Session 14: Trauma II
Fredag d. 26. oktober
09:00-10:30
Lokale: Helsinki/Oslo
Chairmen: Bjarke Viberg og Jeppe Barckmann
Liv Vesterby, Michael Brix, Anne Kathrine Belling Sørensen
Ortopædkirurgisk afdeling, Slagelse Sygehus; Ortopædkirurgisk afdeling, Odense Universitetshospital; Ortopædkirurgisk afdeling, Herlev Hospital
Background: Olecranonfraktur er hyppig og udgør op mod 20% af alle frakturer i den proksimale underarm. Olecranonfrakturerne kan inddeles efter Mayos klassifikation. Mayo type I behandles sædvanligvis konservativt, mens Mayo type II og III, som udgangspunkt behandles operativt. De hyppigste anvendte operationsmetoder er tensionband og skinneosteosyntese. Til trods for at de nævnte operationsmetoder er anerkendte, også til behandling af ældre patienter, er der i flere opgørelser beskrevet høje komplikationsrater. Der er tale om høj risiko for reoperation som følge af gener fra osteosyntesematerialet, postoperative infektioner og frakturskred. Et nyligt publiceret RCT-stuide har søgt at vurdere om konservativ behandling af Mayo type II, kan være favorabel for udvalgte patienter.
Purpose / Aim of Study: Målet med denne KKR er at foretage en systematisk gennemgang af foreliggende litteratur, med henblik på at give en samlet anbefaling til behandling af olecranonfrakturer, Mayo type II, for ældre med lavt funktionsniveau.
Materials and Methods: Pubmed, Embase
Findings / Results: Der foreligger til dato kun et enkelt randomiseret studie omhandlende emnet. Studiet blev stoppet før tid på grund af en uacceptabel høj komplikationsrate i den operativt behandlede gruppe. Der findes case series og studier omhandlende resultater og komplikationer ved behandling af olecranonfrakturer for ældre, hvorfor det vurderes at der er tilstrækkelig evidens til at komme med en anbefaling vedrørende behandlingen.
Conclusions: Anvend kun operativ behandling af olecranonfraktur, Mayo type II, hos ældre med lavt funktionsniveau efter nøje overvejelse, da den gavnlige effekt er usikker, og da der er dokumenterede skadevirkninger, såsom høj risiko for svigt af operationen med frakturskred, dyb infektion og efterfølgende stort behov for fjernelse af osteosyntesemateriale.
Ortopædkirurgisk afdeling, Slagelse Sygehus; Ortopædkirurgisk afdeling, Odense Universitetshospital; Ortopædkirurgisk afdeling, Herlev Hospital
Background: Olecranonfraktur er hyppig og udgør op mod 20% af alle frakturer i den proksimale underarm. Olecranonfrakturerne kan inddeles efter Mayos klassifikation. Mayo type I behandles sædvanligvis konservativt, mens Mayo type II og III, som udgangspunkt behandles operativt. De hyppigste anvendte operationsmetoder er tensionband og skinneosteosyntese. Til trods for at de nævnte operationsmetoder er anerkendte, også til behandling af ældre patienter, er der i flere opgørelser beskrevet høje komplikationsrater. Der er tale om høj risiko for reoperation som følge af gener fra osteosyntesematerialet, postoperative infektioner og frakturskred. Et nyligt publiceret RCT-stuide har søgt at vurdere om konservativ behandling af Mayo type II, kan være favorabel for udvalgte patienter.
Purpose / Aim of Study: Målet med denne KKR er at foretage en systematisk gennemgang af foreliggende litteratur, med henblik på at give en samlet anbefaling til behandling af olecranonfrakturer, Mayo type II, for ældre med lavt funktionsniveau.
Materials and Methods: Pubmed, Embase
Findings / Results: Der foreligger til dato kun et enkelt randomiseret studie omhandlende emnet. Studiet blev stoppet før tid på grund af en uacceptabel høj komplikationsrate i den operativt behandlede gruppe. Der findes case series og studier omhandlende resultater og komplikationer ved behandling af olecranonfrakturer for ældre, hvorfor det vurderes at der er tilstrækkelig evidens til at komme med en anbefaling vedrørende behandlingen.
Conclusions: Anvend kun operativ behandling af olecranonfraktur, Mayo type II, hos ældre med lavt funktionsniveau efter nøje overvejelse, da den gavnlige effekt er usikker, og da der er dokumenterede skadevirkninger, såsom høj risiko for svigt af operationen med frakturskred, dyb infektion og efterfølgende stort behov for fjernelse af osteosyntesemateriale.
Siar Barat, Per Hviid Gundtoft, Lars Rotwitt, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt
Background: Femoral neck fractures (FNF) are often treated using cannulated screws (CS) or sliding hip screws (SHS). A RCT have recently shown no difference between these two types of internal fixation but there are no large studies investigating the external validity.
