Posterudstilling

Torsten Grønbech Nielsen, Lene Miller, Ole Gade Sørensen, Bjarne Mygind-Klavsen, Peter Faunø, Lind Martin
Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital


Background: It is well known that graft harvest at Anterior Cruciate ligament (ACL) -reconstruction leads to donor site morbidity. Typical donor site symptoms are muscle pain (MP), muscle weakness (MW), muscle cramp (MC) and muscle strain sensation (MS). Quadriceps Tendon (QTB) graft harvest for ACL-reconstruction is increasingly used. Donor site morbidity after QTB graft harvest has not been described in details.
Purpose / Aim of Study: The purpose of this present study is to compare the donor site morbidity of two groups of patients who underwent ACL-reconstruction with a graft from either semitendinosus/gracilis (STG) or QTB. We hypothesized less donor site morbidity with QTB graft harvest compared to STG graft harvest.
Materials and Methods: Ninety-nine patients were included in the present study. STG grafts were used in 49 patients and QTB grafts were used in 50 patients. The patients completed a questionnaire 12 month after surgery and included questions concerning: MP, MW, MC and MS from the donor muscle group.
Findings / Results: Twenty-five patients (52%) in the STG- group have donor-site problems, compared to 14 patients (30%) in the QTB-group (p<0.05). The distribution of donor site morbidity for STG is (MP, MW, MC, MS) 13, 20, 16 and 17 patients and for QTB it is 8, 12, 6 and 2 patients respectively. QTB harvest result in less MW and MS than STG harvest. Twenty-three (92%) patients of the STG-patients experience the donor morbidity symptoms in relation to Sport compared to 9 (64%) in the QTB-group. Four patients in the STG categorize their donor site morbidity as severe, compared to 2 patients in the QTB- group.
Conclusions: The findings in the present study demonstrate that STG graft harvesting leads to more donor site morbidity than the QTB graft. In the STG-group MW and MS are the biggest problems compared to the QTB-group.

Haakon Berven, Michael Brix, Kaywan Izadpanah, Eva Johanna Kubosch, Hagen Schmal
Department of Orthopedics and Traumatology, Odense University Hospital; Department of Orthopaedics and Traumatology, Odense University Hospital; Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University Medical Center Freiburg, Germany; Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University Medical Center Freiburg, Germany; Department of Orthopaedics and Traumatology, Odense University Hospital


Background: The optimal method for fixation of proximal tibial fractures with a complete metaphyseal component is unknown.
Purpose / Aim of Study: The purpose of this study was to compare external fixation with the Ilizarov wire frame and internal fixation with locking plates.
Materials and Methods: We carried out a retrospective cohort study with patients from two level 1 trauma centers treated with either external fixation or internal fixation. Adult patients with nonpathological fractures classified as Schatzker type VI or OA 41 A2-A3, C1-C3 were included. Combined clinical and radiological bone healing was the primary outcome. Secondary outcomes included infection rate, range of motion of the knee, axial alignment of the knee, re-operation rate after 6 months, heterotopic ossification and signs of post-traumatic osteoarthritis. Minimum follow up time was 3 months. All data was gathered from patient records and radiographs.
Findings / Results: 62 patients were treated with external fixation and 68 with plate fixation. Time of healing was slightly shorter in the plate fixation group concerning a higher proportion of patients healed after 3-6 months compared to external fixation (67.7% vs 47.1%, p=.017). No difference was seen in the rates of non-union (p=.099). Heterotopic ossification was more prevalent following plate fixation (13.2% vs 1.6%, p=.013). External fixation was associated with a higher rate of superficial infections (40.4% vs 2.9%, p=.000). The initial displacement and the injury severity (ISS) significantly influenced the incidence of non-unions in both groups.
Conclusions: Locking plates might have a shorter time of healing, but otherwise these methods are comparable with different complication profiles.

Rikke Rousing, Mikkel Østerheden Andersen
Rygkirurgisk afdeling, Middelfart Sygehus; Rygkirurgisk afdeling, Middelfart Sygehus


Background: Lumbar Spinal stenosis is treated in different ways. Physiotherapy and manual treatment are two ways of conservative approaches. The neurogenic symptoms are treated with different types of medication. Surgical decompression is an invasive treatment.
Purpose / Aim of Study: The aim of this study is to examine the evidence of conservative and surgical treatment for lumbar spinal stenosis by a review of the literature for the last 10 years.
Materials and Methods: Literature search for randomised studies dealing with symptomatic lumbar spinal stenosis was performed. A protocol for the literatur search performed by the national board of health was the basis for the literature seach. Studies in english, german and scandinavian languages were included.
Findings / Results: There is no evidence for conservative treatment for lumbar spinal stenosis. Neurogenic pain may be relieved with Gabapentin, but there is risk of side effects. In the last 10 years no studies deal with ordinary pain medication for radiating leg pain. Surgical decompression relives leg pain and improves physical and mental outcomes and there is a low risc of complications.
Conclusions: Surgical decompression for symptomatic lumbar spinal stenoses should be considered in case of failed conservative treatment and/or in case of severe and long lasting symptoms. There is a need for future randomised studies concerning conservative treatment, pain medication and surgery for symptomatic lumbar spinal stenosis.

Steffen Sauer, Robert English, Mark Clatworthy
Orthopaedic Surgery and Sports Medicine, Middle more Hospital / Auckland / New Zealand; Orthopaedic Surgery and Sports Medicine, Middlemore Hospital / Auckland / New Zealand; Orthopaedic Surgery and Sports Medicine, Middlemore Hospital / Auckland / New Zealand


Background: Increased lateral tibial posterior slope (LTPS) is associated with higher ACL reconstruction (ACLR) failure rate. Transportal central femoral footprint ACLR is associated with higher failure rate compared to transtibial high anteromedial footprint ACLR due to graft anisometry.
Purpose / Aim of Study: The purpose of this study was to investigate whether the influence of tibial slope on ACL graft failure risk is dependent on graft positioning.
Materials and Methods: Out of 1480 consecutive hamstring ACL reconstructions, 30 transportal (central femoral tunnel placement) and 30 transtibial (high anteromedial tunnel placement) ACLR failures were evaluated and matched one- to-one with non-failure control participants by age, sex, graft and surgical technique. Lateral tibial slope was assessed on MRI using the technique described by Hashemi.
Findings / Results: The risk of graft failure in the transportal group increased by 40.5 percent per degree of increasing LTPS (odds ratio 1.4; 95% CI, 1,05 - 1,87; p=.02). The transportal failure group showed a significantly higher mean tibial slope of 8.6 degrees compared to both the transportal control group with 7.1 degrees (p=.03) and the transtibial failure group with 7.2 degrees (p=.04). Increased tibial slope was associated with shorter time to reconstruction failure (p=.002). The difference between slopes in the transtibial failure group (7.2 degrees) compared to the transtibial control group (7.1 degrees) was not significant (p=0.56).
Conclusions: Increased LTPS is associated with increased risk of graft failure only in transportal ACLR, not in transtibial ACLR. Slope related graft strain may be potentiated by anisometric ACL graft placement. Especially in paediatric ACLR, where increased LTPS is found, non- isometric ACL graft placement should be avoided.

