Pia Kjær Kristensen, Raquel Perez-Vicente, George Leckie, Søren Paaske Johnsen, Juan Merlo
Klinisk Epidemiologisk afdeling , Århus Universitetshospital ; Research Unit of Social Epidemiology, Lund University; Centre for Multilevel Modelling, University of Bristol; Danish Center for Clinical Health Services Research, Aalborg University; Research Unit of Social Epidemiology, Lund University
Background: Mortality is a widely used outcome
measure when comparing hospital care
performance. However, the traditional
approach does not explicitly consider
scenarios like in hip fracture care, where
patients are referred to further care in the
municipality after just a few days of
Purpose / Aim of Study: We aimed to estimate both case-mix
adjusted hospital and municipality
comparisons in order to disentangle the
amount of the total patient variation in
1-year mortality that was attributable to
the hospital and municipality level,
Materials and Methods: We determined 1-year mortality risk in
patients aged 65 or above with hip
fractures registered in Sweden
between 2011 and 2014. We
performed cross-classified multilevel
analysis with 54,999 patients nested
within 54 hospitals and 290
municipalities. We adjusted for
socioeconomic and clinical
characteristics. To quantify the size of
the hospital and municipality variation
we calculated the variance partition
coefficient (VPC) and the area under
the receiver operator characteristic
Findings / Results: The overall 1-year mortality rate was
25.1%. The case-mix adjusted rates
varied from 21.7 % to 26.5 % for the 54
hospitals, and from 18.9 % to 29.5 % for
the 290 municipalities. The VPC was just
0.2% for the hospital and just 0.1 % for
the municipality level. Patient
sociodemographic and clinical
characteristics were strong predictors of
1-year mortality (AUC = 0.716), but adding
the hospital and municipality levels in the
cross-classified model only had a minor
influence (AUC= 0.718).
Conclusions: Overall in Sweden, one-year mortality
after hip-fracture is rather high. However,
only a minor part of the patient variation is
explained by the hospital and municipality
levels. Therefore, special efforts to reduce
mortality after hip fracture should be
focused on vulnerable patient groups of
hip fracture patients wherever they are
rather than directed to specific hospitals or
Tine Nymark, Niels Dieter Röck, Jens Lauritsen
Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital
Background: Hip fracture patients constitutes one of the
largest groups of patients in most of the
orthopedic departments, and represents a
substantial burden to the health system. It is
therefore of interest to study the development of
the number of fractures, and the incidence rates.
From studies conducted in our department we
know, that the annual number of fractures on
Funen in the 70’ties was approximately 500 a
year and the incidence rates were increasing.
Around the millennium, the number was
approximately 800 a year and the rates were
decreasing. We have found it of interest to follow
up on the above mentioned studies.
Purpose / Aim of Study: To compare the incidence rates of hip fractures on
Funen from the periods 2000-2003 and 2017-2019
for patients aged 70+, and see if there has been a
Materials and Methods: Data from the first period are from a study
conducted in our department by Nymark et al. Data
from the second period are calculated from our local
Register, where all patients from Funen (except from
the municipalities of Ærø and Middelfart fractures)
Findings / Results: For men aged 70+ the incidence rates for the two
periods were 0,83 (C.I. 0,72-0,95) and 0,56 (C.I.
0,48-0,65) and for women aged 70+ 1,86 (C.I. 1,72-
2,01) and 1,01 (C.I. 0,91-1,11) in both cases a
significant reduction of 32% and 46%. If the data are
split into four age groups 70-79 80-84 85-90 and
90+the same tendency is seen. The age- and sex
specific rates have decreased between 18,6 and
54,9% in the 8 groups. The number of patients in the
period 2017-19 was 519, 568 and 515 and corrected
for inhabitants in the two excluded municipalities:
570, 631 and 572.
Conclusions: The age- and sex specifik incidence rates for hip
fractures have fallen significantly from the period
2000-2003 to 2017-2019 in all age groups older
than 70. The patient group is still a large group,
but the absolute number of fractures has
decreased as well, which means that the
expected rise, due to an increasing elderly
population, has not been seen. It seems as if the
general health among the elderly population has
improved, and therefore compensated for the
forecasted rise in the number of hip fractures.
