Session 5: Best Posters
Onsdag den 23. oktober
11:00 - 12:00
Lokale: Vingsal 1
Chairmen: Peter Toft Tengberg og Maiken Stilling
Rasmus Wejnold Jørgensen, Frederik Flensted, Kiran Annette Anderson, Claus Hjorth Jensen
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark
Background: Patients with osteoarthritis of the thumb carpometacarpal (CMC) joint perceive pain and lack of function. The problem mostly affects postmenopausal women. Radiographic findings range from mild osteoarthritis to severe degenerative changes. Previous attempts at correlating preoperative radiographic findings of osteoarthritis in the carpometacarpal joint of the thumb with the subjective complaints of the patients have proven difficult. The most common radiographic classification system of the CMC-1 joint is the Eaton and Littler classification system.
Purpose / Aim of Study: The purpose of the study is determining interrater reliability and intrarater reproducibility in the classification of CMC-1 osteoarthritis.
Materials and Methods: 58 preoperative radiographs were analyzed. The standard AP projection was used as well as a thumb view. 5 orthopedic surgeons with a particular interest in hand surgery independently scrutinized the radiographs classifying each in degrees from one to four at two occasions with a minimum of one week in-between. Fleiss and Cohens Kappa values using SPSS v. 24 were calculated and interpreted according to Landis and Koch.
Findings / Results: On the average 11 % were classified as category 1, 30 % as category 2, 43 % as category 3, and 16 % as category 4. The interrater reliability of the classification showed an overall Kappa value of 0.34 at the first round of classification and 0.43 at the second round. Overall intrarater reproducibility of the classification was 0.55.
Conclusions: Interrater reliability was fair to moderate based on the first and second classification, respectively. Intrarater reproducibility showed moderate agreement. Based on the current findings, that are in line with the current literature, we question the use of the Eaton Littler classification system in the classification of osteoarthritis of the thumb carpometacarpal joint.
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark
Background: Patients with osteoarthritis of the thumb carpometacarpal (CMC) joint perceive pain and lack of function. The problem mostly affects postmenopausal women. Radiographic findings range from mild osteoarthritis to severe degenerative changes. Previous attempts at correlating preoperative radiographic findings of osteoarthritis in the carpometacarpal joint of the thumb with the subjective complaints of the patients have proven difficult. The most common radiographic classification system of the CMC-1 joint is the Eaton and Littler classification system.
Purpose / Aim of Study: The purpose of the study is determining interrater reliability and intrarater reproducibility in the classification of CMC-1 osteoarthritis.
Materials and Methods: 58 preoperative radiographs were analyzed. The standard AP projection was used as well as a thumb view. 5 orthopedic surgeons with a particular interest in hand surgery independently scrutinized the radiographs classifying each in degrees from one to four at two occasions with a minimum of one week in-between. Fleiss and Cohens Kappa values using SPSS v. 24 were calculated and interpreted according to Landis and Koch.
Findings / Results: On the average 11 % were classified as category 1, 30 % as category 2, 43 % as category 3, and 16 % as category 4. The interrater reliability of the classification showed an overall Kappa value of 0.34 at the first round of classification and 0.43 at the second round. Overall intrarater reproducibility of the classification was 0.55.
Conclusions: Interrater reliability was fair to moderate based on the first and second classification, respectively. Intrarater reproducibility showed moderate agreement. Based on the current findings, that are in line with the current literature, we question the use of the Eaton Littler classification system in the classification of osteoarthritis of the thumb carpometacarpal joint.
Oliver Zielinski, Rune Bech, Benny Dahl, Martin Gehrchen
HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; Department of Orthopedics, Texas Children's Hospital; HovedOrtoCenteret, Rigshospitalet
Background: Management of Type 2 fractures of the dens remains a point of contention, with both surgical and conservative measures having shown high rates of complications and mortality. Differences in management practices are widespread, and as these fractures become more prevalent due to an aging population, the need for consensus heightens.
Purpose / Aim of Study: Rigshospitalet’s Spine Unit’s management of odontoid fractures is currently dominated by a conservative approach. Our aim was to evaluate the current management practices of Type 2 dens fractures, in our treated patient group.
Materials and Methods: All patients with CT verified Type 2 dens fractures (Anderson and D’Alonzo) referred to the Spine Unit at Rigshospitalet within a two-year period, were prospectively evaluated. Data concerning epidemiological and etiological factors were gathered via the patient’s Electronic Health Record. After a one-year follow-up period, treatment success was assessed, with success defined as no surgical revision, and no renewed contact to a Healthcare Provider due to complications arising from treatment.