Marianne Tjur, Steffan Tabori Jensen, Torben Bæk-Hansen, Inger Mechlenburg , Maiken Stilling
Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital, Holstebro; Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital, Holstebro


Background: Total Hip Arthroplasty (THA) relieve pain and increase function in patients with hip osteoarthritis (OA). Yet, it is unclear if THA leads to higher levels of daily physical activity (PA).
Purpose / Aim of Study: To describe changes in objectively measured PA, and self-reported pain and function until one year after THA in an elderly population.
Materials and Methods: 20 patients (11 males, mean age 75+/-5) with hip OA received a Dual Mobility THA. PA was monitored during two-week periods using a tri-axial accelerometer mounted on the lateral thigh. % time sitting and standing, transfers from sit to stand (nrSSTs) and daily steps was estimated using a MatLab algorithm. Self-reported function and pain were obtained using Oxford Hip Score (OHS) and Visual Analog Scale (VAS). All measures were collected pre-operative (BL), 3 and 12 months after surgery.
Findings / Results: Sitting time decreased from 64% (SD: 12%) at BL to 58% (SD: 11%) at 3 months (p=0.01) followed by an increase to 66% (SD: 12%) at 12 months (p=0.01). Standing time increased from 26% (SD: 10%) at BL to 32% (SD: 11%) at 3 months (p=0.004) but decreased to 25% (SD: 10%) at 12 months (p=0.01). OHS increased from 24 (IQR= 8) at BL, to 38 (IQR: 6) at 3 months (p<0.001), and 46 (IQR:6) at 12 months (p<0.001). VAS at rest decreased from 3.5 cm (IQR: 3 cm) at BL to 1 cm (IQR: 0 cm) at 3 months (p<0.001) and 0 cm (IQR: 0 cm) at 12 months (p<0.0001). VAS during activity decreased from 7 cm (IQR: 4 cm) at BL to 1 cm (IQR: 1 cm) at 3 months (p=0.0001) and 0 cm (IQR: 0 cm) at 12 months (p=0.0001).
Conclusions: Although patients' hip pain and function improved one year after surgery, PA only increased up to 3 months, and then dropped to BL levels. This indicates that improved function after THA has a potential to be translated into PA, but this conversion does not seem to take place on the long term.

Rasmus Elsoe, MD, PhDa Mykola Horodyskyy, MDa, Peter Larsen, PT, PhDb Inge L. Kjær, MDa
Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark


Background: The literature lacks recent epidemiology studies of the incidence, trauma mechanism and fracture classification of calcaneus fractures
Purpose / Aim of Study: The purpose of the present study was to provide up-to-date information concerning the incidence of calcaneus fractures in a large and complete population and report the distribution of fractures, trauma mechanism and patient baseline demographics
Materials and Methods: Population-based epidemiological study of all patients treated for a calcaneus fracture in a 6-year period from 2005 to 2010 at Aalborg University Hospital. Retrospective reviews of clinical and radiological records. All fractures were classified according to the AO and Sanders classifications following review of x-rays and computer tomography (CT) scans.
Findings / Results: A total of 328 patients were treated for 343 calcaneus fractures between 2005 and 2010. The mean age at time of fracture was 47.6 (19.9 SD) years. The mean age for males was 43.0 (18.1SD) years, and for females 57.5 (20.0SD) years. The gender distribution was 68.4% males and 31.8 % females. The overall incidence of calcaneus fractures between 2005 and 2014 was 9.9 /100,000/year. For males, the incidence was 13.6/100,000/year, and for females, 6.3/100,000/year. Of the 343 calcaneus fractures 176 (51.3%) were extraarticular (AO type 83-A). Of the remaining 167 intraarticular fractures, Sanders Classfication type 3 was the most common of all fractures representing (49.7%).
Conclusions: This study shows an incidence of 9.9/100,000/year during a six-year period between 2005 and 2010. The most common fracture type in all age groups was AO type 83-A (extraarticular), representing 51.3% of all fractures. The predominant mode of injury was fall from above 1m (65.6%) followed by fall from standing height (8.8%).

Lene L. Miller, Torsten Grønbech Nielsen, Ole Gade Sørensen, Bjarne Mygind-Klavsen, Peter Faunø, Martin Lind
Div. Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark ; Div. Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark ; Div. Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark ; Div. Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark ; Div. Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark ; Div. Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark


Background: Patella instability is highly correlated to trochlea dysplasia (TD). Severe TD leads to biomechanical and kinematic changes that may require surgical correction in order to obtain successful surgical treatment of patella instability. Failure after patella stabilizing surgery may be caused by lack of correction of severe TD.
Purpose / Aim of Study: The purpose of this present study is to clarify the effect on patella stability and subjective outcome in patients who had trochleoplasty performed as additional procedure to surgical treatment of patella instability or after failed patella instability surgery.
Materials and Methods: Twenty-two patients operated between 2013 and 2017 were included in the present study. 3 males and 19 females. Mean age is 24 years (15-41 years). They all had more than 5 dislocations of the patella and a positive J-sign prior to this operation. 13 patients had one or more previous unsuccessful patellofemoral surgeries. Trochleoplasty was performed using the Bereiter technique either open or arthroscopically. Kujala score and Pain numeric rating scale (NRS) were used to evaluate the effects of intervention.
Findings / Results: Eight patients (36%) had a trochleoplasty procedure done bilaterally. 18 patients (82%) had TD Dejour type D, 3 patients 14% type C and 1 patient type B (4%). The procedure was done arthroscopically in 50% of the patients. The Kujala score increased from 52 preop. to 70 at 1-year follow up. The NRS score at rest decreased from 3,1 to 1,7 and NRS at exercise decreased from 5,4 to 3,2. 5 patients (23%) had a reoperation due to arthrofibrosis. None of the patients had a redislocation of the patella.
Conclusions: Trochleoplasty is a surgical procedure and should be considered in the treatment of recurrent patellar dislocation in cases with severe TD and when previous patellofemoral surgery was unsuccessful.

