires incl. ROM and DASH score were sent by mail. Non-responders were reminded after 3 weeks by phone.
Findings / Results: 30 patients were identified; 1 were lost to follow-up. 5 did not respond despite reminder. 24 patients remained (23 males) with a mean age of 49 years (38-67). Median delay to surgery was 7 days (1-58) and median follow-up time was 25 months (6-58). The median DASH score was 22.5 (0-84.17). Compared to the uninjured side, the mean loss of ROM was: extension 15° (0-50°), flexion 6° (0-40°), supination 18° (0-55°) and pronation 11° (0-50°). 1 re-rupture occurred, but was successfully reoperated using the same technique. No patient had deep infection. 6 patients had neurological symptoms at the latest clinical control: 3 non- specific, 1 had symptoms specifically related to the superficial branch of the radial nerve and 2 had symptoms related to the lateral antebrachial cutaneous nerve. No patients had motor palsy.
Conclusions: Surgical repair of distal biceps tendon rupture with one-incision technique and endobutton fixation had a low rate of mechanical failure. Most patients had only slightly reduced ROM, but there was a relatively high rate of neurological complications. The average DASH score was higher than previously reported.
Ortopædkirurgisk afdeling, Aalborg Universitetshospital, Farsø; Ortopædkirurgisk afdeling, Aalborg Universitetshospital, Farsø
Background: Repair of distal biceps tendon ruptures include one- or two-incision techniques. Among various fixation techniques, biomechanical studies have shown that endobuttons have the highest load-to-failure strengths.
Purpose / Aim of Study: We hypothesize that the use of a single incision and endobutton would provide reliable fixation with good functional result and few complications. Accordingly, the aim of the study was to report our results using this technique.
Materials and Methods: Patients operated during 01.01.10 –01.11.15 were identified by ICD-10 & NOMESCO codes. Patient records were studied and questionnaires incl. ROM and DASH score were sent by mail. Non-responders were reminded after 3 weeks by phone.
Findings / Results: 30 patients were identified; 1 were lost to follow-up. 5 did not respond despite reminder. 24 patients remained (23 males) with a mean age of 49 years (38-67). Median delay to surgery was 7 days (1-58) and median follow-up time was 25 months (6-58). The median DASH score was 22.5 (0-84.17). Compared to the uninjured side, the mean loss of ROM was: extension 15° (0-50°), flexion 6° (0-40°), supination 18° (0-55°) and pronation 11° (0-50°). 1 re-rupture occurred, but was successfully reoperated using the same technique. No patient had deep infection. 6 patients had neurological symptoms at the latest clinical control: 3 non- specific, 1 had symptoms specifically related to the superficial branch of the radial nerve and 2 had symptoms related to the lateral antebrachial cutaneous nerve. No patients had motor palsy.
Conclusions: Surgical repair of distal biceps tendon rupture with one-incision technique and endobutton fixation had a low rate of mechanical failure. Most patients had only slightly reduced ROM, but there was a relatively high rate of neurological complications. The average DASH score was higher than previously reported.
Brian Weng Sørensen, Christopher Jantzen, Thomas Michael Nissen-Juul Sørensen, Kecia Vicki Ardensø, Susanne Kristensen Mallet
Orthopedic, Zealand University Hospital; Orthopedic, Zealand University Hospital; Orthopedic, Zealand University Hospital; Occupational- and Physiotherapy, Zealand University Hospital; Orthopedic, Zealand University Hospital
Background: At our clinic, all patients with an operatively treated distal radius fracture are evaluated by an Occupational Therapist who plans the rehabilitation. Some patients are referred to further rehabilitation at a Physiotherapist. We wanted to investigate which factors predicts referral to physiotherapy.
Purpose / Aim of Study: To investigate factors associated with increased odds of being referred to physiotherapy.
Materials and Methods: Data was gathered from 100 patients enrolled in a randomized study investigating postoperative treatment. We used these data retrospectively for this study. Data was available for 84 patients. The patients was grouped to additional physiotherapy 4 weeks post-operatively or not. Data was collected on: Age, sex, fracture type using AO classification, time-to-surgery, cast or removable cast post- operatively, DASH-score at 4 weeks. Uni- and multivariate analysis was conducted with adjustment for all included variables in the latter and referral to physiotherapy as outcome.