Purpose / Aim of Study: To estimate the risk of complications in patients receiving SHS compared to CS in patients with FNF
Materials and Methods: This is a population based register study from the Danish Fracture Database (DFDB). From 01012015 – 31122016 data was extracted on FNF patients using the AO-classification and treated with SHS or CS. Primary outcome was major complication (re-osteosynthesis, conversion to arthroplasty or girdlestone, and deep infection) within 1 year of primary surgery. Secondary outcome was minor complication in terms of simple implant removal. In order to ensure an acceptable completeness of complications, data from the Danish National Patient Registry (DNPR) will be extracted. Cox proportional hazards were used to estimate and compare relative risk (RR) for complications between SHS and CS (includes 95% confidence interval) and adjusted for age, sex, and ASA score.
Findings / Results: A total of 10,418 FNF were identified in DFDB of which 2,212 were CS and 1,276 SHS. The average age was 73.5 years (72.9;74.1) and 95% were ASA≤3 with no difference between the two groups. There were 66% females in the CS group and 57% in the SHS group (p<0.001). CS had 4.2% major complications and SHS had 3.3% yielding an adjusted RR of 0.80 (0.55;1.15). Concerning minor complications, 1.5% had CS removed and 0.2% had SHS removed yielding a RR of 0.11 (0.03;0.45).
Conclusions: There seems not be any difference in major complications for SHS compared to CS in FNF patients. However, the results will be updated with the DNPR data before the congress and may therefore show a different result
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt
Background: Femoral neck fractures (FNF) are often treated using cannulated screws (CS) or sliding hip screws (SHS). A RCT have recently shown no difference between these two types of internal fixation but there are no large studies investigating the external validity.
Purpose / Aim of Study: To estimate the risk of complications in patients receiving SHS compared to CS in patients with FNF
Materials and Methods: This is a population based register study from the Danish Fracture Database (DFDB). From 01012015 – 31122016 data was extracted on FNF patients using the AO-classification and treated with SHS or CS. Primary outcome was major complication (re-osteosynthesis, conversion to arthroplasty or girdlestone, and deep infection) within 1 year of primary surgery. Secondary outcome was minor complication in terms of simple implant removal. In order to ensure an acceptable completeness of complications, data from the Danish National Patient Registry (DNPR) will be extracted. Cox proportional hazards were used to estimate and compare relative risk (RR) for complications between SHS and CS (includes 95% confidence interval) and adjusted for age, sex, and ASA score.
Findings / Results: A total of 10,418 FNF were identified in DFDB of which 2,212 were CS and 1,276 SHS. The average age was 73.5 years (72.9;74.1) and 95% were ASA≤3 with no difference between the two groups. There were 66% females in the CS group and 57% in the SHS group (p<0.001). CS had 4.2% major complications and SHS had 3.3% yielding an adjusted RR of 0.80 (0.55;1.15). Concerning minor complications, 1.5% had CS removed and 0.2% had SHS removed yielding a RR of 0.11 (0.03;0.45).
Conclusions: There seems not be any difference in major complications for SHS compared to CS in FNF patients. However, the results will be updated with the DNPR data before the congress and may therefore show a different result
Kaja E. Kjørholt, Daniel Prieto-Alhambra, Nickolaj R. Kristensen, Søren P. Johnsen , Alma B. Pedersen
Department of Clinical Epidemiology , Aarhus University Hospital; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, United Kingdom; Department of Clinical Epidemiology , Aarhus University Hospital ; Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University ; Department of Clinical Epidemiology , Aarhus University Hospital
Background: Postoperative infection is a common complication in hip fracture patients and the risk appears to have increased during the last decade. However, the association between postoperative infection and high mortality after hip fracture surgery remains unclear.
Purpose / Aim of Study: To examine the association of any infection, as well as specific common infections, with all-cause mortality following hip fracture surgery.
Materials and Methods: Using Danish medical databases, we conducted a population-based cohort study. We included 74,771 hip fracture patients >65 years old operated from 2005 to 2016. We included hospital-treated infection as a time-dependent exposure, and calculated 30- days mortality rate per 1000 person-years (PY). We used time-dependent Cox Proportional Hazard Regression to compute 30-days adjusted hazards ratios (aHRs) with 95 % confidence interval (CI) comparing the mortality of hip fracture patients with and without infections.
Findings / Results: Within 30 days of surgery, 9592 (12.8%) patients developed any hospital-treated infection. Among these, 30-day mortality rate was 8.43 per 1000 PY compared with 3.34 among patients without infection (aHR=2.74, CI: 2.58-2.91). For patients who developed pneumonia, aHR was 4.22 (CI: 3.94- 4.52), whereas the aHR was 8.75 (7.78-9.83) for patients who developed sepsis. For patients who sustained reoperation due to infection, aHR was 2.95 (CI: 1.88-4.64). The mortality increased irrespective of patients’ age, sex, comorbidity and year of surgery.