Niels Dieter Röck, Lasse Pedersen, Jens Lauritsen
Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital
Background: Since 2018 a local interdisciplinary learning and
quality team has been working with quality
improvements for this patient group. The aim
was to comply with the national objectives to
reduce the average 30-day and 1 year mortality
rate from 10% to 8% and from 28% to 25%, and
no department should exceed 9% and 28%
respectively. Improvement has focused on rapid
preoperative optimization (<4h), early surgery
(<24h) and rapid mobilization (<24h after
surgery). The LKT tasks were: to review and
revise our structured clinical pathway program, to
recommend and implement relevant changes
into daily practice and to apply data driven
quality improvement principles, based on
process- and result indicators.
Purpose / Aim of Study: To evaluate the changes in the quality of treatment
in the period with a LKT.
Materials and Methods: Data related to patients treated in the dept. in 2017-
2020 (until march 22. 2020)(n=1.657 (590, 636, 580,
151 in the 4 years)). We saw no changes in median
age or sex and fracture type distribution in the
period. We collected data as required to the national
hip fracture register, with local supplements. Mantel-
Haenzel Chi2 test for linear trends was applied to
examine periodical trends.
Findings / Results: Over the years we saw a decline in both the 30
day- and the 1 year mortality rate (%): 30 days:
9.3 8.3 7.9 and 7.9 (Chi2 = 2.74, p<0.098 n.s.)
and 1 year: 26.8 24.2 and 24.8 (Chi2 = 0.82,
p<0.365 n.s.). The orthopedic specialist
approved surgical indication within 4 hours after
admission for 61.5 65.3 72.2 and 75.5 % - an
increased non significant trend (Chi2 = 4.69,
p<0.030 n.s.) (median: 2.2 1.9 2.1 1.9 h.). 61.5
65.3 72.2 and 87.4 % were operated within 24
hours, an increased significant trend (Chi2 =
4.69, p<10-6)(median: 22.0 21.8 20.0 16.8 h).
Mobilization was attained for 78.9 71.7 71.0 and
71.2 % within 24 hours after the operation, a
significant negative trend (Chi2 = 8.2, p=0.004)
(median: 20.9 21.2 20.9 and 20.2 h).
Conclusions: Most of the process indicators moved in the desired
direction and the goals related to mortality was
reached. We conclude that the effort of the LKT has
had a positive effect, and we will continue the
process, to further improve the treatment based on
daily data driven management.
Bjarke Viberg, Nickolaj Risbo, Per Hviid Gundtoft, Søren Overgaard, Alma Becic Pedersen
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Surgery for hip fracture in patients treated with new
oral anticoagulant (NOAC) is often delayed due to
the presumed increased risk of bleeding and
mortality. In contrast, surgical delay is associated
with an increased mortality in non-NOAC patients.
Purpose / Aim of Study: To assess the association of surgical delay with
readmission and mortality in hip fracture patients
above 65 years with NOAC treatment.
Materials and Methods: This is a register study from 3 regions during
01.01.2011-31.12.2017. All hip fracture patients
with a dispensing for NOAC within 230 days
before surgery were included. Primary exposure
was surgical delay +/- 36 hours, secondary
exposures were delays of <12 hours, 12 to <24
hours, 24 to <36 hours, 36 to <48, and 48 to <72
hours. Transfusion was defined as red blood cell
transfusion within 7 days of surgery and
readmission as any within 30 days of discharge.
We performed Cox regression to estimate
adjusted Hazard Ratios (aHR) with 95%
confidence intervals adjusting for age, sex, BMI,
comorbidity, marital status, type of fracture, type
of surgery, year of surgery, region of residence,
cohabiting status, and prior medication.
Findings / Results: A total of 911 hip fracture patients in NOAC
treatment were identified. There were 63%
females and 71% were older than 80 years old.
There were 61% patients with a surgical delay
less than 36 hours yielding an aHR for
transfusion of 0.98 (0.79-1.22), for 30-day
mortality 1.39 (0.88-2.17), for 1-year mortality of
1.06 (0.78-1.43), and for any readmission of 1.35
(0.99-1.83) compared to patients operated later
than 36 hours.
We observed no difference concerning
transfusion, 30-day mortality, and 1-year
mortality when comparing patients operated with
delay of <12 hours, 12 to <24 hours, 24 to <36
hours, and 36 to <48 hours to patients operated
between 48 to <72 hours. There is some
indication that early surgery <24 hours is
associated with increased risk of any
Conclusions: Surgical delay in NOAC treated patients was not
associated with transfusion, 30-day or 1-year
mortality. There was an indication of an associated
higher risk of readmission with early surgery which
could be due a proportion of +90 years patients.
