Postersession II
Onsdag den 23. oktober
11:00 12:00
lokale: Stockholm/Copenhagen
Chairmen: Henrik Eckardt / Lars Konradsen
158. Results after plate removal in midshaft clavicle fracture surgery: Focus on coexsisting soft-tissue shoulder injuries.
Ban Ilija, Poulsen Heidi , Troelsen Anders
Orthopaedic Surgery, Copenhagen University Hospital Hvidovre
Background: Primary surgical treatment has become
the preferred treatment for displaced,
midshaft clavicle fractures. Several
studies have shown that plate
osteosynthesis is a safe procedure
associated with good outcome.
However, in close to 30 % of all patients
treated with a precontoured plate the
implant is removed due to soft-tissue
irritation. This high rate of implant
removal is neglected in the overall
discussions that compare surgical
treatment to non-surgical treatment of
acute midshaft, clavicle fractures.
Purpose / Aim of Study: To evaluate results, in terms of
complications and reoperations, of
implant removal of clavicle plates.
Materials and Methods: 54 patients (41 males) operated
between 2007 and 2012 at our institution
with removal of clavicle plates were
included. We retrospectively assessed
complication and reoperation rates by
inquiry to patient files and radiographs.
Findings / Results: In 47 of 54 patients, precontoured
locking plates were removed and in the
remaining 7 patients reconstruction
plates were removed. In 49 cases the
plate was removed within the first 2
years following primary fracture
surgery, with 25 removed during the
first postoperative year. The plate was
removed due to soft-tissue irritation in 43
cases, 2 had neurological deficits and 4
suffered profound pain or discomfort.
Another 4 plates were removed for
unknown reasons and 1 due to patient
demand. A total of 6 patients had
deficits (decreased mobility in 4 cases)
or complications (re-fracture in 2 cases)
following implant removal. All patients
with decreased mobility were, following
plate removal, diagnosed with a
structural soft-tissue injury of the
shoulder.
Conclusions: Plate removal following a midshaft
clavicle fracture seems safe but patients
with profound pain or decreased mobility
should be examined for a structural soft-
tissue injury of the shoulder.
159. Early experiences with the DHS blade in treating femoral neck fractures
Rasmus Stokholm, Lise Hellegaard, Steffen Skov Jensen
Orthopaedic dept., Regionshospitalet Viborg
Background: The most common complications related
to internal fixation of femoral neck
fractures (FNF) is non-union and
avascular necrosis. Failure rates of 6.5 -
13% for undisplaced and 49% for
displaced fractures has been reported
with reoperation rates of 7,7 13 %
and 20 36 % respectively. Randomised
trials of different implants for internal
fixation of FNF are inconclusive.
Biomechanical studies have indicated
that DHS blade is superior in resisting
displacement forces compared to
conventional DHS. To our knowledge no
report has ever been made on the DHS
blade for internal fixation of FNF.
Purpose / Aim of Study: To evaluate the outcome of patients
submitted with a FNF, internally fixated
with a DHS blade, at the Orthopaedic
department, Regionshospitalet Viborg
from 2008 to 2012.
Materials and Methods: 68 patients, mean age 76,2 yrs (32 - 98)
submitted with a FNF treated with
internal fixation with a DHS blade at
regionshospitalet Viborg 2008-2012. No
specific criteria were applied for
choosing DHS blade, as opposed to
conventional DHS, but considerations
were: age, osteoporosis, grade of
dislocation, general- and mental health
status of the patient. Decision to choose
DHS blade was made in plenum or at the
discretion of the attending surgeon.
Mean follow up time was 24,3 months
(6 - 62).
Findings / Results: 50 undislocated and18 dislocated
fractures were treated with DHS blade.
The total number of failures registered in
the follow up period was 8. 5
undislocated (10%) and 3 dislocated
(16,7%).
All were reoperated with convertion to
THA. Mean time to reoperation was 6,5
months (3 16). 17 patients died in the
follow up period.
Conclusions: Our early experiences with the DHS
blade indicate that it is an equal implant
option for internal fixation of FNF.
Further investigation is needed to
evaluate the DHS blade and its place in
treatment of FNF.
160. Retrospective review of radiographic referral, interpretation and treatment plan in a Danish emergency department in comparison to an international benchmark.
Mohamed Shalaby, Wajeha Malik , Christine Hilbrandt, Valentina Makolli, Thomas Houe
Orthopedic surgery, Slagelse hospital; Emergency department, Slagelse hospital
Background: Though Denmark had dramatic changes in
the emergency department (ED) system
organization, still lacks designated ED
doctors and specialists.
Purpose / Aim of Study: To evaluate discrepancies in plain X-ray
interpretation, treatment plan and
referral rate for radiography in a
Danish hospital emergency department
(ED) between junior house officers,
residents and orthopedic surgeons, and
their clinical spectrum and outcome.
Materials and Methods: Primary Emergency journals for ED
patients and their radiograph reports
were reviewed (by a radiologist and a
senior orthopedic surgeon) during 3
months. All discrepancies and their
management were noted on a computerized
data base.