Findings / Results: Sixty patients with a Type 2 dens fracture were registered, of which 58 were treated conservatively with a stiff neck collar. 89.7% of conservatively managed patients had no further contact with a Healthcare Provider due to their injury, after end of treatment. Two patients underwent surgical correction at a later date, while 4 patients had ongoing contact, all due to pain issues. Total one- year mortality was 23.3%, and 38.3% of patients suffered complications due to their injury, primarily pseudarthrosis. Complications to treatment were observed to be associated with a higher degree of displacement, at initial evaluation.
Conclusions: We have estimated that a large majority of Type 2 dens fractures referred to our Spine Unit have been successfully managed conservatively, with only 3.4% converting to surgical management. Although our mortality and complications rates seem substantial, these findings are in line with previous reports. We conclude that conservative management of Type 2 dens fractures remains a viable strategy, especially in high-risk patient groups, though further research is needed to establish best practices in this area.
HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; Department of Orthopedics, Texas Children's Hospital; HovedOrtoCenteret, Rigshospitalet
Background: Management of Type 2 fractures of the dens remains a point of contention, with both surgical and conservative measures having shown high rates of complications and mortality. Differences in management practices are widespread, and as these fractures become more prevalent due to an aging population, the need for consensus heightens.
Purpose / Aim of Study: Rigshospitalet’s Spine Unit’s management of odontoid fractures is currently dominated by a conservative approach. Our aim was to evaluate the current management practices of Type 2 dens fractures, in our treated patient group.
Materials and Methods: All patients with CT verified Type 2 dens fractures (Anderson and D’Alonzo) referred to the Spine Unit at Rigshospitalet within a two-year period, were prospectively evaluated. Data concerning epidemiological and etiological factors were gathered via the patient’s Electronic Health Record. After a one-year follow-up period, treatment success was assessed, with success defined as no surgical revision, and no renewed contact to a Healthcare Provider due to complications arising from treatment.
Findings / Results: Sixty patients with a Type 2 dens fracture were registered, of which 58 were treated conservatively with a stiff neck collar. 89.7% of conservatively managed patients had no further contact with a Healthcare Provider due to their injury, after end of treatment. Two patients underwent surgical correction at a later date, while 4 patients had ongoing contact, all due to pain issues. Total one- year mortality was 23.3%, and 38.3% of patients suffered complications due to their injury, primarily pseudarthrosis. Complications to treatment were observed to be associated with a higher degree of displacement, at initial evaluation.
Conclusions: We have estimated that a large majority of Type 2 dens fractures referred to our Spine Unit have been successfully managed conservatively, with only 3.4% converting to surgical management. Although our mortality and complications rates seem substantial, these findings are in line with previous reports. We conclude that conservative management of Type 2 dens fractures remains a viable strategy, especially in high-risk patient groups, though further research is needed to establish best practices in this area.
Dennis Winge Hallager, Jonathan D Commins, Stig Brorson, Benny T Dahl, Martin Gehrchen
Dept. of Orthopedic Surgery, Zealand University Hospital; Dept. of Orthopedic Surgery, Zealand University Hospital; Dept. of Orthopedic Surgery, Zealand University Hospital; Spine Unit, Texas Childrens Hospital and Baylor College of Medicine; Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background: The ODI is commonly used to measure patient- perceived disability in adult spinal deformity (ASD) disorders. Notwithstanding, the psychometric properties of ODI have never been assessed using Rasch item response theory (IRT) in patients with ASD. Rasch IRT is the gold standard for psychometric validation of PROMs. The goal of this study was to assess the Danish ODI with respect to dimensionality, local response dependency (LD), and differential item functioning (DIF) in a cohort of patients with ASD.
Purpose / Aim of Study: To test whether the ODI is an appropriate patient- reported outcome measure (PROM) for patients with ASD.
Materials and Methods: ODI data collected from 322 consecutive adult patients referred for spinal deformity evaluation at Rigshospitalet (mean age 54 years, range 18-85, 229 women) were assessed using a Rasch partial credit model. The data is part of a previous publication (PMID: 26656058). Overall and individual item fit were assessed, LD, and DIF for exogenous variables of gender; age (more/less than 40 years); etiology (degenerative, adolescent idiopathic scoliosis, other); and history of spinal surgery.
Findings / Results: A 10-item partial credit model was confirmed (overall fit: Chi² = 42.66 [df 40]; P=0.36), as was individual fit for all 10 items with no LD or DIF. Item 4 (walking) showed under-discrimination with a fit residual of +5.4 (normative = ± 2.5). After collapsing distance categories, the fit residual was 2.1. Items 8, 9, and 10 also revealed problematic response categories, which warrant further collapsing. ODI showed adequate targeting with a slight ceiling effect.
Conclusions: The Danish version of the ODI satisfied unidimensional Rasch model expectations after minor modifications. Thus, ODI shows solid psychometric performance characteristics in patients with ASD. Future studies should investigate whether the modifications will be confirmed in a new cohort.