Thomas Giver Jensen, Louise Ørts Vinstrup, Simone Dalskov, Martin Aasbrenn, Henrik Palm, Søren Andreas Rugolo, Merete Thanning Vendelø, Signe Dollerup, Sine Alette Nogel Eriksen, Troels Haxholdt Lunn
Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospiatl; Department of Orthopaedic Surgery, Bispebjerg Hospital; Geriatric Research Unit, Department of Geriatrics, Bispebjerg Hospital ; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Emergency Medicine, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital; Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital
Background: Surgical treatment of hip fractures within 24-48
hours decreases morbidity and mortality, but goals
for early surgery have not been widely achieved so
Purpose / Aim of Study: The primary aim of this study was to investigate the
feasibility of implementation of a hip call, and the
secondary aim was to investigate the effect of the
hip call on time for preoperative preparation and
surgery compared to a historical control cohort.
Materials and Methods: From March 4, 2019 until June 30, 2019, admission
of patients at Copenhagen University Hospital,
Bispebjerg, Denmark with a suspected hip fracture
triggered an acute hip call. Key personnel are
summoned to secure rapid preoperative preparation
and surgery. The implementation was defined
feasible, if ≥75% of the patients were ready for
surgery within four hours and had surgery initiated
within 24 hours of hospital arrival. The historical
control cohort was patients with hip fractures in the
same period in 2018.
Findings / Results: 128 patients were included in 2019, and 99 in 2018.
After vs. before hip call, 88% vs. 51% were operated
within 24 hours and 96% vs. 79% within 36 hours.
Time from admission to surgery (hh:mm) was
reduced: Mean difference 10:33 (CI 07:46 – 13:20),
Conclusions: The implementation of a hip call was feasible with
88% of patients with hip fracture being operated
within 24 hours, and time for preoperative
preparation and surgery was reduced compared with
a historical control cohort. Future large-scale studies
should clarify potential benefits on clinical outcome.
Thomas Johannesson Hjelholt, Søren Paaske Johnsen, Peter Krogh Brynningsen, Alma Becic Pedersen
Department og Clinical Epidemiology, Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University; Department of Geriatrics, Aarhus University Hospital; Department og Clinical Epidemiology, Aarhus University
Background: Patients undergoing hip fracture surgery have an
increased risk of stroke, compared to the general
population. The CHA2DS2-VASc score has been
widely used to assess stroke risk in patients with
atrial fibrillation (AF) and could also be used to
assess risk of cardiovascular events in hip fracture
patients without AF.
Purpose / Aim of Study: Evaluate the association of CHA2DS2-VASc score
and stroke, thromboembolism and all-cause
mortality in hip fracture patients with or without AF.
Materials and Methods: All incident hip fracture patients in Denmark age 65
years and older with surgical repair procedures
between 2004 and 2016 were identified using the
Danish Multidisciplinary Hip Fracture Registry.
Outcomes were ischemic stroke, all
thromboembolisms (stroke, myocardial infarction,
peripheral arterial embolism or pulmonary
embolism), or death. We calculated cumulative
incidences and hazard ratios (HR) with 95%
confidence intervals, by CHA2DS2-VASc score,
stratified on previous history of AF.
Findings / Results: Among 78,096 hip fracture patients, 12,319
(15.8%) had a diagnosis of AF. Only 31 % of
patients in the AF- group were treated with
anticoagulants at the time of admission.
The cumulative incidence of ischemic stroke 1
year after hip fracture increased with ascending
CHA2DS2-VASc score, being 1.9% for patients
with a score of 1 and 8.6% for patients with a
score of >5 in the AF group. Corresponding
incidences in the non-AF group were 1.6% and
7.6%. Compared with a CHA2DS2-VASc score
of 1, adjusted HRs were 5.53 (95% CI: 1.37-
22.24) among AF patients and 4.91 (95% CI:
3.40-7.10) among non-AF patients with a score
of >5. All-cause mortality risks and HRs were
substantially higher for all CHA2DS2-VASc
scores above 1 in both the AF and non-AF
Conclusions: Among hip fracture patients, CHA2DS2-VASc score
was associated with risk of stroke, thromboembolism
and death in patients with and without AF. Patients
with high CHA2DS2-VASc scores had almost similar
absolute risks for cardiovascular outcomes,
irrespective of AF. Less than one third of the patients
diagnosed with AF were treated with anticoagulants,
indicating a very conservative treatment approach in
these high-risk patients.