Conclusions: Infection within 30 days of hip fracture surgery is associated with a substantially increased mortality risk.
Department of Clinical Epidemiology , Aarhus University Hospital; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, United Kingdom; Department of Clinical Epidemiology , Aarhus University Hospital ; Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University ; Department of Clinical Epidemiology , Aarhus University Hospital
Background: Postoperative infection is a common complication in hip fracture patients and the risk appears to have increased during the last decade. However, the association between postoperative infection and high mortality after hip fracture surgery remains unclear.
Purpose / Aim of Study: To examine the association of any infection, as well as specific common infections, with all-cause mortality following hip fracture surgery.
Materials and Methods: Using Danish medical databases, we conducted a population-based cohort study. We included 74,771 hip fracture patients >65 years old operated from 2005 to 2016. We included hospital-treated infection as a time-dependent exposure, and calculated 30- days mortality rate per 1000 person-years (PY). We used time-dependent Cox Proportional Hazard Regression to compute 30-days adjusted hazards ratios (aHRs) with 95 % confidence interval (CI) comparing the mortality of hip fracture patients with and without infections.
Findings / Results: Within 30 days of surgery, 9592 (12.8%) patients developed any hospital-treated infection. Among these, 30-day mortality rate was 8.43 per 1000 PY compared with 3.34 among patients without infection (aHR=2.74, CI: 2.58-2.91). For patients who developed pneumonia, aHR was 4.22 (CI: 3.94- 4.52), whereas the aHR was 8.75 (7.78-9.83) for patients who developed sepsis. For patients who sustained reoperation due to infection, aHR was 2.95 (CI: 1.88-4.64). The mortality increased irrespective of patients’ age, sex, comorbidity and year of surgery.
Conclusions: Infection within 30 days of hip fracture surgery is associated with a substantially increased mortality risk.
Ann-Louise H. Kristiansen, Debra Freund, Jan Duedal Rölfing, Rikke Thorninger
Dept. of Orthopaedics, Regionshospitalet Randers; Dept. of Anaesthesiology, Regionshospitalet Randers; Corporate HR, MidtSim and Dept. of Clinical Medicine, Central Denmark Region and Aarhus University; Dept. of Orthopaedics, Regionshospitalet Randers
Background: In-situ trauma team training can help to identify obstacles within the organization and to improve the performance of teams and individuals through training of non-technical and technical skills. However, the development and implementation of trauma team training can be a cumbersome and overwhelming task.
Purpose / Aim of Study: Prospective evaluation of a ready-to-implement, off- the-shelf trauma team training package with predefined scenarios at a secondary hospital in Denmark in terms of time to milestone events in trauma management
Materials and Methods: We developed a trauma team training package with predefined scenarios, action cards and guidelines on how to plan and execute in-situ simulation in order to improve trauma management at regional hospitals. The trauma team training was implemented at one regional hospital in Denmark on six occasions of two hours duration dispersed from January till September 2017. The mean trauma processing times were recorded 3 months before (n=24) and 3 months after the introduction period (n=20). Processing times from arrival of the patient until chest x-ray, trauma CT, and total time in the trauma unit were prospectively evaluated.
Findings / Results: Mean total time in the trauma unit was reduced from 78 ±10 to 67 ±10 min (p>0.05). Mean time from arrival until chest x-ray was reduced from 9 ±1 to 6 ±1 min (p>0.05). Mean time from arrival until trauma CT was 28 ±3 before and 29 ±3 min after training (p>0.05). Furthermore, trauma team training helped to identify missing and illogical placement of equipment at an organizational level.
Conclusions: A trend towards faster processing times of trauma was observed, which potentially can help to save resources. Furthermore, the ready-to-implement, off- the-shelf trauma team training proved to be valuable to streamline the trauma management at an organizational level.
Dept. of Orthopaedics, Regionshospitalet Randers; Dept. of Anaesthesiology, Regionshospitalet Randers; Corporate HR, MidtSim and Dept. of Clinical Medicine, Central Denmark Region and Aarhus University; Dept. of Orthopaedics, Regionshospitalet Randers
Background: In-situ trauma team training can help to identify obstacles within the organization and to improve the performance of teams and individuals through training of non-technical and technical skills. However, the development and implementation of trauma team training can be a cumbersome and overwhelming task.