Adriano axel Ceccotti, Larsen Peter, Rasmus Elsøe,
Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.; ,


Background: Fracture of the distal end of the femur are rare, with the literature reporting a prevalence of 0.5% of all fractures. Incidence rates of distal femur fractures has only been reported in a small number of studies with the most resent reporting an overall incidence during a one-year period (2010-2011) from an adult and well-defined population in Scotland as 7.0/100,000/year. The literature lacks recent epidemiology studies of the incidence, trauma mechanism and fracture classification of distal femur fractures.
Purpose / Aim of Study: To provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population and to report on the distribution of fracture classification, trauma mechanisms, and patient baseline demographics
Materials and Methods: Retrospective reviews of clinical and radiological records were performed on distal femur fractures in the Northern Region of Denmark between 2005 and 2010.
Findings / Results: A total of 293 patients were treated for 302 distal femur fractures. The mean age for males was 44.0 (26.8SD) years, and for females 71.6 (24.0SD) years. The gender distribution was 33.4% males and 66.6% females. The overall incidence of distal femur fractures was 8.7/100,000/year. After the age of 60 years a rapid increase in the incidence of distal femoral fractures was observed for both genders with a large female predominance. Low energy injuries were the most common mode of injury in both genders (97%), with approximately 61% being the result of a fall from standing height. AO classification type A was the most common of all fractures (38.6%).
Conclusions: This study shows an incidence of 8.7/100,000/year of distal femur fractures. After the age of 60 years a rapid increase in the incidence of distal femoral fractures was observed for both genders with considerable female predominance.

Joachim Svensson, Helle Mätzke Rasmussen, Nis Nissen, Anders Holsgaard-Larsen
Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark; Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark; Department of Orthopaedics, Lillebaelt Hospital, Kolding; Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark


Background: Critical threshold values of range of motion (ROM) during clinical examinations of children with cerebral palsy (CP) have been implemented by the Danish Cerebral Palsy Follow-up Program (CPOP) for the purpose of early detection of restricted movements of joints and potential intervention.
Purpose / Aim of Study: The aim of the present study was to test the hypothesis that ROM measures in children with CP were associated with gait function by means of Gait Profile Score (GPS) and Gait Variable Score (GVS), and to determine if ROM threshold values (red, yellow and green), influences gait function.
Materials and Methods: 60 children with CP classified in GMFCS I- II, age 5-9 years, were included. Clinical examination of ROM of lower extremities was performed according to procedures described by CPOP. Gait summary measures (GPS and GVS), calculated through 3-dimensional gait analysis, were collected at baseline from the CPinMOTION trial (ClinicalTrials.gov: NCT02160457).
Findings / Results: Overall, the children demonstrated impaired gait function (GPS: 10.5, IQR: 8.2-11.7). Weak associations were found between GVS and ROM measures of clinical examination (r2= 0.19-0.25, p<0.05). Multiple regression combining ROM of knee extension, hip extension and hip external rotation explained 10.5 % of variance in gait. Differences in GVS between ROM categories red vs. green were demonstrated in hip extension (p<0.05) and ankle dorsiflexion with extended knee (p<0.05).
Conclusions: Clinical examination of ROM demonstrated weak association with gait summary measures in the present group of children with CP. Distinction of the thresholds of ROM categories and the association with gait function may be questioned and needs further examination, as an indication for intervention.

Bo Mussmann, Poul Erik Andersen, Trine Torfing, Søren Overgaard
Dept. of radiology, Odense University Hospital; Dept. of radiology, Odense University Hospital; Dept. of radiology, Odense University Hospital; Dept. of Orthopaedic surgery and traumatology, Odense University Hospital


Background: Bone density measurements around hip implants are challenged by artifacts and the complex anatomy of the acetabulum. We developed 3D segmentation software and used dual energy CT to reduce artifacts.
Purpose / Aim of Study: To test the between-scan agreement and reliability of segmentation software and to compare bone mineral density (BMD) measurements in single- and dual energy CT (SECT and DECT)
Materials and Methods: 24 male patients with total hip arthroplasty (12 cemented and 12 uncemented) were scanned and rescanned using SECT and virtual monochromatic DECT images. 3D- ROIs were defined slice-by-slice and BMD was calculated adjacent to the acetabular cup.
Findings / Results: Mean BMD for SECT was 411 mg/ccm with a between scan difference of 21 mg/ccm, p=<0.0001 in the uncemented cup. DECT showed a mean BMD of 153 mg/ccm with a difference of 10 mg/ccm, p<0.0001. Around the cemented cup the mean BMD for SECT was 523 mg/ccm with a between-scan difference of 14 mg/ccm, p=0.25 and 186 mg/ccm in DECT with a difference of 6 mg/ccm, p=0.15. ICC was >0.95 with more narrow limits of agreement in DECT compared with SECT. Computed tomography dose index (CTDI) was 25% higher with DECT and subjective image quality was better in SECT.
Conclusions: Equally reliable BMD measurements adjacent to acetabular cemented and uncemented cups can be performed using the segmentation software. The absolute between-scan agreement was better in DECT. Virtual monochromatic DECT with fast kVp switching may be beneficial in estimating BMD adjacent to metal implants, but radiation dose and image quality should be taken into consideration. BMD cannot be measured interchangeably with SECT and DECT.

Stina Brogård Andersen, Karen Højmark, Frederik Busch, Mikkel Andersen
Rygkirurgisk sektor, Rygcenter Syddanmark, Sygehus Lillebælt; Rygkirurgisk Sektor, Rygcenter Syddanmark, Sygehus Lillebælt; Rygkirurgisk Sektor, Rygcenter Syddanmark, Sygehus Lillebælt; Rygkirurgisk Sektor, Rygcenter Syddanmark, Sygehus Lillebælt


Background: Accurate knowledge on complication rates following lumbar discectomy is important, when obtaining informed consent from the patients and balancing the surgeon and the patient’s expectation about surgery
Purpose / Aim of Study: The purpose of the present study is to determine the complication-rate of severe complications after lumbar discectomy.
Materials and Methods: All patients who underwent primary discectomy due to lumbar disc herniation from June 2010 to February 2017 at Center for Spine Surgery and Research, Middelfart were included. Data on new onset neurological deficits and urinary disorders were reported by physiotherapists at follow- up consultations one month postoperative. Data on: thrombosis, embolism, urinary retention, perioperative infection, root injury or cauda equina reported by surgeons at discharge, and data on: deep infection, thrombosis or embolism up till 3 months postoperative, reported by patients one year postoperative, were collected from the national spine surgery database DaneSpine.
Findings / Results: 129 the 2596 patients identified had experienced at least one severe complication after surgery (5%). Distribution of complications: Thrombosis (8), embolism (1), urinary retention (5), root injury (8), cauda equina (3), infection perioperative (1), deep infection (25), new neurological deficits (40), new urinary disorder (53). 15 patients experienced two complications.
Conclusions: In this study the rate of serious complications after primary lumbar discectomy is 5%. However which complications are considered severe needs further discussion, as well as by whom, when and how they should be reported. Furthermore one should be aware that some deficits could actually be a consequence of the primary disc herniation.