Rasmus Elsøe, Isa Motahar, Firas Mahdi, Charlotte Buch Gøthgen, Peter Larsen
Orthopaedic surgery, Aalborg University Hospital; Deparment of radiology, Aalborg University Hospital; Deparment of radiology, Aalborg University Hospital; Orthopaedic surgery, Aalborg University Hospital, Hjøring; Orthopaedic surgery, Aalborg University Hospital
Background: Soft tissue injuries following lateral tibial
plateau fracture affect more than half of
patients. Regardless of the type of soft
tissue injured, it is still unclear how different
treatment strategies influence postoperative
Purpose / Aim of Study: The aim of this study was to report the 12
months Knee Injury and Osteoarthritis
Outcome Score (KOOS5) of patient with
surgical managed lateral tibial plateau
fractures divided into groups with and
without conservatively managed MRI
verified soft tissue injuries.
Materials and Methods: Prospective cohort study. Patients treated
surgically following a lateral tibial plateau
fracture, (AO-41B) between December 2013
and November 2016 were included. Soft
tissue injuries were evaluated with
preoperative MRI scans. The primary
outcome score was the 12 months KOOS5
score divided into groups with and without
soft tissue injuries.
Findings / Results: A total of 56 patients were included.
Average patient age was 56 years (range
22-86). Thirty-three patients (59%) were
female. 50% of patients presented with MRI
verified soft tissue injuries. At 12 months
postoperatively the mean KOOS5 score for
patients with soft tissue injuries was 53.5
(95%CI: 44.8-62.1) and the KOOS5 score
for patients without soft tissue injuries was
59.6 (95%CI: 50.7-68.6). No significant
difference in the KOOS5 score between
patients with and without soft tissue injuries
was observed (P=0.31)
Conclusions: Patient-reported outcome 12 months
following lateral tibial plateau fractures is not
associated to MRI verified soft tissue
injuries. More research is needed to
investigate the effects of surgical vs. non-
surgical treatment strategies of associated
soft tissue injuries following lateral tibial
Natascha GK Lange, Pernille Engell Bovbjerg, Niels Dieter Röck, Jens Lauritsen
Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery, Odense University Hospital; Dept. of Orthopedic Surgery/dept Clinical Medicine, Odense University Hospital/University of Southern Denmark
Background: Due to the Covid-19 situation in early 2020 several governmental restrictions were imposed on population contacts, transportation, leisure, cultural events etc. Since it is well known that injuries vary with activity, behaviour and circumstances, the restrictions constituted a “natural experiment” which could affect injury occurrence.
Purpose / Aim of Study: To describe the effect of the Covid-19 lockdown on volume, composition, causal pattern and severity of acute injuries treated at an Emergency Department.
Materials and Methods: All first time injury contacts to the emergency department at OUH during two identical 56 day periods (same number of week- and weekend days) in 2019 (Febr. 14th to April 10th) and 2020 (February 13th to April 8th) were included. Two 28 day periods (Split pre/post: 12th of March 2019, 13th of March 2020) gave four periods (2019:p1+p2, 2020: p3+p4), where p4 is after the lockdown. Binary indicators included were: sex, child (age < 15), elderly (age>74), severity (Any “fracture – excl. nose+finger+toe/amputation/nerve lesion”), type: traffic, work, home-work (=private repair and garden work) and area: garden, schools+sports, bar (bars+restaurant+disco). To verify similarity of the before periods, P1 and p3 were compared , and the lockdown effect was analyzed as (p2 vs p4) and (p3 vs p4) by counts, Chi2 tests and Odds Ratios (OR,[95% CI]).
Findings / Results: A slightly larger percentage of traffic injuries (11 vs 8%) was seen in p1 vs p3 (all other indicators: p>0.10). Total number of visits in the four periods (n,avg/day): (2194,78.4), (2442,87.2), (2333,83.3) and (1357,48.5). Highly significant lower n in p4 (p<10-5). Comparison of p3/p4: No difference in sex, child, severity or work. Significant (p<10-3): higher proportion of elderly (OR=1.42,[1.16-1.74]), home-work (OR=2.6,[1.97-3.44]), garden (OR=3.9,(3.1-4.9). Less traffic injuries (OR=0.60,[0.47-0-77]), schools+sports area (OR=0.10,[0.07-0.13]), bars+restaurants (p3:n=60, p4:n=2) (OR=0.06,[0.01-0.23]). The same results were seen for comparison of p2/p4.