Findings / Results: Patients in the group receiving physiotherapy had a significant higher median DASH-score (50 vs. 63.39 – p=0.002), and higher prevalence of Type C fractures (72 % vs. 43.64 % - p=0.002) The univariate analysis showed that patients suffering from a high DASH-score at 4 weeks (OR 1.67 per 10 unit – p=0.003) or Type B (OR 7.19 – p=0.03) or C fracture (OR 8.63 – p=0.01) had increased odds of being referred to physiotherapy. This association was still significant for Type C fractures (OR 8.96 – p=0.04) and DASH-score (OR 1.57 per 10 unit – p=0.02) after adjustment for age, sex, time-to- surgery, DASH-score at 4 weeks and postoperative use of wrist-laser.
Conclusions: Our study shows that patients with a high DASH- score at 4 weeks or a Type-C fracture had increased odds of being referred to physiotherapy.
Orthopedic, Zealand University Hospital; Orthopedic, Zealand University Hospital; Orthopedic, Zealand University Hospital; Occupational- and Physiotherapy, Zealand University Hospital; Orthopedic, Zealand University Hospital
Background: At our clinic, all patients with an operatively treated distal radius fracture are evaluated by an Occupational Therapist who plans the rehabilitation. Some patients are referred to further rehabilitation at a Physiotherapist. We wanted to investigate which factors predicts referral to physiotherapy.
Purpose / Aim of Study: To investigate factors associated with increased odds of being referred to physiotherapy.
Materials and Methods: Data was gathered from 100 patients enrolled in a randomized study investigating postoperative treatment. We used these data retrospectively for this study. Data was available for 84 patients. The patients was grouped to additional physiotherapy 4 weeks post-operatively or not. Data was collected on: Age, sex, fracture type using AO classification, time-to-surgery, cast or removable cast post- operatively, DASH-score at 4 weeks. Uni- and multivariate analysis was conducted with adjustment for all included variables in the latter and referral to physiotherapy as outcome.
Findings / Results: Patients in the group receiving physiotherapy had a significant higher median DASH-score (50 vs. 63.39 – p=0.002), and higher prevalence of Type C fractures (72 % vs. 43.64 % - p=0.002) The univariate analysis showed that patients suffering from a high DASH-score at 4 weeks (OR 1.67 per 10 unit – p=0.003) or Type B (OR 7.19 – p=0.03) or C fracture (OR 8.63 – p=0.01) had increased odds of being referred to physiotherapy. This association was still significant for Type C fractures (OR 8.96 – p=0.04) and DASH-score (OR 1.57 per 10 unit – p=0.02) after adjustment for age, sex, time-to- surgery, DASH-score at 4 weeks and postoperative use of wrist-laser.
Conclusions: Our study shows that patients with a high DASH- score at 4 weeks or a Type-C fracture had increased odds of being referred to physiotherapy.
Ane Simony, Mikkel Osterheden Andersen, Steen Bach Christensen
Sector for Spine Surgery & Research, Middelfart Hospital; Sector for Spine Surgery & Research, Middelfart Hospital; Sector for Spine Surgery & Research, Middelfart Hospital
Background: Boston brace treatment has been used for conservative treatment of Adolescent Idiopathic Scoliosis, since the 1970´ies. The treatment has been shown to stop the progression of the deformity, in several long time studies.
Purpose / Aim of Study: The purpose of this retrospective study was to examine the curve characteristics in patients, who progressed during brace treatment.
Materials and Methods: 153 AIS patients were treated with Boston braces, at Rigshospitalet from 1983-1990. A retrospective study was performed, of the radiological characteristics of the brace treated patients. Curves were classified according to the King Moe classification, and apex was described. Curve magnitude is described by Cobb measurement, The Harrington factor was calculated and Spinal rotation was described using Pedriolle.
Findings / Results: 138/153 patient completed their brace treatment and was included in this study. Mean age when brace treatment was initiated was 14.1 y (+/- 1.6 y), Time in brace 2.6 y (+/- 1.0 y) and Mean Cobb before treatment 39° +/- 10°. Brace treatment did not alter the spinal rotation (p> 0.3), age at start Brace treatment (p>0.8) or Age at menarche (p>0.05) was not correlated with progression during brace treatment. The curve correction was significant better in curves, with apex between Th11 and L1 (p< 0.0001). A correlation was seen in between the in brace correction and Cobb angel during side bending films pre- treatment (p< 0.002). The Harrington Factor seems to correlate with progression during brace treatment (p< 0.001) and no patients with a Harrington Factor less than 5 ° progressed during Brace treatment.
Conclusions: Boston braces are effective in the conservative treatment of AIS. Curves should be evaluated prior to brace treatment and close attention is recommended if risk factors are identified.