Purpose / Aim of Study: Prospective evaluation of a ready-to-implement, off- the-shelf trauma team training package with predefined scenarios at a secondary hospital in Denmark in terms of time to milestone events in trauma management
Materials and Methods: We developed a trauma team training package with predefined scenarios, action cards and guidelines on how to plan and execute in-situ simulation in order to improve trauma management at regional hospitals. The trauma team training was implemented at one regional hospital in Denmark on six occasions of two hours duration dispersed from January till September 2017. The mean trauma processing times were recorded 3 months before (n=24) and 3 months after the introduction period (n=20). Processing times from arrival of the patient until chest x-ray, trauma CT, and total time in the trauma unit were prospectively evaluated.
Findings / Results: Mean total time in the trauma unit was reduced from 78 ±10 to 67 ±10 min (p>0.05). Mean time from arrival until chest x-ray was reduced from 9 ±1 to 6 ±1 min (p>0.05). Mean time from arrival until trauma CT was 28 ±3 before and 29 ±3 min after training (p>0.05). Furthermore, trauma team training helped to identify missing and illogical placement of equipment at an organizational level.
Conclusions: A trend towards faster processing times of trauma was observed, which potentially can help to save resources. Furthermore, the ready-to-implement, off- the-shelf trauma team training proved to be valuable to streamline the trauma management at an organizational level.
Morten Tange Kristensen, Buket Öztürk, Niels Dieter Rock, Annette Ingeman, Henrik Palm, Alma B Pedersen
Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Hvidovre University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery O, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery, Bispebjerg University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Early recovery of the pre-fracture basic mobility status is considered an important first step of rehabilitation from hip fracture (HF). However, critics say that achievement during hospitalization is just a matter of length of stay (LOS).
Purpose / Aim of Study: To examine if the severity of pre-fracture basic mobility loss at hospital discharge was associated with 30-day post-discharge mortality after a first time HF.
Materials and Methods: Using the nationwide Danish Multidisciplinary Hip Fracture Database (DMHFD) from Jan. 2015 through Dec. 2015, we included 5,147 patients. The Cumulated Ambulation Score (CAS) was recorded at pre-fracture (questionnaire) and objectively at discharge. The severity of pre-fracture CAS-points lost (from 1-6 points) at discharge was entered into Cox regression analyses, adjusted by sex, age, BMI, Charlson Comorbidity Index, type of fracture, residential status, and LOS.
Findings / Results: The mean LOS for the 60% (n=3,097) of patients who had not regained their pre-fracture CAS level at discharge was 9.5 days compared to 8.5 days for the 2,050 who did. In adjusted analyses, the risk of 30-days mortality increased with increasing loss of CAS points. Thus, the risk of death (hazard ratio, 95%CI) was 1.3 (0.7; 2.2), 1.7 (0.99; 2.9), 2.6 (1.7; 3.8), 4.2 (2.6; 7.0), 5.1 (2.7; 9.7) and 12.3 (7.0; 21.5) times higher for patients who respectively lost 1, 2, 3, 4, 5 and 6 CAS points, compared to no loss.
Conclusions: In this large national HF registry study, we found that the severity of pre-fracture basic mobility loss upon acute hospital discharge was strongly associated with 30-day post-discharge mortality in the adjusted analysis including LOS. Further, the analysis indicates that it's not only a matter of the complete regain of the pre-fracture CAS level since less CAS points lost the more patients seem to survive.
Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Hvidovre University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery O, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery, Bispebjerg University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Early recovery of the pre-fracture basic mobility status is considered an important first step of rehabilitation from hip fracture (HF). However, critics say that achievement during hospitalization is just a matter of length of stay (LOS).
Purpose / Aim of Study: To examine if the severity of pre-fracture basic mobility loss at hospital discharge was associated with 30-day post-discharge mortality after a first time HF.
Materials and Methods: Using the nationwide Danish Multidisciplinary Hip Fracture Database (DMHFD) from Jan. 2015 through Dec. 2015, we included 5,147 patients. The Cumulated Ambulation Score (CAS) was recorded at pre-fracture (questionnaire) and objectively at discharge. The severity of pre-fracture CAS-points lost (from 1-6 points) at discharge was entered into Cox regression analyses, adjusted by sex, age, BMI, Charlson Comorbidity Index, type of fracture, residential status, and LOS.
Findings / Results: The mean LOS for the 60% (n=3,097) of patients who had not regained their pre-fracture CAS level at discharge was 9.5 days compared to 8.5 days for the 2,050 who did. In adjusted analyses, the risk of 30-days mortality increased with increasing loss of CAS points. Thus, the risk of death (hazard ratio, 95%CI) was 1.3 (0.7; 2.2), 1.7 (0.99; 2.9), 2.6 (1.7; 3.8), 4.2 (2.6; 7.0), 5.1 (2.7; 9.7) and 12.3 (7.0; 21.5) times higher for patients who respectively lost 1, 2, 3, 4, 5 and 6 CAS points, compared to no loss.