Dept. of Orthopedic Surgery, Zealand University Hospital; Dept. of Orthopedic Surgery, Zealand University Hospital; Dept. of Orthopedic Surgery, Zealand University Hospital; Spine Unit, Texas Childrens Hospital and Baylor College of Medicine; Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background: The ODI is commonly used to measure patient- perceived disability in adult spinal deformity (ASD) disorders. Notwithstanding, the psychometric properties of ODI have never been assessed using Rasch item response theory (IRT) in patients with ASD. Rasch IRT is the gold standard for psychometric validation of PROMs. The goal of this study was to assess the Danish ODI with respect to dimensionality, local response dependency (LD), and differential item functioning (DIF) in a cohort of patients with ASD.
Purpose / Aim of Study: To test whether the ODI is an appropriate patient- reported outcome measure (PROM) for patients with ASD.
Materials and Methods: ODI data collected from 322 consecutive adult patients referred for spinal deformity evaluation at Rigshospitalet (mean age 54 years, range 18-85, 229 women) were assessed using a Rasch partial credit model. The data is part of a previous publication (PMID: 26656058). Overall and individual item fit were assessed, LD, and DIF for exogenous variables of gender; age (more/less than 40 years); etiology (degenerative, adolescent idiopathic scoliosis, other); and history of spinal surgery.
Findings / Results: A 10-item partial credit model was confirmed (overall fit: Chi² = 42.66 [df 40]; P=0.36), as was individual fit for all 10 items with no LD or DIF. Item 4 (walking) showed under-discrimination with a fit residual of +5.4 (normative = ± 2.5). After collapsing distance categories, the fit residual was 2.1. Items 8, 9, and 10 also revealed problematic response categories, which warrant further collapsing. ODI showed adequate targeting with a slight ceiling effect.
Conclusions: The Danish version of the ODI satisfied unidimensional Rasch model expectations after minor modifications. Thus, ODI shows solid psychometric performance characteristics in patients with ASD. Future studies should investigate whether the modifications will be confirmed in a new cohort.
Veronique Vestergaard, Alma Becic Pedersen, Peter Toft Tengberg, Anders Troelsen, Henrik Morville Schrøder
Dept of Orthopaedic Surgery, Slagelse Hospital; Dept of Clinical Epidemiology, Aarhus University Hospital; Dept of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Dept of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Dept of Orthopaedic Surgery, Naestved Hospital
Background: Approximately 3,500 knee fractures are registered in Denmark annually. Knee fractures can lead to impaired function and pain as well as societal costs and spent hospital resources. During 1996-2017 in Denmark, children ages 0-5 accounted for the largest incidence rate (IR) spike claiming >7% of conservatively treated knee fractures. These patients have not previously been described in literature.
Purpose / Aim of Study: To calculate IRs and describe characteristics of knee fractures in children ages 0-5 during 1996-2017 in Denmark.
Materials and Methods: This nationwide cohort study included all patients ages 0-5 with knee fracture ICD-10 codes ±knee surgery code/s from Danish National Patient Registry (DNPR). IRs for knee fractures were computed per 100,000 inhabitants with 95% confidence intervals (CIs). The study population was described by sex, age, Charlson Comorbidity Index (CCI), treatment-, fracture- and surgery-type.
Findings / Results: 3,655 children sustained 3,686 knee fractures. Sex was evenly distributed, mean age was 3, >93.7% of patients had CCI=0 and 5.2% CCI=1. There were 79 surgeries in total. In conservatively-treated patients, mean age was 3, 77.2% had proximal tibia fracture, 19.1% distal femur fracture and 3.7% patella fracture. In surgically- treated patients, mean age was 4, 49.3% had distal femur fracture, 46.7% proximal tibia fracture and 4% patella fracture. The most frequent surgeries were closed reduction of distal femur fracture (n=22), closed reduction of proximal tibia fracture (n=15) and K-wires for distal femur fracture (n=14). IR for conservatively-treated knee fractures was 30(95% CI 25-35) in 1996 increasing to 74(95% CI 65-84) in 2017 corresponding to an increase of 150% while IR for surgically-treated knee fractures remained stable.
Conclusions: The IR for conservatively-treated knee fractures in children ages 0-5 increased 150% in 22 years. This could perhaps be explained by a cultural shift towards more radiographs being performed on children so as not to oversee a potential fracture, aided by novel lower-radiation x-ray machines. Another explanation could be increased registrations to DNPR. Further research is needed to explain the spike in conservatively-treated knee fractures in children ages 0-5.