Sector for Spine Surgery & Research, Middelfart Hospital; Sector for Spine Surgery & Research, Middelfart Hospital; Sector for Spine Surgery & Research, Middelfart Hospital
Background: Boston brace treatment has been used for conservative treatment of Adolescent Idiopathic Scoliosis, since the 1970´ies. The treatment has been shown to stop the progression of the deformity, in several long time studies.
Purpose / Aim of Study: The purpose of this retrospective study was to examine the curve characteristics in patients, who progressed during brace treatment.
Materials and Methods: 153 AIS patients were treated with Boston braces, at Rigshospitalet from 1983-1990. A retrospective study was performed, of the radiological characteristics of the brace treated patients. Curves were classified according to the King Moe classification, and apex was described. Curve magnitude is described by Cobb measurement, The Harrington factor was calculated and Spinal rotation was described using Pedriolle.
Findings / Results: 138/153 patient completed their brace treatment and was included in this study. Mean age when brace treatment was initiated was 14.1 y (+/- 1.6 y), Time in brace 2.6 y (+/- 1.0 y) and Mean Cobb before treatment 39° +/- 10°. Brace treatment did not alter the spinal rotation (p> 0.3), age at start Brace treatment (p>0.8) or Age at menarche (p>0.05) was not correlated with progression during brace treatment. The curve correction was significant better in curves, with apex between Th11 and L1 (p< 0.0001). A correlation was seen in between the in brace correction and Cobb angel during side bending films pre- treatment (p< 0.002). The Harrington Factor seems to correlate with progression during brace treatment (p< 0.001) and no patients with a Harrington Factor less than 5 ° progressed during Brace treatment.
Conclusions: Boston braces are effective in the conservative treatment of AIS. Curves should be evaluated prior to brace treatment and close attention is recommended if risk factors are identified.
Søren Ohrt-Nissen, Naeem Bukhari, Jacob Steensballe, Martin Gehrchen, Benny Dahl
Orthopedic Surgery, Spine Unit, Rigshospitalet; Orthopedic Surgery, Spine Unit, Rigshospitalet; Anaesthesiology, Rigshospitalet; Orthopedic Surgery, Spine Unit, Rigshospitalet; Orthopedic Surgery, Spine Unit, Rigshospitalet
Background: Surgical management of adolescent idiopathic scoliosis (AIS) involves a risk of substantial perioperative bleeding despite the use of cell salvage as well as infusion of antifibrinolytic agents. Avoidance of allogeneic blood transfusion is of importance considering the cost, the infection risk and the risk of autoimmunization.
Purpose / Aim of Study: To investigate potential predictors of blood transfusion following instrumented fusion for AIS in a center with well-defined transfusion guidelines.
Materials and Methods: A retrospective cohort study was carried out on all patients undergoing posterior instrumented fusion for AIS in the period May 1st 2011 through December 31st 2015. Data was extracted from medical records and surgical charts. A logistic regression analysis was conducted with transfusion of red blood cells before discharge as outcome variable. Predictor variables were chosen a priori.
Findings / Results: The study included 149 patients. Mean age was 16.3±2.4 years and 83% were female. Fifty patients (34%) received transfusion and this group had significantly higher preoperative Cobb angle, longer operation time, lower body mass index (BMI) and a lower preoperative hemoglobin (hgb) than the non- transfusion group (p < 0.014). Multiple logistic regression including these factors as well as fusion length and mean arterial pressure showed that only BMI (OR: 0,77, 95% CI: 064-089) and preoperative hgb (OR: 0,26; 95% CI: 0,12-0,50) were significantly associated with risk of transfusion. Nine out of ten patients with a preoperative hgb level of less than 7.5 mmol/l required transfusion.
Conclusions: Preoperative hgb was the strongest predictor of patients requiring transfusion following surgery for AIS. Adopting a preoperative minimum level of 7.5 mmol/l may be considered.
Orthopedic Surgery, Spine Unit, Rigshospitalet; Orthopedic Surgery, Spine Unit, Rigshospitalet; Anaesthesiology, Rigshospitalet; Orthopedic Surgery, Spine Unit, Rigshospitalet; Orthopedic Surgery, Spine Unit, Rigshospitalet
Background: Surgical management of adolescent idiopathic scoliosis (AIS) involves a risk of substantial perioperative bleeding despite the use of cell salvage as well as infusion of antifibrinolytic agents. Avoidance of allogeneic blood transfusion is of importance considering the cost, the infection risk and the risk of autoimmunization.
Purpose / Aim of Study: To investigate potential predictors of blood transfusion following instrumented fusion for AIS in a center with well-defined transfusion guidelines.