Axel Ceccotti, Henrik Larsen Jørgensen
orthopedic surgery, AAUH; clinical laboratory, BBH


Background: Hip fractures are a well-known cause of mortality, especially for the older patients and in patients suffering osteoporosis.
Purpose / Aim of Study: The aim of this study was to investigate the time-trend in incidence of hip fractures and mortality after 30 days in the adult Danish population between 1996 and 2012.
Materials and Methods: Participants were any patient aged 18 years or above registered in the Danish National Patient Registry with a hip fracture in Denmark during the period from the 1st of January 1996 to the 31st of December 2012. Outcomes were defined as 1) diagnosis of hip fracture or 2) all-cause mortality 30 days after diagnosed hip fracture. The National Central Civil Register, which contains information about death and migration, was used to analyse the mortality rate.
Findings / Results: The total number of hip fractures decreased 33% from 11.339 in 1996 to 7,665 in 2012. The mean age for first hip fracture during the period 1996-2012 for women was 80 years for women and 74 years for men. The incidence in hip fracture was 217 per 100,000 in 1996 and 137 per 100,000 in 2012, higher for female. The mean age for mortality 30 days after hip fracture in the period 1996-2012 was 85 years for women and 82 years for men.
Conclusions: Our present study showed a continuously decrease in incidence of hip fracture for women and a slight decrease in incidence for men. Explanations could be interventions including ant-osteoporotic medication, an increased attention paid to the fall phenomenon, increased use of glucocorticoids, a remarkably increase in preventive health consultations. Male's death rate were higher than female's. Variables which affect death rate after hip fractures are sex, time to surgery and comorbidities. Interventions as orthopedic- geriatric were made to decrease mortality. Further interventions are needed.

Mette Lund Madsen, Daniel Wæver, Jan Duedal Rölfing, Lars Carl Borris, Lise Loft Nagel, Mads Henriksen, Rikke Thorninger
Ortopædkirurgisk afdeling, Regionshospital Randers; Ortopædkirurgisk afdeling, Regionshospital Randers; Ortopædkirurgisk afdeling, Aarhus Universitetshospital; Ortopædkirurgisk afdeling, Aarhus Universitetshospital; Røntgen og Skanning, Aarhus Universitetshospital; Røntgen og Skanning, Aarhus Universitetshospital; Ortopædkirurgisk afdeling, Aarhus Universitetshospital


Background: Recent studies question the clinical advantage and cost effectiveness of volar locking plates. Here, we investigate whether volar plating can restore the anatomy after distal radius fracture.
Purpose / Aim of Study: The purpose of the study was to determine the radiologic outcome after volar plating of distal radius fractures. Our hypothesis was that volar locking plate surgery restores the anatomic angulation and length of the radius.
Materials and Methods: 576 patients (median age 63, 78% women) were treated with 2 different volar locking plates (VariAx and Acu-Loc) over a period of 3.2 years by 64 surgeons. Three independent observers evaluated angulation and ulnar variance (>2mm) on the latest radiographs before surgery and postoperatively at 0 and 5 weeks.
Findings / Results: The mean angulation was -18.0 ±5.4 and 15.5 ±11.2 degrees for volarly and dorsally displaced fractures, respectively. After surgery, there was no statistically significant difference between volarly and dorsally displaced fractures and the type of plates. Immediately after surgery the mean angulation was -4.5 ±6.3 degrees. After 5 weeks the mean angulation of -3.9 ±7.0 degrees did not statistically differ from the immediately postoperative measurements, p=0.79. Thus, the anatomic angulation of -12 degrees was not achieved (p<0.001). The mean differences between the three independent observers were minor, ranging from 0.3-1.8 degrees at the different time points (p<0.05). Shortening of the radius (>+2mm ulnar variance) was still present in 13% (95%CI 10-16) after surgery.
Conclusions: Contrary to common perception, volar locking plate surgery did not restore normal anatomy in terms of volar angulation and radial length. The clinical implication is unclear, because functional outcome was not available.

Charlotte Hartig-Andreasen, Lena Schroll, Jeppe Lange
Orthopaedic surgery, Regionshospitalet Horsens; Orthopaedic surgery, Regionshospitalet Horsens; Orthopaedic surgery, Regionshospitalet Horsens


Background: The optimal minimal invasive treatment for Dupuytren contractures remains debated. Xiapex is a treatment introduced into the commercial marked since its approval in 2009. When introducing new efficacious modalities into everyday practice the effectiveness of these must be properly evaluated.
Purpose / Aim of Study: The aim of this study was to evaluate the effect of xiapex treatment at Regionshospitalet Horsens after minimum one-year follow-up (FU).
Materials and Methods: 118 MCP joints and 60 PIP joints treated from Jan 2013 to May 2016 were available for follow-up. Mean FU were 2.5 years (95%CI 2.4-2.6). Mean age at treatment was 68 years (95%CI 67-69). 82% was male. 37 had received treatment in the affected joint prior to our XIAPEX, 21 percutaneous needle fascioctomi, 12 open surgery and 4 XIAPEX. XIAPEX® treatment was performed according to manufactures guidelines. Outcomes were 1) absolute change in extension deficit (ED) in degrees from baseline to follow-up in metacarpo phalangeal (MCP) and proximal interphalangeal (PIP) joints 2) contraction recurrence defined as ED above 20degrees, 3)Hurst endpoint defined as ED below 5 degrees .
Findings / Results: Baseline mean ED 49° (range 20° -90°) for MCP and 56° (range 20°-90°) for PIP. Immediately after cord rupture the mean ED 0° (range 0°-10°) for MCP and 8° (range 0°-80°) for PIP. The absolute change in ED was 48° (95%CI 46-51) for MCP and 47° (95%CI 42-52) for PIP. Contraction recurrence rate was 89% (95%CI 83-95) for MCP and 22%(95%CI 11-32) for PIP. Hurst endpoint was reach in 74% (95%CI 66-82) for MCP and 5% (95%CI 0-11) for PIP. 91% of the evaluated patients were willing to have XIAPEX treatment again if necessary. No safety aspects were detected at FU.
Conclusions: XIAPEX® is a viable first-line treatment of MCP Dupuytrens contractures, however inferior in PIP joints.