Conclusions: The number of injuries treated was about half during the Covid-19 lockdown period. Major changes in the injury composition was observed compared to the same period in 2019 as earlier in 2020.
Jonas Adjal, Ilija Ban
Orthopaedic Department, CORH, Hvidovre Hospital; Orthopaedic Department, CORH, Hvidovre Hospital
Background: Patella fractures requiring surgery are
traditionally treated using metallic implants
which are associated with high re-operations
rates mainly due to implant prominence. Non-
metallic fixation methods could be a solution
to this problem.
Purpose / Aim of Study: To report results on adults with a patella
fracture treated with a new non-metallic
fixation method, the “KnotMe” technique.
Materials and Methods: From 1st of November 2018 all adult
patients with a patella fracture requiring
surgery was treated with the novel
“KnotMe” technique. Prior to surgery all
were informed of this experimental
technique and the possibility to be treated
with the standard metallic tension band
technique. 24 patients were enrolled
consecutively by the end of august 2019
with no patients declining the “KnotMe”
treatment. We had no exclusion criteria
regarding high age, fracture type, or
functional level. 2 surgeons performed the
surgery. The standardized postoperative
regimen comprised partial knee
immobilization for 4 weeks. Follow-up was
done at 2 and 4 weeks and 3 and 6
Findings / Results: No patients were lost to follow-up. 15 of 24
were females, median age of 59 years
(19-81 years), and 8 open fractures.
Fractures were simple 2-part in 5 cases
and comminuted in 19 cases. In one case
additional k-wires were needed for stability
due to severe comminution. At 6 months
the median knee ROM was 125 degrees
(90-150), median pain VAS at rest was 0,3
(0-2), median pain VAS at activity was 1,2
(0-5). Data on VAS were missing on two
All but 1 united radiologically. 7 patients
had unexpected events (1 with
asymptomatic non-union needing no
further intervention, 2 with superficial
wound infections treated successfully with
oral antibiotics, 1 with prominent knots
requiring implant removal, 2 with
inflammation of the quadriceps tendon
requiring corticoid injections and
prolonged rehabilitation, 1 with deep
venous thrombosis requiring oral
Conclusions: The "KnotMe" technique seems to be a safe
alternative fixation method for all types of
patella fractures with a potential to
significantly reduce the problem of prominent
Anders Bo Rønnegaard, Per Hviid Gundtoft, Peter Toft Tengberg, Bjarke Viberg
Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt; Department of Orthopedic Surgery, Hvidovre Hospital; Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt & Odense University Hospital
Background: The Danish Fracture Database (DFDB) has
delivered data for numerous studies and
currently there are more than 75,000 fracture-
related surgical procedures registered. However,
the validity of the data is only known for two
Purpose / Aim of Study: To determine validity of the Danish Fracture
Materials and Methods: All patients in the Region of Southern
Denmark registered with a primary or
planned secondary procedure in the DFDB in
2016 were included. For validity, patient
medical records were assessed using a
sample of 10% of the study population. The
sample was randomly selected and stratified
according to anatomical region and treating
hospital. Validity was calculated as positive
predictive value (PPV) and negative
predictive value (NPV) for dichotomous
variables. For non-dichotomous variables
validity was calculated as the percentage of
conformity between the DFDB and patient
medical records. Key variables were
identified as date of surgery, operated side,
and type of surgery. For type of surgery,
validity was defined as the presence of the
correct type of surgery in DFDB, regardless
of other types of surgery registered.
Observations that were unavailable in patient
medical records or containing missing values
Findings / Results: The sample population consisted of 429
patients. The mean age was 55 years (3-98
years) and 43.1% were male.
Conformity for key variables was 96% for
date of surgery, 97% for operated side of the
patient, and 98% for type of surgery.
Dichotomous variables had a PPV ranging
from 81% to 100% with trauma status at 81%
and pathological fracture at 100% (n=1).
NPV ranged from 89.5% to 100% with
antibiotic prophylaxis at 89.5% and
pathological fracture at 100%. For variables
other than trauma status, PPV was more
than 95% and for variables other than
antibiotic prophylaxis, NPV was more than
99%. Validity in percentage of conformity
ranged from 84% for ASA score to 100% for
location of periprosthetic fracture (n=2). For
variables other than ASA score, conformity
was more than 93%.