Dept of Orthopaedic Surgery, Slagelse Hospital; Dept of Clinical Epidemiology, Aarhus University Hospital; Dept of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Dept of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Dept of Orthopaedic Surgery, Naestved Hospital
Background: Approximately 3,500 knee fractures are registered in Denmark annually. Knee fractures can lead to impaired function and pain as well as societal costs and spent hospital resources. During 1996-2017 in Denmark, children ages 0-5 accounted for the largest incidence rate (IR) spike claiming >7% of conservatively treated knee fractures. These patients have not previously been described in literature.
Purpose / Aim of Study: To calculate IRs and describe characteristics of knee fractures in children ages 0-5 during 1996-2017 in Denmark.
Materials and Methods: This nationwide cohort study included all patients ages 0-5 with knee fracture ICD-10 codes ±knee surgery code/s from Danish National Patient Registry (DNPR). IRs for knee fractures were computed per 100,000 inhabitants with 95% confidence intervals (CIs). The study population was described by sex, age, Charlson Comorbidity Index (CCI), treatment-, fracture- and surgery-type.
Findings / Results: 3,655 children sustained 3,686 knee fractures. Sex was evenly distributed, mean age was 3, >93.7% of patients had CCI=0 and 5.2% CCI=1. There were 79 surgeries in total. In conservatively-treated patients, mean age was 3, 77.2% had proximal tibia fracture, 19.1% distal femur fracture and 3.7% patella fracture. In surgically- treated patients, mean age was 4, 49.3% had distal femur fracture, 46.7% proximal tibia fracture and 4% patella fracture. The most frequent surgeries were closed reduction of distal femur fracture (n=22), closed reduction of proximal tibia fracture (n=15) and K-wires for distal femur fracture (n=14). IR for conservatively-treated knee fractures was 30(95% CI 25-35) in 1996 increasing to 74(95% CI 65-84) in 2017 corresponding to an increase of 150% while IR for surgically-treated knee fractures remained stable.
Conclusions: The IR for conservatively-treated knee fractures in children ages 0-5 increased 150% in 22 years. This could perhaps be explained by a cultural shift towards more radiographs being performed on children so as not to oversee a potential fracture, aided by novel lower-radiation x-ray machines. Another explanation could be increased registrations to DNPR. Further research is needed to explain the spike in conservatively-treated knee fractures in children ages 0-5.
Peter Skrejborg, Kristian Kjær Petersen, Søren Kold, Andreas Kappel, Christian Pedersen, Svend Erik Østgaard, Ole Simonsen, Lars Arendt-Nielsen
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine., Aalborg University, Aalborg, Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Background: Chronic postsurgical knee-pain (CPSP) is a burden for approx. 20% of the patients following total knee replacement (TKR). Presurgical pain intensities have consistently been found associated with CPSP and it is suggested that e.g. comorbidities are likewise important for development of CPSP.
Purpose / Aim of Study: This study aimed to identify presurgical risk factors for development of CPSP 5 years after TKR based on medical records containing information regarding comorbidities.
Materials and Methods: Patients undergoing primary TKR surgery were contacted 5 years after TKR. Presurgical Knee Society Score and comorbidities were evaluated. Postsurgical knee-pain at 5-years follow-up was assessed on a numeric rating scale (NRS, 0-10). Logistic regression models were utilized to identify patients with moderate-to- severe (NRS3) and mild-to-no (NRS<3) CPSP at 5-year follow-up. An odds ratio (OR) for significant factors were calculated.
Findings / Results: A total of 604 patients were contacted, 493 patients responded, 352 patients provided a complete questionnaire. A total of 107 patients reported NRS3 at follow-up. Significant presurgical factors associated with CPSP were fibromyalgia (OR 20.66, p=0.024), chronic pain in other body parts than the knee (OR 6.70, p=0.033), previous diagnosis of cancer (OR 3.06, p=0.001), knee instability (OR 2.16, p=0.021), age (OR 2.15, p=0.007), and presurgical knee- pain (OR 1.61, p=0.044). Regression analysis identified 36 out of 107 (33.6%) patients with CPSP based on presurgical factors, and 231 patients (94.3%) without CPSP were classified correct.
Conclusions: The current study found that a variety of presurgical clinical factors can correctly classify 33.6% of patients at risk for developing CPSP 5 years following TKR.
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine., Aalborg University, Aalborg, Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Background: Chronic postsurgical knee-pain (CPSP) is a burden for approx. 20% of the patients following total knee replacement (TKR). Presurgical pain intensities have consistently been found associated with CPSP and it is suggested that e.g. comorbidities are likewise important for development of CPSP.
Purpose / Aim of Study: This study aimed to identify presurgical risk factors for development of CPSP 5 years after TKR based on medical records containing information regarding comorbidities.