Conclusions: In this large national HF registry study, we found that the severity of pre-fracture basic mobility loss upon acute hospital discharge was strongly associated with 30-day post-discharge mortality in the adjusted analysis including LOS. Further, the analysis indicates that it's not only a matter of the complete regain of the pre-fracture CAS level since less CAS points lost the more patients seem to survive.
Laureen Marsault, Hagen Schmal
Department of Orthopedics and Traumatology , Odense Universitetshospital; Department of Orthopedics and Traumatology , Odense Universitetshospital
Background: Physical activity in elderly patients suffering from proximal femoral fractures is crucial for recovery. However, the importance of objective activity measurement is not yet clarified.
Purpose / Aim of Study: To evaluate the use of accelerometers in the postoperative treatment course.
Materials and Methods: 54 patients undergoing operative treatment of proximal femur fractures (81.3±7.5 years) were included. 12 patients with fall but without fracture of the lower extremities (80.8±9.5 years) served as a control. An Axivity AX3 tracker continuously measured activity during the hospital stay by recording signal vector magnitudes. 2±1 and 8±3 days (time point [TP] 1 and 2) after the operation functional independence and quality of life were evaluated using Barthel-20 and EuroQol-5D, respectively
Findings / Results: Physical activity (PA) increased in all patients with time independent of the group. A multiple regression analysis revealed that high Barthel-20 before fracture, low age, high BMI and low C-reactive protein levels were independent predictors for a high PA (p<0.05). Accelerometer signals correlated significantly with EuroQol-5D at TP1 and 2 (p<0.02) and Barthel-20 at TP1 and 2 (p≤0.002). Furthermore, PA at TP1 predicted PA, EuroQol-5D, and Barthel-20 at TP2 (p<0.01). A multiple regression, correcting for confounders, demonstrated that PA in patients without a fracture was not different from patients with an operatively treated proximal femur fracture at any examined TP
Conclusions: Accelerometer signals reliably reflect postoperative physical activity in elderlies. A high functional independence and good nutrition status positively influence recovery following a fall. A timely and sufficient operation provided, there is no difference between activity-characterizing parameters in the recovery process between patients with and without a fracture.
Department of Orthopedics and Traumatology , Odense Universitetshospital; Department of Orthopedics and Traumatology , Odense Universitetshospital
Background: Physical activity in elderly patients suffering from proximal femoral fractures is crucial for recovery. However, the importance of objective activity measurement is not yet clarified.
Purpose / Aim of Study: To evaluate the use of accelerometers in the postoperative treatment course.
Materials and Methods: 54 patients undergoing operative treatment of proximal femur fractures (81.3±7.5 years) were included. 12 patients with fall but without fracture of the lower extremities (80.8±9.5 years) served as a control. An Axivity AX3 tracker continuously measured activity during the hospital stay by recording signal vector magnitudes. 2±1 and 8±3 days (time point [TP] 1 and 2) after the operation functional independence and quality of life were evaluated using Barthel-20 and EuroQol-5D, respectively
Findings / Results: Physical activity (PA) increased in all patients with time independent of the group. A multiple regression analysis revealed that high Barthel-20 before fracture, low age, high BMI and low C-reactive protein levels were independent predictors for a high PA (p<0.05). Accelerometer signals correlated significantly with EuroQol-5D at TP1 and 2 (p<0.02) and Barthel-20 at TP1 and 2 (p≤0.002). Furthermore, PA at TP1 predicted PA, EuroQol-5D, and Barthel-20 at TP2 (p<0.01). A multiple regression, correcting for confounders, demonstrated that PA in patients without a fracture was not different from patients with an operatively treated proximal femur fracture at any examined TP
Conclusions: Accelerometer signals reliably reflect postoperative physical activity in elderlies. A high functional independence and good nutrition status positively influence recovery following a fall. A timely and sufficient operation provided, there is no difference between activity-characterizing parameters in the recovery process between patients with and without a fracture.
Adam Omari, Jes Bruun Lauritzen, Christian Medom Madsen, Henrik Løvendahl Jørgensen, Fie Juhl Vojdeman
Department of Orthopedic Surgery, Bispebjerg Hospital; Department of Orthopedic Surgery, Bispebjerg Hospital; Department of Clinical Biochemistry, Herlev and Gentofte Hospital; Department of Clinical Biochemistry, Hvidovre Hospital; Department of Clinical Biochemistry, Bispebjerg Hospital
Background: Patients who experience a hip fracture present a worldwide challenge to the healthcare system due to their excess morbidity and mortality. The younger patients have been largely overlooked as few and relatively small studies exist.
Purpose / Aim of Study: This study assessed the incidence, mortality and the effect of comorbidities among patients aged 18-65 in a nation-wide population-based study.