Conclusions: This indicates that the DFDB in general has high
validity and we expect the nationwide results to
be comparable (will be presented at the
Nanna S. Smidt, Line L. Nielsen, Julie L. Erichsen, Henrik Palm, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark
Background: Undisplaced femoral neck fractures (uFNFs) are
traditionally classified using the Garden
classification. However, in 2009 Palm et al.
suggested a new measurement of posterior tilt of
the femoral head on a lateral radiograph and using
this as a predictor of the outcome following
osteosynthesis of uFNFs. Several studies have
since been perfomed but there has yet to be
conducted a pooled analysis.
Purpose / Aim of Study: To conduct a systematic review on the effect of
posterior tilt on reoperations, patient related
outcome measures (PROM) and functional outcome
following osteosynthesis of uFNFs.
Materials and Methods: A search string was developed in collaboration with
a scientific librarian and studies were extracted from
the PubMed, CINAHL and Embase databases.
Supplementary search was performed in Google
Scholar. Studies were screened by two independent
readers using Covidence. References of included
studies were screened as well as studies citing the
included studies using Web of Science. The present
study was registered in Prospero. Data were
extracted for the final analysis and a quality
assessment was performed using Robins-I tool.
Pooled data was assessed for heterogeneity using
Chi2 and I2 tests. A Random-effects model was
used to estimate risk ratio.
Findings / Results: 10 cohort studies with 3699 patients were included.
The mean age was 76 years and 72% were female.
In general, the studies were assessed to be of poor
quality mainly due possible bias and confounding.
10.9% reoperations were identified, but there were
10.3% reoperations in the group with posterior tilt
<20 degrees whereas there were 24.5% in the
group with posterior tilt >20 degrees. The meta-
analysis revealed an overall risk ratio of 0.11 (95%
confidence interval; 0.04-0.18) for failure with a
posterior tilt >20 degrees. Only one study
investigated functional outcome using ADL as
measurement but found no significant difference. No
studies investigated PROM.
Conclusions: A posterior tilt >20 degrees leads to a higher risk of
reoperations in uFNF. Even though the studies were
of poor quality, the results suggest that we should
include measuring posterior tilt in uFNF.
Jan Duedal Rölfing, Rune Dall Jensen, Charlotte Paltved
Ortopædkirurgi, Aarhus Universitetshospital, Koncern HR, MidtSim, Region Midt; Koncern HR, MidtSim, Region Midt; Koncern HR, MidtSim, Region Midt
Background: Virtual reality simulation of hip fracture surgery is
available for orthopaedic residents in Denmark.
Summative assessment of learning applying the
learning curve cumulative summation test (LC-
CUSUM) has not been utilized in orthopaedic
simulation training. The strength of the LC-CUSUM
is that it assumes incompetency and signals
competency based on solid statistics. The present
study HipSim investigates the LC-CUSUM
characteristics of novices stepwise mastering the
simulated dynamic hip screw (DHS) procedure.
Purpose / Aim of Study: The aim of this study was to describe the LC-
CUSUM characteristics of DHS simulation training
(HipSim) of 1st-year-orthopaedic residents and
associate the results with the participants’ career
status after ≥2 years follow-up.
Materials and Methods: Thirty-two 1st-year-orthopaedic residents
participated in HipSim and its three subsequent LC-
CUSUM evaluations: placing a Kirschner wire,
placing a Kirschner wire in different patients, and
performing the entire DHS procedure in different
patients. The career status of the participants, i.e.
still working in orthopaedics or another specialty
was recorded ≥2 years after participation and
associated with the simulation performance
Findings / Results: 13/14 participants passing HipSim according to LC-
CUSUM were still working in orthopaedics, while
9/18 participants failing HipSim had quit
orthopaedics at ≥2 years follow-up. None of the
simulator-generated feedback differed statistical
significantly between the groups and all participants
achieved a tip apex distance ≤ 20 mm.
Conclusions: LC-CUSUM and its summative pass/fail assessment
of each simulation was feasible in this formative
simulation program. Clinical educators can be
reassured that participants passing HipSim are likely
to continue to 2nd-5th-year of residency, while failing
HipSim should raise concerns and career
counseling and close clinical supervision seem to be
appropriate measures. The motivational aspect of
LC-CUSUM pass/fail assessment when designing
formative simulation training warrants further
Morten Tange Kristensen, Jeppe Damgren Vesterager, Alma Becic Pedersen
PMR-C, Departments of Physiotherapy and Orthopedic Surgery, Amager-Hvidovre University Hospital, Copenhagen; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
Background: The loss of pre-fracture basic mobility status is associated with increased mortality and any readmission after hip fracture (HF). However, it is less known if the loss of pre-fracture mobility has impact on acquiring a post-discharge infection.