Jens Brahe Pedersen, Martin Gottliebsen
Ortopædkirurgisk Afdeling E, Traumesektionen, Aarhus Universitetshospital; Ortopædkirurgisk Afdeling E, Børnesektionen, Aarhus Universitetshospital


Background: Children have great potential for fracture remodeling. A large proportion of pediatric forearm fractures can be treated safely with closed reduction and casting. A cast index (CI) above 0.8 can be used as a predictor for loss of reduction. Studies have shown that these injuries are increasingly being managed with surgery and internal fixation. This trend does not appear to be backed by clinical research. We conducted a survey on training and knowledge of closed treatment techniques amongst specialist orthopaedic surgeons and trainees in Denmark.
Purpose / Aim of Study: Our aim was to investigate if the level of knowledge and training of closed reduction and casting techniques was associated to doctors' preferred treatment of paediatric forearm fractures.
Materials and Methods: An electronic questionnaire was distributed to responders through all orthopaedic departments in Denmark and the Facebook page of YODA (forum for orthopedic trainees in Denmark).
Findings / Results: 236 doctors completed the survey. 152 (65%) favored surgical treatment. Only 59 (25%) were able to correctly identify CI as a predictor for loss of fracture reduction. Doctors who lacked knowledge of closed treatment techniques were significantly more likely to prefer surgical treatment and significantly less likely to apply casts independently.
Conclusions: Closed reduction and casting of paediatric forearm fractures is a safe, noninvasive technique with good results if performed properly. Surgical treatment is preferred by a majority of responders but our survey indicates that lack of experience with closed techniques affects treatment preference. We recommend that casting techniques become a formal part of the curriculum for Danish orthopaedic trainees.

Casper Sæbye, Johnny Keller, Henning Andersen, Thomas Baad-Hansen
Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark; Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark


Background: Only few studies have investigated strength in soft tissue sarcoma patients by using objective measurements.
Purpose / Aim of Study: This study intends to determine the effects of limb-sparing surgery on the functional outcome measured by strength at the first 3 months in soft tissue sarcoma patients.
Materials and Methods: Patients who underwent surgery for a soft tissue sarcoma in the extremities at Aarhus University Hospital were included. Patients with disseminated disease or patients who had undergone replacement surgery in the disease-affected extremity were excluded. Patients completed a dynometric muscle test with the Biodex System 3 dynamometer before surgery, 1 month and 3 months after surgery on both the disease-affected and healthy side. The results were compared to normative data. A percentage between the obtained value compared to the expected value was calculated.
Findings / Results: This study included 25 patients who completed pre-operative measurement, while 13 patients completed 1 months and 3 months after surgery measurement. There was no significant difference found between healthy and disease-affected side pre-operatively and 3 months after surgery (p=0.57 and p=0.10, respectively). However, 1 month after surgery the healthy side was significantly stronger (p<0.01). Before surgery patients had a mean strength on 78.96% of the expected (95%-CI: 72.11-85.81). 1 month after surgery, they had a mean strength on 77.90% of the expected (95%-CI: 68.46-87.34). While 3 months after surgery patients had a mean strength of 77.48% of the expected (95%-CI: 65.46-89.49).
Conclusions: We did not find any significant difference in function, measured by the dynamometer, between the disease-affected side and the healthy side after 3 months. However, soft-tissue sarcoma patients have significant reduced strength when compared to healthy people.

Rasmus Wejnold Jørgensen, Lars Solgård, Jens-Christian Vedel, Claus Hjorth Jensen
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen


Background: Complications following fasciectomy for Dupuytren’s Disease (DD) include digital nerve injury, wound healing complications, necrosis, hematoma formation and infections.
Purpose / Aim of Study: The purpose of this study was to evaluate the number of postoperative complications, and hematomas in particular following fasciectomy for DD.
Materials and Methods: 362 patient charts were retrospectively reviewed. Postoperative events were recorded. Student T-test was used for numerical values. Chi-Square and Fisher’s Exact test was used for binomial outcomes. P<0.05 was considered statistically significant.
Findings / Results: No patients had ongoing treatment at the time of follow up (1-3 y). The mean age at follow-up was 67.6 years (SD 9.1, range 34- 95 y). There were 43 wound defects (11.9 %), 27 hematomas (7.5 %), 14 recurrences (3.9 %) and 11 infections (3 %) postoperatively. Those with postoperative hematoma had a mean of 9.75 (SD 4.2) outpatient visits postoperatively, those without had 3.71 (SD 2.8), P<0.0001. Infections occurred in 2.3 % of patients without postoperative hematoma and in 16.7 % of patients with postoperative hematoma, P=0.0065. There were no differences in wound defects or recurrence rates when comparing patients with postoperative hematomas to those without, P>0.05. The use of anticoagulants, the use of tobacco or whether the patients were operated on by junior doctors under supervision did not vary on any parameters, P>0.05. Operating on three or more fingers in one setting compared to one or two fingers resulted in more postoperative outpatient visits (P=0.007), wound defects (P=0.049), and hematomas (P=0.012).
Conclusions: Operating on three or more fingers leads to more complications and should be avoided when possible. A postoperative hematoma results in significantly more postoperative outpatient visits and more infections.

Karen Dyreborg, Michael Mørk Petersen, Anne Grete Kjersgaard, Søren Solgaard
Orthopaedic surgery, Rigshospitalet; Orthopaedic surgery, Rigshospitalet; Orthopaedic surgery, Gentofte Hospital; Orthopaedic surgery, Gentofte Hospital


Background: The ArcosTM Modular Femoral Revision System is a comprehensive, press-fit revision stem design including various possibilities for modular proximal and distal reconstruction in femoral revision THA surgery.
Purpose / Aim of Study: To evaluate the early results after femoral revision in a consecutive series of patients operated in the period August 2011 to December 2014 at Gentofte Hospital.
Materials and Methods: 118 patients (mean age=67(39-95) years, F/M=61/57) were included in the study with a clinical observation time of 2.5 to 5 years. The material included all femoral revisions (index operation cemented or uncemented THA, causes of revision septic and aseptic loosening). Clinical examination including present function of the hip assessed by HHS, OHS, EQ5D and radiographic evaluation was performed. The primary endpoint was the rate of re- revisions using data from the Danish Hip Arthroplasty Registry, the Patient Administrative System and the National Patient Registry. Secondary endpoints were the rate of complications (dislocations, periprosthetic fractures, infection (re-infection) and the present function of the hip. Statistics: Kaplan Meier survival analysis
Findings / Results: Of the 118 patients, 15 patients died in the interim and were consequently only included in the implant survivorship analysis. 68 patients attended the follow-up control. 11 (9%) hips were re-revised due to infection (n=5), aseptic loosening (n=2), fracture (n=2) or other causes (n=2). The 1, 3, and 5 year probability of implant survival (95% confidence interval) was 99% (87%-97%), 91% (86%-96%) and 88% (81%-96%) respectively.
Conclusions: The early results of the Arcos Femoral Revision System are promising. The early survival of the implant is acceptable, and the clinical results are satisfying in spite of an often preoperatively severely damaged femoral bone.