Materials and Methods: Patients undergoing primary TKR surgery were contacted 5 years after TKR. Presurgical Knee Society Score and comorbidities were evaluated. Postsurgical knee-pain at 5-years follow-up was assessed on a numeric rating scale (NRS, 0-10). Logistic regression models were utilized to identify patients with moderate-to- severe (NRS3) and mild-to-no (NRS<3) CPSP at 5-year follow-up. An odds ratio (OR) for significant factors were calculated.
Findings / Results: A total of 604 patients were contacted, 493 patients responded, 352 patients provided a complete questionnaire. A total of 107 patients reported NRS3 at follow-up. Significant presurgical factors associated with CPSP were fibromyalgia (OR 20.66, p=0.024), chronic pain in other body parts than the knee (OR 6.70, p=0.033), previous diagnosis of cancer (OR 3.06, p=0.001), knee instability (OR 2.16, p=0.021), age (OR 2.15, p=0.007), and presurgical knee- pain (OR 1.61, p=0.044). Regression analysis identified 36 out of 107 (33.6%) patients with CPSP based on presurgical factors, and 231 patients (94.3%) without CPSP were classified correct.
Conclusions: The current study found that a variety of presurgical clinical factors can correctly classify 33.6% of patients at risk for developing CPSP 5 years following TKR.
Merete Nørgaard Madsen, Maria Lange Kirkegaard, Thomas Martin Klebe, Charlotte Lorenzen Linnebjerg, Stine Junge Due, Søren Martin Riis Villumsen, Jeanette Trøstrup, Hans Okkels Birk, Lone Ramer Mikkelsen
Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Department of Public Health, University of Copenhagen; 1)Elective Surgery Centre, Silkeborg Regional Hospital
Background: Extended scope physiotherapists (ESP) are increasingly used to diagnose patients with musculoskeletal disorders. At our orthopedic clinic, ESPs share this task with orthopedic surgeons (OSs). Previous studies have reported satisfactory diagnostic agreement between ESPs and OSs but methodological quality is generally low and studies addressing shoulder disorders are sparse.
Purpose / Aim of Study: To evaluate agreement on diagnosis and treatment plan between ESPs and OSs examining patients with shoulder disorders.
Materials and Methods: An inter-agreement study was conducted in an orthopedic outpatient shoulder clinic. Four OSs and three ESPs participated. All ESPs had completed a specialist education at the hospital. 69 patients were examined twice on the same day independently by both ESP and OS in random order. Each professional registered primary and secondary diagnoses (nine predefined categories) and treatment plan (five predefined categories). Diagnostic agreement was calculated using three estimates: A) agreement on the primary diagnosis, B) agreement on the combination of diagnoses, but with a different ranking of primary/secondary diagnoses, and C) partial diagnostic agreement, which was considered present if the primary diagnosis registered by one of the professionals was also registered as either primary or secondary diagnosis by the other. Full agreement on overall treatment plan was defined as full concordance between categories chosen, while partial agreement was defined as ESP and OS agreeing on one or more recommendations on treatment.
Findings / Results: ESP and OS agreed on the primary diagnosis in 62 % (95 % CI: [50; 73]) of the cases. In 79 % (95% CI: [70; 89]) the professionals registered the same combination of diagnoses. Partial diagnostic agreement was 96 % (95% CI: [91; 100]). Full agreement on treatment plan was 43 % (95 % CI: [31; 54]) and partial agreement 96 % (95 % CI: [91; 100]). Agreement on each treatment category varied between 68 % and 100 %.
Conclusions: The majority of patients received the same or almost the same diagnosis and treatment plan from the ESP and the OS. We find that our results support that ESPs and OSs can share the task of examining patients with shoulder disorders in an orthopedic clinic.
Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Department of Public Health, University of Copenhagen; 1)Elective Surgery Centre, Silkeborg Regional Hospital
Background: Extended scope physiotherapists (ESP) are increasingly used to diagnose patients with musculoskeletal disorders. At our orthopedic clinic, ESPs share this task with orthopedic surgeons (OSs). Previous studies have reported satisfactory diagnostic agreement between ESPs and OSs but methodological quality is generally low and studies addressing shoulder disorders are sparse.
Purpose / Aim of Study: To evaluate agreement on diagnosis and treatment plan between ESPs and OSs examining patients with shoulder disorders.
Materials and Methods: An inter-agreement study was conducted in an orthopedic outpatient shoulder clinic. Four OSs and three ESPs participated. All ESPs had completed a specialist education at the hospital. 69 patients were examined twice on the same day independently by both ESP and OS in random order. Each professional registered primary and secondary diagnoses (nine predefined categories) and treatment plan (five predefined categories). Diagnostic agreement was calculated using three estimates: A) agreement on the primary diagnosis, B) agreement on the combination of diagnoses, but with a different ranking of primary/secondary diagnoses, and C) partial diagnostic agreement, which was considered present if the primary diagnosis registered by one of the professionals was also registered as either primary or secondary diagnosis by the other. Full agreement on overall treatment plan was defined as full concordance between categories chosen, while partial agreement was defined as ESP and OS agreeing on one or more recommendations on treatment.