Purpose / Aim of Study: To examine if the loss of pre-fracture basic mobility status at hospital discharge was associated with hospital-treated or community-acquired infections within 30-days of hospital discharge after a first time HF.
Materials and Methods: Using the nationwide Danish Multidisciplinary Hip Fracture Registry from Jan. 2016 through Dec. 2016, we included 5,330 patients. The Cumulated Ambulation Score (CAS, 0-6 points) was recorded using questionnaire at admission (pre-fracture CAS) and objectively at discharge. The loss of any CAS-points at discharge compared with pre-fracture CAS was calculated and dichotomized (yes/no). Using Cox regression analyses, we estimated the hazard ratio (HR) with 95% confidence interval (CI) of any hospital-treated (based on ICD-codes) or community-acquired infection (based on antibiotic dispensing’s). HRs were adjusted for sex, age, body mass index, Charlson Comorbidity Index, type of fracture, and length of hospital stay.
Findings / Results: Total of 3,261 (61%) patients lost their pre-fracture CAS status at discharge. Among patients who had lost their pre-fracture CAS, 7.3% sustained a hospital-treated infection compared to 5% of those who did not. Correspondingly, 11.4% versus 7.8% sustained a community-acquired infection. The risk of 30-day post-discharge infection increased with loss of pre-fracture CAS status. The adjusted HRs for hospital-treated and community-acquired infection were 1.35 (CI: 1.04-1.76) and 1.55 (CI: 1.24-1.92), respectively, for patients who had lost their pre-fracture CAS status, compared to patients who did not.
Conclusions: In this large national HF registry study, we found that any loss of pre-fracture basic mobility status upon hospital discharge was strongly associated with 30-day post-discharge risk of developing infection. These findings underscore the clinical importance of carefully focusing on regaining the pre-fracture basic mobility status before discharging the patient.
Pia Kjær Kristensen, Nickolaj Risbo, Alma Becic Pedersen
Klinisk Epidemiologisk afdeling , Aarhus Universitetshospital; Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital; Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital
Background: Surgery for hip fractures frequently
requires red blood cell (RBC)
transfusion in order to treat pre-
existing and acute acquired anemia
and operative bleeding. Postoperative
anemia in hip fracture patients is
associated with reduced rehabilitation
and functional independence, as well
as increased mortality. However, the
indications for RBC transfusion in
elderly with hip fractures had not been
Purpose / Aim of Study: We examined the variation in use of RBC
transfusion within seven days after hip
fracture surgery across orthopaedic
departments in Denmark.
Materials and Methods: In this nationwide population-based
cohort study, patients who underwent
surgery for an incident hip fracture in
2016 and 2017 (n=11,372) were
identified in the Danish
Multidisciplinary Hip Fracture Registry.
Data on RBC transfusion were
obtained from the Danish Transfusion
Database. The outcome was defined
as RBC transfusion within 7 days after
hip fracture surgery (yes/no), and the
prevalence of RBC transfusion was
estimated overall and among 21
orthopaedic departments in Denmark.
In addition, prevalence of RBC
transfusion was estimated in patients
treated at departments with 30-day
morality <8% and >10% in 2016-2017.
Findings / Results: The overall prevalence of RBC
transfusion was 32.9 %. However, the
unadjusted prevalence of RBC
transfusion varied from 19.7% to
72.8% across 21 departments. At
Hvidovre orthropaedic department,
almost three quarters of hip fracture
patients received RBC transfusion,
whereas only ever fifth hip fracture
patient at Esbjerg orthropaedic
department received RBC transfusion.
At Aarhus orthropaedic department
every second hip fracture patient
received transfusion. Among patients
treated at departments with 30-day
mortality <8%, the prevalence of RBC
transfusion was 38.8%, compared with
28.4% among patients treated at
departments with 30-day mortality
Conclusions: We observed a substantial variation in use
of RBC transfusion within 7 days after hip
fracture surgery among Danish
orthopaedic departments. Further
analyses to examine characteristics
associated with blood transfusion, and the
impact of transfusion on prognosis of
elderly hip fracture patients is needed.