Materials and Methods: Subjects were extracted from the National Patient Registry from 1996 to 2012 with a 1-year follow-up period. A total of 19,682 patients with primary unilateral hip-fracture diagnosis at first admission were included in this study. T-tests, Chi2 tests, and cox proportional hazards models were used to assess differences between groups and for survival analysis.
Findings / Results: Among 19,682 patients, 17,722 (90.0%) were grouped as middle-aged (40-65 years old) and 1,960 (10.0%) were grouped as young (18-40 years old). The 1-year mortality rate was 13 % (n=2,259) and 4 % (n=77) for the middle-aged and young group, respectively. Diabetes, heart-, liver- or renal disease were associated with increased 30-day and 1-year mortality in both age groups. Pulmonary disease and cancer were linked to increased 30- mortality in the middle-aged group only (p<0.0001). Multivariate analysis showed age, sex, cancer, diabetes, liver-, renal-, and pulmonary disease to be linked with increased 30-day mortality in the middle- aged group, as opposed to heart disease and diabetes for the young group.
Conclusions: Young hip fracture patients experience, as older, an increased post-fracture mortality rate. Comorbidities such as heart-, chronic pulmonary-, renal-, and peptic ulcer disease increases the mortality rate more than 2 fold in these patients. This calls for changes in the surveillance in the clinic to prevent deaths in hip patients with comorbidity.
Department of Orthopedic Surgery, Bispebjerg Hospital; Department of Orthopedic Surgery, Bispebjerg Hospital; Department of Clinical Biochemistry, Herlev and Gentofte Hospital; Department of Clinical Biochemistry, Hvidovre Hospital; Department of Clinical Biochemistry, Bispebjerg Hospital
Background: Patients who experience a hip fracture present a worldwide challenge to the healthcare system due to their excess morbidity and mortality. The younger patients have been largely overlooked as few and relatively small studies exist.
Purpose / Aim of Study: This study assessed the incidence, mortality and the effect of comorbidities among patients aged 18-65 in a nation-wide population-based study.
Materials and Methods: Subjects were extracted from the National Patient Registry from 1996 to 2012 with a 1-year follow-up period. A total of 19,682 patients with primary unilateral hip-fracture diagnosis at first admission were included in this study. T-tests, Chi2 tests, and cox proportional hazards models were used to assess differences between groups and for survival analysis.
Findings / Results: Among 19,682 patients, 17,722 (90.0%) were grouped as middle-aged (40-65 years old) and 1,960 (10.0%) were grouped as young (18-40 years old). The 1-year mortality rate was 13 % (n=2,259) and 4 % (n=77) for the middle-aged and young group, respectively. Diabetes, heart-, liver- or renal disease were associated with increased 30-day and 1-year mortality in both age groups. Pulmonary disease and cancer were linked to increased 30- mortality in the middle-aged group only (p<0.0001). Multivariate analysis showed age, sex, cancer, diabetes, liver-, renal-, and pulmonary disease to be linked with increased 30-day mortality in the middle- aged group, as opposed to heart disease and diabetes for the young group.
Conclusions: Young hip fracture patients experience, as older, an increased post-fracture mortality rate. Comorbidities such as heart-, chronic pulmonary-, renal-, and peptic ulcer disease increases the mortality rate more than 2 fold in these patients. This calls for changes in the surveillance in the clinic to prevent deaths in hip patients with comorbidity.
Anne Marie Nyholm , Henrik Palm, Håkon Sandholdt, Anders Troelsen, Kirill Gromov
CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; Ortopædkirurgisk afdeling, Bispebjerg Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital
Background: Revision rate following osteosynthesis of a femoral neck fracture (FNF) is high. Optimal position of the implants is debated and may affect the revision rate.
Purpose / Aim of Study: To estimate the effect of the position of parallel implants (PI) on risk of revision within 12 months following osteosynthesis of a FNF.
Materials and Methods: 1206 consecutive surgeries for a primary FNF with PI from December 2011 to November 2015 were identified from the Danish Fracture Database. Data included age, gender, surgical delay and ASA score. Fracture displacement, posterior tilt, number of implants, angulation of implants and posterior-, calcar- and tip-cartilage-distance were measured on pre- and postoperative x-rays. Data on vital status and revisions was collected from the Civil Registrational System. Data was evaluated by cox regression analysis.
Findings / Results: Median age was 73.3 and 69% were female. 2 implants were used in 83% (997) of patients and 3 in 17 % (209). 13% (157) of patients underwent a relevant revision within 1 year and 19% (228) died. Increasing age, female gender, high ASA score and displaced fracture were associated with increased risk of reoperation. Surgical delay was associated with increased risk of reoperation in displaced fractures only. Insufficient reduction of the fracture (HR 1.88), placing the implants with an angle to the shaft below 126° (HR1.91) and perforating cartilage with an implant (HR 3.07) significantly increased risk of reoperation. We found no effect of posterior distance, calcar distance, tip-cartilage distance or if the implants were parallel.