Findings / Results: ESP and OS agreed on the primary diagnosis in 62 % (95 % CI: [50; 73]) of the cases. In 79 % (95% CI: [70; 89]) the professionals registered the same combination of diagnoses. Partial diagnostic agreement was 96 % (95% CI: [91; 100]). Full agreement on treatment plan was 43 % (95 % CI: [31; 54]) and partial agreement 96 % (95 % CI: [91; 100]). Agreement on each treatment category varied between 68 % and 100 %.
Conclusions: The majority of patients received the same or almost the same diagnosis and treatment plan from the ESP and the OS. We find that our results support that ESPs and OSs can share the task of examining patients with shoulder disorders in an orthopedic clinic.
Roshan Latifi, Jonatan Damsgaard, Niels Krarup, Marianne Toft Vestermark
Orthopaedic surgery, Viborg Hospital; Orthopaedic Surgery, Viborg Hospital; Orthopaedic Surgery, Viborg Hospital; Orthopaedic Surgery, Viborg Hospital
Background: Studies of large registry databases on periprosthetic fractures (PPF) are technically difficult because of ambiguity of reporting and completeness. Previous literature has mostly studied surgery related (SR) factors on mortality, but studies dealing with patient related (PR) factors and morbidity are scarce.
Purpose / Aim of Study: Our primary outcome was to study the impact and predictive value of SR and PR factors on mortality and morbidity in patients with hip PPF.
Materials and Methods: In this retrospective cohort study all hip PPF, admitted to a single trauma unit between 2014 and 2019 were included. Information about the operation, demographic data and comorbidities were registered. Furthermore, the patients were followed up 3 months, 6 months and 1 year after operation. Logistic regression analysis was used to identify factors associated with mortality and morbidity after operation.
Findings / Results: 50 consecutive unselected PPF were identified. The median age at operation, time to fracture, operation delay and hospitalization period were 81 years, 9.3 years, 2 days and 6 days respectively. Vancouver B2 was the most common fracture (n = 19). Mortality rate(MR) 1 month(1m), 3 months(3m) and 1 year(1y) after surgery were 10%, 18% and 25% respectively. Dementia is an independent risk factor for 3m (OR: 1.98, CI: 0.41-3.50, P: 0.013) and 1y mortality (OR: 2.41, CI: 0.86-3.96, P: 0.002). Living in a nursing home (NH) is another independent risk factor for 3m (OR: 2.66, CI: 0.99-4.33, P: 0.002) and 1y mortality (OR: 2.41, CI: 0.86-3.96, P: 0.002). 16% of the patients, who were living in NH and were ambulatory, were bounded to wheelchair at 3m follow up. Patients living in NH had the most pronounced drop in walking ability 3m postoperatively (OR: 1.97, CI: 0.31-3.63, P: 0.020). The patients with several cardiac diseases are at high risk of 1m mortality (OR: 7.57, SE: 8.39, CI: 95, P: 0.067).
Conclusions: PPF patients have a high risk of mortality. PR factors such as comorbidities and living in NH seem to have a significant impact on mortality and morbidity. Further studies with larger group of patients are needed but it might be recommendable that patients with PPF should get specialized geriatric care before and after surgery.
Orthopaedic surgery, Viborg Hospital; Orthopaedic Surgery, Viborg Hospital; Orthopaedic Surgery, Viborg Hospital; Orthopaedic Surgery, Viborg Hospital
Background: Studies of large registry databases on periprosthetic fractures (PPF) are technically difficult because of ambiguity of reporting and completeness. Previous literature has mostly studied surgery related (SR) factors on mortality, but studies dealing with patient related (PR) factors and morbidity are scarce.
Purpose / Aim of Study: Our primary outcome was to study the impact and predictive value of SR and PR factors on mortality and morbidity in patients with hip PPF.
Materials and Methods: In this retrospective cohort study all hip PPF, admitted to a single trauma unit between 2014 and 2019 were included. Information about the operation, demographic data and comorbidities were registered. Furthermore, the patients were followed up 3 months, 6 months and 1 year after operation. Logistic regression analysis was used to identify factors associated with mortality and morbidity after operation.