Veronika Murlasits, Michelle Fog Andersen, Andreas Hermann, Lasse Bayer, Jesper Sonntag
Department of orthopedic surgery, Nordsjælland hospital, Hillerød, Denmark; Department of orthopedic surgery, Holbæk, Denmark; Department of orthopedic surgery, Nordsjælland hospital, Hillerød, Denmark; Department of orthopedic surgery, Nordsjælland hospital, Hillerød, Denmark; Department of orthopedic surgery, Nordsjælland hospital, Hillerød, Denmark


Background: Ankle fractures are one of the most common skeletal injuries and increasing in the elderly population. Controversy remains concerning the choice of optimal treatment of unstable ankle fractures in patients with vulnerable soft tissue.
Purpose / Aim of Study: To investigate the functional and radiological outcome after isolated osteosynthesis of lateral malleolus with Fibula Rod after bi- or trimalleolar ankle fracture in this selected patient group.
Materials and Methods: We performed a retrospective review of all patients who underwent primary surgery for an unstable bi- or trimalleolar ankle fracture and were treated with isolated osteosynthesis of lateral malleolus using the Fibula Rod System (Acumed®) at Nordsjaellands Hospital between 01.01.12–31.12.16. A total of 62 patients were included. Demographic- and fracture-dependent data, function, x-ray and postoperative complications where evaluated (mean follow up 10,5 months).
Findings / Results: 97,4% of fractures of the lateral malleolus and 53,9% of fractures of the medial malleolus where healed at last x-ray. In total, 11,3% of them had pain ad last follow up. There was no significant connection between postoperative pain and healing of the medial malleolus. The complication rate was 19,2% caused by infection, screw migration and fracture dislocation. The postoperative function was significant (p<0,00) dependent on the preoperative function.
Conclusions: Fibula Rod as a salvage procedure in high-risk patients, where soft tissue is too vulnerable for common osteosythesis after AO-principles, gives acceptable functional and radiological outcome.

Michala Skovlund Sørensen, Thomas A. Gerds, Klaus Hindsø, Michael Mørk Petersen
Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Musculoskeletal Tumor Section; Department of Biostatistics, University of Copenhagen; Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Section of pediactrics; Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Musculoskeletal Tumor Section


Background: The SPRING (Sørensen, PeteRsen, hINdsø, Gerds) score was introduced in 2016 as tool to assist the surgeon in the decision making of a surgical implant that will outlive the patient in the treatment of metastatic bone disease in the appendicular skeleton (MBDA). The scores performance in a population based cohort is pending.
Purpose / Aim of Study: Refit and external validate the SPRING score in a population based cohort.
Materials and Methods: 270 patients having surgery with total joint replacement for MBDA from January 2003 – December 2013 was used to refit the model and an independent cohort of 165 patients having surgery in the Capital Region of Denmark from May 19, 2014 to May 18, 2016 was used as a validation cohort. Survival outcome was predicted at 3, 6 and 12 months after surgery using a logistic regression model fitted with primary cancer, pre-operative hemoglobin, fracture versus impending fracture, Karnofsky score, visceral metastases, multiple bony metastases and American Society of Anaesthesiologist's score. We evaluated using Brier score, AUC of ROC and calibration plots.
Findings / Results: The predictive scores obtained showed AUC values of 81.9 % (C.I.: 72.5%-91.2%),84.5% (C.I.: 75.6%-93.3%) and 85.8 (C.I.: 76.7-94.9%) at 3, 6 and 12 months respectively. Brier score was 0.155, 0.162 and 0.152 at 3, 6, 12 months respectively. The model showed good calibration at all three end- points.
Conclusions: The SPRING score is applicable to a general population to estimate residual life expectancy after surgery for MBDA and can assist the surgeon in decision making in regard to surgical solution.

Torsten Grønbech Nielsen, Miller Lene, Bjarne Mygind-Klavsen, Lind Martin
Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital; Div. Sports Trauma, Orthopedic Dept, Aarhus University Hospital


Background: Anterior knee pain (AKP) is a common knee problem seen in adolescents and young adults characterized by non- specific knee pain, pain when climbing stairs, riding a bike, walking and running. This leads to an impairment of both recreative and activities of daily living.
Purpose / Aim of Study: The purpose of the present study is to investigate the effect of a 3 months multimodal intervention including AKP- education, exercise program, footwear adjustment and foot orthoses in AKP patients.
Materials and Methods: 42 patients (Age 19 (10-32)) with the diagnosis AKP were included in a consecutive prospective cohort. The patients were educated in AKP and were instructed in a 3 months exercise program focusing on hip abduction, hip external rotation and normal movement pattern. Footwear was adjusted (for patients with angle valgus) and foot orthoses were recommended to patients with too much foot roll (pronation). Kujala score and Pain numeric rating scale (NRS) were used to evaluate the effects of intervention. Intraarticular knee pathology was excluded by MRI and clinical examination.
Findings / Results: The Kujala score improve from 71 to 86 months after 3 months. The NRS- rest and NRS-Walk improve from 3.0 to 1.3 and 6.4 to 3.0 respectively. All improvement are statically significant (p<0.01). 55% of the patients have at clinical improvement (>10 points on the Kujala score) and 57% and 74% had a clinical improvement on the NRS-rest and NRS-walk, respectively (≥ 2 points improvement). None of the patients have a decrease in outcome scores after 3 months.
Conclusions: An AKP multimodal treatment strategy focusing at footwear, orthoses and simple hip muscle exercise the patient significantly improve functional outcome and reduce pain. Further investigation is needed to evaluate the long time follow up.

Christian Dippmann, Line Borskov Dahl, Michael Rindom Krogsgaard
M51 section of sportstraumatology, Bispebjerg Hospital; Center for cardio-vascular surgery, Abdominal Center Rigshospital; M51 section of sportstraumatology, Bispebjerg Hospital


Background: With an incidence of 1-2/100.000 the distal biceps tendon rupture is an often overlooked injury. Surgical approach and the post-operative treatment is varying depending on the surgeons preference
Purpose / Aim of Study: The purpose of this prospective case study was to analyze the outcome after implementation of a standardized treatment regime
Materials and Methods: From September 2011 to February 2015 41 patients underwent reinsertion of the distal biceps tendon with a modified Boyd-Andersen technique. Post-operatively all patient were immobilized in an elbow cast for 2 weeks, followed by 6 weeks partial mobilization in a hinged brace. Active supination/pronation was allowed from day 1, active flexion/extension was restricted and gradually increased. All patients received pre- operative instructions by a ergotherapist, followed by 8-12 weeks supervised training. Elbow function was documented by the Oxford Elbow Score and by measuring active ROM (AROM). Data was collected prospectively before and 3, 6 and 12 months after surgery. 7 patients were excluded while 34 patients were included
Findings / Results: All 34 patients improved significantly (p<0.00) in the Oxford Elbow Score from pre-operatively median 22 to median 42. AROM (flexion/extension) improved significantly from pre-operatively mean 120,3 (SD 35,67) degrees to 145.9 (SD 18,36) degrees after 12 months (p<0,00) while AROM (supination/pronation) decreased from mean 161,6 (SD 15,89) degrees pre-operatively to 157,5 (SD 17,33) degrees after 12 months, although not significantely (p=0.365). Compared to the un-injured side, there was no significant difference in flexion/extension (p<0,00), but in supination/pronation (p=0.009)
Conclusions: Following our rehabilitation protocol for distal biceps tendon repair all 34 patients in this prospective case series, achieve excellent results in AROM and ADL