Conclusions: Insufficient reduction, varus position of the implants and perforating femoral head cartilage were the only surgical factors influencing risk of revision. Sufficient fracture reduction is perhaps more important than focusing on an optimal osteosynthesis.
CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; Ortopædkirurgisk afdeling, Bispebjerg Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital; CORH - Ortopædkirurgisk afdeling, Hvidovre Hospital
Background: Revision rate following osteosynthesis of a femoral neck fracture (FNF) is high. Optimal position of the implants is debated and may affect the revision rate.
Purpose / Aim of Study: To estimate the effect of the position of parallel implants (PI) on risk of revision within 12 months following osteosynthesis of a FNF.
Materials and Methods: 1206 consecutive surgeries for a primary FNF with PI from December 2011 to November 2015 were identified from the Danish Fracture Database. Data included age, gender, surgical delay and ASA score. Fracture displacement, posterior tilt, number of implants, angulation of implants and posterior-, calcar- and tip-cartilage-distance were measured on pre- and postoperative x-rays. Data on vital status and revisions was collected from the Civil Registrational System. Data was evaluated by cox regression analysis.
Findings / Results: Median age was 73.3 and 69% were female. 2 implants were used in 83% (997) of patients and 3 in 17 % (209). 13% (157) of patients underwent a relevant revision within 1 year and 19% (228) died. Increasing age, female gender, high ASA score and displaced fracture were associated with increased risk of reoperation. Surgical delay was associated with increased risk of reoperation in displaced fractures only. Insufficient reduction of the fracture (HR 1.88), placing the implants with an angle to the shaft below 126° (HR1.91) and perforating cartilage with an implant (HR 3.07) significantly increased risk of reoperation. We found no effect of posterior distance, calcar distance, tip-cartilage distance or if the implants were parallel.
Conclusions: Insufficient reduction, varus position of the implants and perforating femoral head cartilage were the only surgical factors influencing risk of revision. Sufficient fracture reduction is perhaps more important than focusing on an optimal osteosynthesis.
Bjarke Viberg, Per Hviid Gundtoft, Mette Rosenstand, Michael Brix
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Tourniquet (TQ) is widely used in orthopaedic surgery but there is known complications directly related to its use. However, evidence concerning the frequency of complications during fracture surgery due TQ is sparse.
Purpose / Aim of Study: To assess the risk of TQ use in patients with surgical treated ankle fractures.
Materials and Methods: This is a population based register study from the Danish Fracture Database (DFDB). From 01012015 – 31122016 data was extracted on patients with an ankle fracture using the AO- classification. Patients with primary internal fixation and +/- the use of TQ was compared. Primary outcome was major complications defined as re-osteosynthesis, amputation, deep infection, wound healing problems, arthroplasty, arthrodesis, thrombosis, and complex regional pain syndrom. In order to ensure an acceptable completeness of complications, data from the Danish National Patient Registry (DNPR) will be extracted. Multivariate regression analysis was performed for relative risk (RR) adjusted for age and sex. All results are reported with 95% confidence interval.
Findings / Results: There were 4,215 eligible patients and final cohort included 679 (16.5%) with TQ and 3,444 (83.5%) without TQ. The average age was 53.4 years (52.8;54.0), 61% were female and 99.5% had an ASA score of 3 or less with no statistical difference between the 2 groups. A total of 37 patients were re- operated due to major complications, 4 (0.6%) in the TQ group and 33 (1%) in the non-TQ group. This yields an adjusted RR of 1.44 (0.51;4.07) of major complications for non-TQ compared to TQ.
Conclusions: There seems not be any difference in major complications for ankle fracture patients with or without tourniquet during surgery. However, complications are low and the results will be updated with DNPR data before the congress and may show a different result.
Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Tourniquet (TQ) is widely used in orthopaedic surgery but there is known complications directly related to its use. However, evidence concerning the frequency of complications during fracture surgery due TQ is sparse.
Purpose / Aim of Study: To assess the risk of TQ use in patients with surgical treated ankle fractures.
Materials and Methods: This is a population based register study from the Danish Fracture Database (DFDB). From 01012015 – 31122016 data was extracted on patients with an ankle fracture using the AO- classification. Patients with primary internal fixation and +/- the use of TQ was compared. Primary outcome was major complications defined as re-osteosynthesis, amputation, deep infection, wound healing problems, arthroplasty, arthrodesis, thrombosis, and complex regional pain syndrom. In order to ensure an acceptable completeness of complications, data from the Danish National Patient Registry (DNPR) will be extracted. Multivariate regression analysis was performed for relative risk (RR) adjusted for age and sex. All results are reported with 95% confidence interval.