Materials and Methods: A retrospective cohort study was carried out on all patients undergoing posterior instrumented fusion for AIS in the period May 1st 2011 through December 31st 2015. Data was extracted from medical records and surgical charts. A logistic regression analysis was conducted with transfusion of red blood cells before discharge as outcome variable. Predictor variables were chosen a priori.
Findings / Results: The study included 149 patients. Mean age was 16.3±2.4 years and 83% were female. Fifty patients (34%) received transfusion and this group had significantly higher preoperative Cobb angle, longer operation time, lower body mass index (BMI) and a lower preoperative hemoglobin (hgb) than the non- transfusion group (p < 0.014). Multiple logistic regression including these factors as well as fusion length and mean arterial pressure showed that only BMI (OR: 0,77, 95% CI: 064-089) and preoperative hgb (OR: 0,26; 95% CI: 0,12-0,50) were significantly associated with risk of transfusion. Nine out of ten patients with a preoperative hgb level of less than 7.5 mmol/l required transfusion.
Conclusions: Preoperative hgb was the strongest predictor of patients requiring transfusion following surgery for AIS. Adopting a preoperative minimum level of 7.5 mmol/l may be considered.
Thea Hovgaard, Tine Nymark, Michael Mørk Petersen
Orthopaedic Department, Rigshospitalet; Orthopaedic Department, Odense University Hospital; Orthopaedic Department, Rigshospitalet
Background: Current routine follow-up policy for soft tissue sarcomas (STS) lacks evidence. Early detection and surgical removal of lung metastases (LM) is associated with improved survival. In Jan. 2010 we introduced a new follow-up program in which intermediate- and high-grade malignant STS the first 2 years post surgery were followed 4 times a year alternating between clinical examination (CE) preceded by focal MRI plus low-dose chest CT-scan without contrast (CT) and a CE with regular chest X-ray (XR).
Purpose / Aim of Study: To evaluate the new surveillance program for identification of LM in intermediate- and high-grade STS within the first 2 years postoperatively.
Materials and Methods: We retrospectively assessed the medical files of all patients (n=116, mean age 59 (18-87) years, F/M=57/59) with STS of the extremities and trunk wall, who underwent surgery from 2010-2013. We extracted information on how LM were detected during the first 25 months post-surgery. Statistics: Kaplan Meier survival analysis and 2x2 contingency table with chi2-test.
Findings / Results: 19/116 patients experienced LM within the first 25 months post-surgery (25 months-LM free rate 87%). Compared to XR, CT led to a larger amount of suspicions of LM (23/285 versus 6/278, p<0.002). Furthermore the suspicions on CT seemed more accurate than on XR (16/23 affirmed versus 2/6 affirmed, p<0.103). The only cases where an XR finding of LM was correct were in 2 cases where an XR was the first chest examination after surgery and radiotherapy. CT (n=285) found a larger number of LM than XR (n=278) did (16 (5.6%) versus 2 (0.7%), p<0.001). Three patients suspected LM themselves, 1 of them was affirmed.
Conclusions: Bi-annual CT the first 2 postoperative years after surgical treatment of STS, seemed to detect LM better than plain WR, and therefore render regular WR between these CT unnecessary.
Orthopaedic Department, Rigshospitalet; Orthopaedic Department, Odense University Hospital; Orthopaedic Department, Rigshospitalet
Background: Current routine follow-up policy for soft tissue sarcomas (STS) lacks evidence. Early detection and surgical removal of lung metastases (LM) is associated with improved survival. In Jan. 2010 we introduced a new follow-up program in which intermediate- and high-grade malignant STS the first 2 years post surgery were followed 4 times a year alternating between clinical examination (CE) preceded by focal MRI plus low-dose chest CT-scan without contrast (CT) and a CE with regular chest X-ray (XR).
Purpose / Aim of Study: To evaluate the new surveillance program for identification of LM in intermediate- and high-grade STS within the first 2 years postoperatively.
Materials and Methods: We retrospectively assessed the medical files of all patients (n=116, mean age 59 (18-87) years, F/M=57/59) with STS of the extremities and trunk wall, who underwent surgery from 2010-2013. We extracted information on how LM were detected during the first 25 months post-surgery. Statistics: Kaplan Meier survival analysis and 2x2 contingency table with chi2-test.