Findings / Results: 50 consecutive unselected PPF were identified. The median age at operation, time to fracture, operation delay and hospitalization period were 81 years, 9.3 years, 2 days and 6 days respectively. Vancouver B2 was the most common fracture (n = 19). Mortality rate(MR) 1 month(1m), 3 months(3m) and 1 year(1y) after surgery were 10%, 18% and 25% respectively. Dementia is an independent risk factor for 3m (OR: 1.98, CI: 0.41-3.50, P: 0.013) and 1y mortality (OR: 2.41, CI: 0.86-3.96, P: 0.002). Living in a nursing home (NH) is another independent risk factor for 3m (OR: 2.66, CI: 0.99-4.33, P: 0.002) and 1y mortality (OR: 2.41, CI: 0.86-3.96, P: 0.002). 16% of the patients, who were living in NH and were ambulatory, were bounded to wheelchair at 3m follow up. Patients living in NH had the most pronounced drop in walking ability 3m postoperatively (OR: 1.97, CI: 0.31-3.63, P: 0.020). The patients with several cardiac diseases are at high risk of 1m mortality (OR: 7.57, SE: 8.39, CI: 95, P: 0.067).
Conclusions: PPF patients have a high risk of mortality. PR factors such as comorbidities and living in NH seem to have a significant impact on mortality and morbidity. Further studies with larger group of patients are needed but it might be recommendable that patients with PPF should get specialized geriatric care before and after surgery.
Sidsel Fruergaard, Casper Dragsted, Mohit J. Jain, Lorenzo Deveza, David Liu, John Heydemann, Søren Ohrt-Nissen, Martin Gehrchen, Benny Dahl
Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA
Background: The overall objective of Adolescent Idiopathic Scoliosis (AIS) corrective surgery is to achieve a balanced spine both in the coronal and sagittal plane. The implications of sagittal malalignment are well documented in the adult population but less is known about the consequences in AIS. Recently, a new spinal sagittal classification has been proposed by Abelin-Genevois to provide guidelines for the surgical strategy.
Purpose / Aim of Study: The purpose of the present study was to validate this classification.
Materials and Methods: We retrospectively included 105 consecutive AIS patients who underwent posterior spinal fusion. Preoperative long standing EOS radiographs were available on all patients. Patients were classified according to the four suggested sagittal patterns; type 1, 2a, 2b or 3. Several predetermined sagittal parameters were compared between the four groups.
Findings / Results: The mean preoperative Cobb angle was 64±12° and 73 % of the patients were female. Of 105 patients, 51 were type 1, 14 were type 2a, one was type 2b and 39 were type 3. The distribution of the four sagittal patterns was significantly different compared with the original publication (p<0.05). However, the two study populations were comparable in terms of Lenke- and Roussouly types (p=0.49 and 0.47, respectively). In our study population, the main three sagittal groups differed significantly in terms of thoracic kyphosis, length of thoracic and lumbar curves, lumbar lordosis, thoracic slope, C7 slope, pelvic incidence, and sacral slope (p<0.05). We found no difference between the groups in terms of cervical lordosis or upper and lower cervical angle.
Conclusions: The distribution of the four sagittal patterns varies between AIS populations. Type 2b was rare, which limits the clinical applicability. Contrary to the original publication, we found that the spinopelvic parameters, lumbar lordosis, pelvic incidence and sacral slope were significantly different between the three Abelin-Genevois types. Hence, the corrective surgical strategy may need to incorporate these spinopelvic parameters to achieve a balanced spine requiring a minimum of energy expenditure.
Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Orthopedic Department, Spine Unit, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA
Background: The overall objective of Adolescent Idiopathic Scoliosis (AIS) corrective surgery is to achieve a balanced spine both in the coronal and sagittal plane. The implications of sagittal malalignment are well documented in the adult population but less is known about the consequences in AIS. Recently, a new spinal sagittal classification has been proposed by Abelin-Genevois to provide guidelines for the surgical strategy.
Purpose / Aim of Study: The purpose of the present study was to validate this classification.
Materials and Methods: We retrospectively included 105 consecutive AIS patients who underwent posterior spinal fusion. Preoperative long standing EOS radiographs were available on all patients. Patients were classified according to the four suggested sagittal patterns; type 1, 2a, 2b or 3. Several predetermined sagittal parameters were compared between the four groups.
Findings / Results: The mean preoperative Cobb angle was 64±12° and 73 % of the patients were female. Of 105 patients, 51 were type 1, 14 were type 2a, one was type 2b and 39 were type 3. The distribution of the four sagittal patterns was significantly different compared with the original publication (p<0.05). However, the two study populations were comparable in terms of Lenke- and Roussouly types (p=0.49 and 0.47, respectively). In our study population, the main three sagittal groups differed significantly in terms of thoracic kyphosis, length of thoracic and lumbar curves, lumbar lordosis, thoracic slope, C7 slope, pelvic incidence, and sacral slope (p<0.05). We found no difference between the groups in terms of cervical lordosis or upper and lower cervical angle.