Jan Arnholtz Overgaard, Morten Tange Kristensen
Department of Rehabilitation, Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Municipality of Lolland, Denmark; Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark


Background: Debate exists regarding the definition of sarcopenia and when to be sarcopenic. Lately, Menant et al. (Osteoporosis Int 2016) showed that isometric knee- extension muscle strength cut-points with values of the lowest sex-specific quintile; <23.64 kg for men and <15.24 kg for women could predict sarcopenic conditions.
Purpose / Aim of Study: To investigate if these cut-points gave similar associations in the outcome of older adults with a hip fracture (HF) after ceased municipality-based rehabilitation.
Materials and Methods: Eighty (62 women) older adults with a mean (SD) age of 76.6(7.8) years (46 with a femoral neck - and 34 with a trochanteric fracture) were evaluated four months after HF. Maximal isometric knee-extension strength in the non-fractured limb with cut-points by Menant et al. were compared with the Timed Up & Go (TUG) test; the 10 m walk test (10mWT), and the 6-minute walk test (6MWT).
Findings / Results: The maximal knee-extension strength was on average 27.7(14.1) kg in men and 16.8(7.4) kg in women (p=0.005), and of whom 28% and 26% respectively (p=0.8), had signs of sarcopenia. The group with signs of sarcopenia performed significantly (p<.03) worse in the TUG (mean diff. 3.02 [95%CI: 1.67 to 4.37] seconds), walked slower in the 10mWT (0.23 [0.1 to 0.35] meter per second), and walked a shorter distance in the 6MWT (66.64 [29.9 to 103.19] meters), compared to the non- sarcopenic group.
Conclusions: Although confirming the findings by Menant et al. in older adults with HF, our findings probably underestimate the presence of sarcopenia in the HF population. Thus, the estimate of approximately 25% with signs of sarcopenia after ceased rehabilitation was established in a group of older adults with a high pre-fracture functional level, which underlines the importance of muscle strength exercises offered to all older adults with HF.

Anders Falk Brekke, Søren Overgaard, Asbjørn Hróbjartsson, Anders Holsgaard-Larsen
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Center for Evidence-Based Medicine, Odense University Hospital, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark


Background: Excessive anterior pelvic tilt has been linked to pain and dysfunction of the hip and pelvic region. Conservative treatment (e.g. manual therapy and physical training) is suggested in correcting the tilt and eventually related symptoms. However, the effectiveness in reducing excessive anterior pelvic tilt in adults is unknown.
Purpose / Aim of Study: To systematically review studies investigating the effectiveness of conservative treatment in reducing anterior pelvic tilt in adults and evaluate the quality of evidence.
Materials and Methods: MEDLINE, EMBASE, Web of Science and Cochrane (CENTRAL) were searched for relevant studies up to February 2017. Conservative intervention studies on adults aiming at reducing anterior pelvic tilt were included. Titles/abstracts screening was done by one reviewer and full text articles were assessed for methodology quality by two reviewers using Cochrane Collaboration’s tool for assessing risk of bias in RCT’s and the ROBINS-I tool (Risk Of Bias In Non-randomized Studies - of interventions). Data was synthesized qualitatively. The GRADE approach was used to determine the overall quality of the evidence. PROSPERO protocol id: CRD42017056927
Findings / Results: Four studies, two RCT´s and two trials without control, were included (n=5047). All four interventions were different and had duration from one day up to eight weeks. Two studies intervened on symptomatic and two on healthy subjects, respectively. Three of the studies demonstrated a significant reduction in anterior pelvic tilt. The two studies intervening on symptomatic subjects demonstrated a significant reduction in pain and disability, respectively.
Conclusions: Very low quality of evidence suggests that further studies are needed to clarify whether conservative treatment may reduce anterior pelvis tilt and reduce symptoms in relation to faulty posture.

Mikkel Ø Andersen, Carsten Ernst, Rasmussen Jesper , Dahl Søren , Leah Carreon
Sector for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark; Sector for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark; Department of Occupational Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Department of Occupational Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Sector for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark


Background: Lumbar disc herniation (LDH) is associated with high morbidity and significant socio-economic impact as the majority of the patients are of working age.
Purpose / Aim of Study: The purpose of this study was to determine the impact of length of sick leave on the return-to-work rate after lumbar disc herniation surgery.
Materials and Methods: Single-centre study of LDH patients who underwent surgery from 18 May 2009 through 28 November 2014. Data were collected prospectively from the DaneSpine database. Questions in DaneSpine include preoperative length of sick leave and working status one year postoperatively.
Findings / Results: A total of 678 patients were included and 72% of the patients had returned to work one year after their surgery. The rate of patients returning to work decreases significantly with the length of preoperative sick leave. Among the patients who were on sick leave prior to their surgery, 83% returned to work if surgically treated within 3 months. In contrast, only 50% of those whose sick leave exceeded 3 months returned to work.
Conclusions: The present analysis suggests that the return-to- work rate after lumbar disc herniation surgery is affected by the length of sick leave.

Ulrik Kähler Olesen, Tobias Nygaard
Reconstructive orthopedic surgery, trauma section, Rigshospitalet; Reconstructive orthopedic surgery, peadiatric orthopedics, Rigshospitalet


Background: Open femoral fractures with bone loss are difficult to treat.
Purpose / Aim of Study: A new technique to treat femoral bone loss, using a plate and a motorized lengthening nail is presented.
Materials and Methods: Three patients with extra articular femoral bone defects from open fractures were operated in 2016. The patients were evaluated for LLD, MAD, time to weight bearing, defect size, complications. Follow up was minimum 30 weeks. Surgical technique: After debridement and external fixation, a plate spanning the defect is inserted, maintaining length and rotation. Meticulous surgical planning was done using long standing radiographs and radiographs of contralateral femur with a calibration device to estimate correct length. After 6 weeks, negative biopsies and negative infection count (WBC,CRP) were found. The nail was then inserted in a retrograde or antegrade fashion and a transport segment created with a drill bit osteotomy. Some shortening was necessary to allow soft tissue closure in two cases. In one case the nail was pre- distracted to allow retrograde transport (pulling the segment)
Findings / Results: Average defect size was 75 mm. All patients were fully weight bearing at 25 weeks. LLD was zero,15 and 45 mm respectively. MAD was within normal limits in all cases. All patients displayed some degree of heterotopic ossification and reduced knee motion. All patients needed grafting and a docking procedure
Conclusions: The presented technique is simple and efficient, eliminating the side effects of external fixation. It may reduce treatment time compared to alternative methods. Femoral fractures with bone loss are prone to cause quadriceps fibrosis and heterotopic ossification, that may require further surgery, irrespective of which bone substitution method is used. Strict infection control and meticulous surgical planning is required.