Findings / Results: There were 4,215 eligible patients and final cohort included 679 (16.5%) with TQ and 3,444 (83.5%) without TQ. The average age was 53.4 years (52.8;54.0), 61% were female and 99.5% had an ASA score of 3 or less with no statistical difference between the 2 groups. A total of 37 patients were re- operated due to major complications, 4 (0.6%) in the TQ group and 33 (1%) in the non-TQ group. This yields an adjusted RR of 1.44 (0.51;4.07) of major complications for non-TQ compared to TQ.
Conclusions: There seems not be any difference in major complications for ankle fracture patients with or without tourniquet during surgery. However, complications are low and the results will be updated with DNPR data before the congress and may show a different result.
Hagen Schmal, Helge Eberbach, Peter C Strohm, Norbert P Südkamp, Jens Lauritsen, Jörn Zwingmann
Department of Orthopaedic Surgery, Odense University Hospital; Department of Orthopaedic Surgery, Freiburg University Hospital; Department of Orthopaedic Surgery, Bamberg Hospital; Department of Orthopaedic Surgery, Freiburg University Hospital; Department of Orthopaedic Surgery, Odense University Hospital; Department of Orthopaedic Surgery, Freiburg University Hospital
Background: Pelvic lateral compression fractures are the most stable of the unstable fractures.
Purpose / Aim of Study: Therefore, decision making regarding operative or non-operative therapy is still a matter of debate.
Materials and Methods: Factors, influencing decision making for therapy, were explored based on prospectively collected register data of a single trauma center. The analysis included epidemiological records, and injury characterizing parameters. In-hospital mortality and complications served as short-term outcome variables. After matching for relevant confounders, long-term results were compared between operatively and non-operatively treated patients, evaluating the Merle d’Aubigne and the EQ5D-3L scores.
Findings / Results: Over an 11-year period (2004-14), 134 patients suffered from lateral compression fractures out of 567 pelvic fractures. After excluding complex pelvic fractures, pubic symphysis ruptures and pediatric fractures, 114 patients could be included in the analysis. 61 patients were treated conservatively (54%), 53 with an operation (46%). The operated patients were younger, had higher Injury Severity Scores (ISS) and fracture dislocations (p<0.001). The length of hospital stay was shorter in the conservatively treated group (p<0.02). Although the types of complications were different, the incidence was not. The mortality was less in the operated group (1.9% vs. 6.6%), however, a logistic regression analysis showed that only the ISS was an independent risk factor, but not the type of therapy. Merle d’Aubigne and EQ5D-3L scores were not different in the matched cohorts.
Conclusions: Decision-making for operative therapy was favored in severely injured young patients with high dislocation. However, short- and long-term outcomes showed no difference between operatively and non-operatively treated patients.
Department of Orthopaedic Surgery, Odense University Hospital; Department of Orthopaedic Surgery, Freiburg University Hospital; Department of Orthopaedic Surgery, Bamberg Hospital; Department of Orthopaedic Surgery, Freiburg University Hospital; Department of Orthopaedic Surgery, Odense University Hospital; Department of Orthopaedic Surgery, Freiburg University Hospital
Background: Pelvic lateral compression fractures are the most stable of the unstable fractures.
Purpose / Aim of Study: Therefore, decision making regarding operative or non-operative therapy is still a matter of debate.
Materials and Methods: Factors, influencing decision making for therapy, were explored based on prospectively collected register data of a single trauma center. The analysis included epidemiological records, and injury characterizing parameters. In-hospital mortality and complications served as short-term outcome variables. After matching for relevant confounders, long-term results were compared between operatively and non-operatively treated patients, evaluating the Merle d’Aubigne and the EQ5D-3L scores.
Findings / Results: Over an 11-year period (2004-14), 134 patients suffered from lateral compression fractures out of 567 pelvic fractures. After excluding complex pelvic fractures, pubic symphysis ruptures and pediatric fractures, 114 patients could be included in the analysis. 61 patients were treated conservatively (54%), 53 with an operation (46%). The operated patients were younger, had higher Injury Severity Scores (ISS) and fracture dislocations (p<0.001). The length of hospital stay was shorter in the conservatively treated group (p<0.02). Although the types of complications were different, the incidence was not. The mortality was less in the operated group (1.9% vs. 6.6%), however, a logistic regression analysis showed that only the ISS was an independent risk factor, but not the type of therapy. Merle d’Aubigne and EQ5D-3L scores were not different in the matched cohorts.
Conclusions: Decision-making for operative therapy was favored in severely injured young patients with high dislocation. However, short- and long-term outcomes showed no difference between operatively and non-operatively treated patients.