Conclusions: The distribution of the four sagittal patterns varies between AIS populations. Type 2b was rare, which limits the clinical applicability. Contrary to the original publication, we found that the spinopelvic parameters, lumbar lordosis, pelvic incidence and sacral slope were significantly different between the three Abelin-Genevois types. Hence, the corrective surgical strategy may need to incorporate these spinopelvic parameters to achieve a balanced spine requiring a minimum of energy expenditure.
Line Kjeldgaard Pedersen, Jens Svendsson, Ahmed Abood, Søren Harving
Department of Children's Orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aalborg University Hospital; Department of Children's Orthopedics, Aalborg University Hospital; Department of Children's Orthopedics, Aalborg University Hospital
Background: Leg length discrepancy (LLD) in children may be treated using circumferential periosteal release (CPR); however, it is controversial how minor LLD in children are best managed. Currently, limb lengthening with intramedullary lengthening nails or ring fixators are used widespread for major LLD. When the child is approaching skeletal maturity total epihysiodesis of the longer leg may be used, however previous reports has shown CPR to stimulate longitudinal bone growth in the shorter leg.
Purpose / Aim of Study: The primary purpose was to evaluate whether CPR can improve leg length discrepancy in children. The secondary purpose was to evaluate reproducibility of 2D EOS imaging of leg length parameters.
Materials and Methods: Sixteen children (12 boys and 4 girls) aged 7-12 years were retrospectively evaluated after treatment of LLD with CPR between 2016 and 2018 in the department of children’s orthopedics at Aalborg University Hospital. The causes of LLD were Legg-Calve-Perthes disease (n=9), Cerebral Palsy (n=4) and idiopathic (n=3). Limb length can be assessed using biplanar X-ray (EOSTM). In present study all preoperative and postoperative EOS scans were assessed by manual assessment. The primary outcome of the study is the change of LLD before and after CPR. The secondary outcome is the interrater reliability of the manual leg length assessments on EOS scans presented by Intra-Class Correlations (ICC).
Findings / Results: For the manual assessments a ratio between the non-operated and the operated femur and functional lengths were calculated. The preoperative femoral ratio were 0.026 (SD=0.019) and the postoperative femur length ratio were 0.014 (SD=0.022), with a difference of 0.012 (p=0.001). The preoperative functional length ratio were 0.02 (SD=0.008) and the postoperative functional length ratio were 0.012 (SD=0.013), with a difference of 0.007 (p=0.004). A test-retest showed excellent inter-rater reliability with Intra Class Correlations of 0.99-1.00.
Conclusions: Circumferential periosteal release may improve minor LLD. The improvement amounts to 1.2% on the femur and 0.7% of the functional lower limb length. However statistically significant, it can be discussed whether present improvement are clinically relevant.
Department of Children's Orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aalborg University Hospital; Department of Children's Orthopedics, Aalborg University Hospital; Department of Children's Orthopedics, Aalborg University Hospital
Background: Leg length discrepancy (LLD) in children may be treated using circumferential periosteal release (CPR); however, it is controversial how minor LLD in children are best managed. Currently, limb lengthening with intramedullary lengthening nails or ring fixators are used widespread for major LLD. When the child is approaching skeletal maturity total epihysiodesis of the longer leg may be used, however previous reports has shown CPR to stimulate longitudinal bone growth in the shorter leg.
Purpose / Aim of Study: The primary purpose was to evaluate whether CPR can improve leg length discrepancy in children. The secondary purpose was to evaluate reproducibility of 2D EOS imaging of leg length parameters.
Materials and Methods: Sixteen children (12 boys and 4 girls) aged 7-12 years were retrospectively evaluated after treatment of LLD with CPR between 2016 and 2018 in the department of children’s orthopedics at Aalborg University Hospital. The causes of LLD were Legg-Calve-Perthes disease (n=9), Cerebral Palsy (n=4) and idiopathic (n=3). Limb length can be assessed using biplanar X-ray (EOSTM). In present study all preoperative and postoperative EOS scans were assessed by manual assessment. The primary outcome of the study is the change of LLD before and after CPR. The secondary outcome is the interrater reliability of the manual leg length assessments on EOS scans presented by Intra-Class Correlations (ICC).
Findings / Results: For the manual assessments a ratio between the non-operated and the operated femur and functional lengths were calculated. The preoperative femoral ratio were 0.026 (SD=0.019) and the postoperative femur length ratio were 0.014 (SD=0.022), with a difference of 0.012 (p=0.001). The preoperative functional length ratio were 0.02 (SD=0.008) and the postoperative functional length ratio were 0.012 (SD=0.013), with a difference of 0.007 (p=0.004). A test-retest showed excellent inter-rater reliability with Intra Class Correlations of 0.99-1.00.
Conclusions: Circumferential periosteal release may improve minor LLD. The improvement amounts to 1.2% on the femur and 0.7% of the functional lower limb length. However statistically significant, it can be discussed whether present improvement are clinically relevant.