Mette Hjorth Holm, Inger Mechlenburg, Marianne Tjur, Kjeld Søballe, Maiken Stilling
Orthopaedic Research Department, Aarhus University Hospital; Orthopaedic Research Department, Aarhus University Hospital; Orthopaedic Research Department, Aarhus University Hospital; Orthopaedic Research Department, Aarhus University Hospital; Orthopaedic Research Department, Aarhus University Hospital


Background: Metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) was presumed to provide superior functional outcomes compared to metal-on-polyethylene (MoP) THA.
Purpose / Aim of Study: To compare muscle mass and power, block-step test and patient reported outcomes between MoM THA/HRA and MoP THA patients.
Materials and Methods: 51 MoM THA/HRA (33 male) and 23 standard MoP THA (8 male) patients participated in a cross- sectional study mean 6.5 (0.6 – 12.5) years postoperative. Muscle mass was measured by total- body Dual energy X-ray Absorption scans and muscle power in a Leg Extensor Power Rig. Block- step test estimates were obtained with an Inertial Measurement Unit. Clinical outcome scores were Harris Hip Score (HHS) and The Copenhagen Hip and Groin Outcome Score (HAGOS).
Findings / Results: MoM THA/HRA patients had a greater interlimb difference in hip muscle mass compared to MoP THA patients (P=0.02), but otherwise, the interlimb differences in muscle masses and power was similar (P>0.05). Muscle mass of the thigh and calf area in both legs, and muscle power in both legs was higher in MoM THA/HRA patients compared to MoP THA patients (P<0.009). Block step time asymmetry when ascending was lower in MoM THA/HRA patients compared to MoP THA patients (P=0.03). HHS and HAGOS were similar between groups (P>0.07).
Conclusions: MoM THA/HRA patients had a higher interlimb difference in hip muscle mass which could be related to surgical factors, or to an inflammatory response to the metal wear debris. Furthermore, MoM THA/HRA patients had less block-step time asymmetry when ascending compared with MoP patients.

Christian Skovgaard Nielsen, Henrik Husted , Kristian Stahl Otte, Thue Ørsnes , Anders Troelsen , Kirill Gromov
Departement for Orthopedic Surgery , Hvidovre Hospital ; Departement for Orthopedic Surgery , Hvidovre Hospital ; Department of Orthopedic Surgery , Hvidovre Hospital ; Department of Orthopedic Surgery , Hvidovre Hospital ; Clinical Orthopedic Research Hvidovre Hospital , Hvidovre Hospital ; Department of Orthopedic Surgery , Hvidovre Hospital


Background: For patients undergoing Total Knee Arthroplasty (TKA) and simultaneously in anticoagulation treatment with vitamin-K antagonist (VAK), the treatment is usually discontinued prior to surgery. However, studies have shown high frequency of thromboembolic (TE) complications with discontinued VAK.
Purpose / Aim of Study: Thus, aim of this study was to describe intraoperative, 24 h calculated total blood loss (TBL) and complications for primary TKA without discontinuing VAK.
Materials and Methods: Eight consecutive patients undergoing TKA and in VAK treatment were enrolled; 7 had unilateral TKA and 1 bilateral TKA. All 8 patients discontinued VAK, and all TKA were performed in a fast-track setup without use of tourniquet. Patient demographics, intra-and postoperative data plus complications within 90 days were recorded. TBL was calculated by Gross’ formula.
Findings / Results: Seventy-five % were men, age and BMI were 73 y (IQR 68y-78y) and 31 (IQR 26-35), respectively, 63 % were ASA III and 6 patients and high TE risk whereas 2 patients had low TE risk. Surgical time was 49 min (IQR 44-55 min). All procedures were performed with International Normalized Ratio (INR) in therapeutic range. Calculated TBL for unilateral TKA’s was 1273 ml (IQR 1141-1428 ml), intraoperative blood loss was 200 ml (IQR 100-200) and 2 patients had blood transfusions, 1 and 2 units respectively. Length of stay (LOS) was 3 days (IQR 2.8-4.3 days). The bilateral TKA had a TBL of 3029 ml. No complications related to anticoagulation or surgery were recorded < 90 days.
Conclusions: TKA without discontinuation of VAK might increase TBL slightly, though; TBL was comparable to published data on patients without VAK. Considered the frequency of TE complications with paused VAK in high-risk patients, this descriptive study indicates a benefit of not discontinuing VAK for TKA surgery.

Zaid Al-Saadi, Niels Clausen, Peter Suder, Gerhardt Teichert
Shoulder and Elbow unit, orthopedic dept., Horsens Hospital; Shoulder and Elbow unit, orthopedic dept, Horsens Hospital; Shoulder and Elbow unit, orthopedic dept, Horsens Hospital; Shoulder and Elbow unit, orthopedic dept, Horsens Hospital


Background: Surgical reconstruction of acromioclavicular joint (ACJ) dislocations has been performed in our department using the modified Weaver Dunn procedure with either a PDS band or an anatomical designed Baltzer ACJ-hook plate as temporary reinforcement
Purpose / Aim of Study: Aim of this study was to assess clinical outcome of reconstructions of ACJ dislocation using our two traditional techniques.
Materials and Methods: From 01.01.2014 until 01.07.2016 forty patients were operated for ACJ reconstruction due to an clinically unstable ACJ with modified Weaver Dunn technique with either a PDS band or a Baltzer ACJ hook plate as a temporary reinforcement. Clinical evaluation was done with the Oxford Shoulder scoring system. 34 patients returned the questionnaire (20 patients operated with a modified Weaver Dunn with PDS band and 14 patients operated with a with a Baltzer plate). A separate subjective evaluation of the cosmesis of the operation was included in the evaluation. The Baltzer ACJ-hook plate was removed surgically after 6-8 weeks in GA, whereas the PDS band is reabsorbabel and no secondary operation is needed.
Findings / Results: The mean Oxford Score was 37.4 ( 37,3 for the PDS group and 37,6 for Baltzer plate group). Median was 44 (36-47) , p = 0.91. There was no statistically significant differences in any of the clinical outcomes between the two different techniques. 25 patients had good results (score 30- 48) and 9 patients had moderate to unsatisfied results. The result of cosmetic satisfaction was in favour of the PDS band.
Conclusions: Our results is similar to other studies with reconstruction of the chronic unstable ACJ with failure rates between 15-25 %. The modified Weaver Dunn procedure offers an acceptable solution to an unstable ACJ in symptomatic patients using either a temporary reinforcement with the PDS band or the Baltzer plate.