Findings / Results: 19/116 patients experienced LM within the first 25 months post-surgery (25 months-LM free rate 87%). Compared to XR, CT led to a larger amount of suspicions of LM (23/285 versus 6/278, p<0.002). Furthermore the suspicions on CT seemed more accurate than on XR (16/23 affirmed versus 2/6 affirmed, p<0.103). The only cases where an XR finding of LM was correct were in 2 cases where an XR was the first chest examination after surgery and radiotherapy. CT (n=285) found a larger number of LM than XR (n=278) did (16 (5.6%) versus 2 (0.7%), p<0.001). Three patients suspected LM themselves, 1 of them was affirmed.
Conclusions: Bi-annual CT the first 2 postoperative years after surgical treatment of STS, seemed to detect LM better than plain WR, and therefore render regular WR between these CT unnecessary.
Kim Schantz, Ulrik Kragegaard Knudsen, Tommy Henning Jensen, John Kloth Petersen, Signe Rosenlund
Orthopedic Surgery and Traumatology, Zealand University Hospital; Orthopedic Surgery and Traumatology, Zealand University Hospital; Orthopedic Surgery and Traumatology, Zealand University Hospital; orthopedic, Zealand University Hospital; Orthopedic Surgery and Traumatology, Zealand University Hospital
Background: The Copeland resurfacing hemiarthroplasty (RHA) has been used to treat patients with degenerative shoulder disease since the mid 1990’s. The Copeland prosthesis has been linked to high revision rates and inferior patient-reported outcome
Purpose / Aim of Study: We investigated the 1 year post-operative patient-reported outcome after Copeland RHA with or without AC-joint resection and the overall revision rate
Materials and Methods: We include all patients who had surgery with the Copeland prosthesis at Koege Hospital Orthopaedic department in a 6 years period from January 2008 to December 2013. The Danish Shoulder Arthroplasty Registry (DSR) was crosschecked to identify all patients with Copeland RHA surgery at our department in that period and to gain WOOS score one year post-operatively. The WOOS score at one year was used to evaluate the patient-reported outcome Revision rates were obtained from the DSR and crosschecked with the National Patient Register in january 2016
Findings / Results: In total 137 consecutive Copeland RHA in 131 patients were evaluated. The mean follow-up time was 4.0 years. The cohort included 48 (35%) males and 89 (65%) females. The mean age was 69.2 (± 8.8) years at surgery. AC-joint resection was performed in 51 (37%) shoulders. In the 89 patients who returned the WOOS questionnaire at one year the median WOOS score was 89.5 There was nió difference between those who har an ac resektion and those without. 7 patients had a revision and 19 patients died prior to December 2015.
Conclusions: The cohort had a high patient-reported outcome after one year and a low revision rate. We found no difference in patient-reported outcome for patients with and without AC-joint resection. We conclude that the Copeland prothesis is an unpredictable prothesis yeilding varied results i differeret series.
Orthopedic Surgery and Traumatology, Zealand University Hospital; Orthopedic Surgery and Traumatology, Zealand University Hospital; Orthopedic Surgery and Traumatology, Zealand University Hospital; orthopedic, Zealand University Hospital; Orthopedic Surgery and Traumatology, Zealand University Hospital
Background: The Copeland resurfacing hemiarthroplasty (RHA) has been used to treat patients with degenerative shoulder disease since the mid 1990’s. The Copeland prosthesis has been linked to high revision rates and inferior patient-reported outcome
Purpose / Aim of Study: We investigated the 1 year post-operative patient-reported outcome after Copeland RHA with or without AC-joint resection and the overall revision rate
Materials and Methods: We include all patients who had surgery with the Copeland prosthesis at Koege Hospital Orthopaedic department in a 6 years period from January 2008 to December 2013. The Danish Shoulder Arthroplasty Registry (DSR) was crosschecked to identify all patients with Copeland RHA surgery at our department in that period and to gain WOOS score one year post-operatively. The WOOS score at one year was used to evaluate the patient-reported outcome Revision rates were obtained from the DSR and crosschecked with the National Patient Register in january 2016
Findings / Results: In total 137 consecutive Copeland RHA in 131 patients were evaluated. The mean follow-up time was 4.0 years. The cohort included 48 (35%) males and 89 (65%) females. The mean age was 69.2 (± 8.8) years at surgery. AC-joint resection was performed in 51 (37%) shoulders. In the 89 patients who returned the WOOS questionnaire at one year the median WOOS score was 89.5 There was nió difference between those who har an ac resektion and those without. 7 patients had a revision and 19 patients died prior to December 2015.
Conclusions: The cohort had a high patient-reported outcome after one year and a low revision rate. We found no difference in patient-reported outcome for patients with and without AC-joint resection. We conclude that the Copeland prothesis is an unpredictable prothesis yeilding varied results i differeret series.