Findings / Results: A total of 6724 patient were examined in
the ED, 3056 of them had injuries with
potential need for radiographic
examination. Of these, 1363 patient were
photographed, with a referral rate 44.6%.
Out of 1363 cases, there were 85 (6.2%)
diagnostic or management errors, 39
(2.8%) fractures were missed, 22 (1.6%)
cases were diagnosed but inadequately
treated, and 35 (2.5%) errors were
insignificant without impact on the
patients treatment.
Conclusions: A radiographic referral rate of 44.6% is
appropriate to referral rate benchmark
in UK (44%).
However 3.7% of ED patients had
significant diagnostic or treatment
errors which prompted a change in
management after joint
radiographic-orthopedic conference next
working day. This is relatively high in
comparison to other similar studies in
UK (0.3%-1%) and US (0.4%-2.8%).
A possible explanation for this could be
a longer history of ED medicine
sub-specialty in the countries used for
benchmark in our study and the results
calls for further evaluation and focus
on ED education and supervision but also
emphasizes the importance of routine
joint radiographic-orthopedic evaluation
in close relation to hospital ED treatment.
161. Feasibility of progressive strength training immediately after hip fracture surgery.
Lise Kronborg, Thomas Bandholm, Henrik Palm, Henrik Kehlet, Morten Tange Kristensen
Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Department of Physical Therapy, Copenhagen University Hospital at Hvidovre; Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Department of Physical Therapy, , Copenhagen University Hospital at Hvidovre; Department of Orthopedic Surgery, Copenhagen University Hospital at Hvidovre; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University
Background: Muscle strength relates to functional
performance in patients with a hip fracture.
During the first week in the acute orthopedic
ward, patients with a hip fracture loose
more than 50% of their knee-extension
muscle strength in the fractured limb when
compared to the non-fractured limb.
Purpose / Aim of Study: The aim of this study was to examine the
feasibility of progressive strength training
when initiated in the acute ward based on
pre-specified criteria for feasibility.
Materials and Methods: Thirty-six patients (9 men and 27 women)
with a hip fracture having a mean (SD) age
of 79.4 (8.3) years. They followed a daily
(on weekdays) program of progressive
knee-extension strength training for the
fractured limb, using ankle weight cuffs as
loading. At each session, they performed 3
sets of 10 repetition maximum (RM) loadings
(adjusted on a set-by-set basis). Maximal
isometric knee-extension strength of both
limbs was measured with a fixated
dynamometer.
Findings / Results: The training load (kilograms lifted) increased
progressively by an average of 2.7 (1.5) kg
from 1.6 (0.8) to 4.3 (1.7) kg (p<0.001) over
4.3 (2.2) training sessions. Strength training
was initiated 2.4 (0.7) days after surgery
and ended at mean day 8.6 (4.2). The
average knee-extension strength deficit in
the fractured limb decreased from 50%
(34%) to 32% (25%) of the non-fractured
limb at discharge. More than 80% of patients
reported no or just light hip pain during the
strength training sessions.
Conclusions: Progressive knee-extension strength training
of the fractured limb in hip fracture patients
commenced in the acute orthopedic ward
seems feasible and may reduce knee-
extension strength asymmetry. Hip fracture-
related pain did not compromise strength
training or testing. The clinical value of early
progressive strength training will be studied
in a randomized design.
167. Surgery for Kyphoscoliosis in Parkinson's Disease
Ebbe Stender Hansen, Dharmendra Singh, Cody Bünger
Department of Orthopedic Surgery, Aarhus University Hospital; Department of orthopedic Surgery, Aarhus University Hospital
Background: A frequent complication to Parkinsons
disease is camptocormia, i.e. severe,
involuntary, reversible thoracolumbar
kyphosis during standing and walking.
With time, the spine tends to develop
structural degenerative kyphoscoliosis
with spondylosis, spinal stenosis, pain
and severe loss of function. The
international literature on scoliosis
surgery in this condition is extremely
scarce, mostly case reports of failures.
Purpose / Aim of Study: This is a review of our first six cases, in
fact the lagest material published so far.
Materials and Methods: In 2000 - 2010 we performed corrective
scoliosis surgery in six Parkinson
patients with camptocormia and
kyphoscoliosis, age 58-70 years, four
men, two women. Surgery included
Smith Petersens osteotomies and PSO
where needed, long posterior fixation
with pedicle screws/rods, and auto-
plus allografting.
Findings / Results: Operation time was 4 to 10 hours, the
initial postop care was in ICU in 5 of 6
cases, and hospitalization ranged from
8 - 32 days. Correction was good initially
in all cases. One developed a hematoma,
which was evacuated, two had
hallucinations postoperatively, and three
developed pneumonia. All six
experienced implant breakage and/or
screw loosening, and three were
reoperated upon several times. The total
numer of reoperations was 13 in the
series. In spite of this, five patients
reported good satisfaction. Four are still
active, two are in nursing home for other
reasons..
Conclusions: This case series represents a llearning
curve. Scoliosis surgery in Parkinsons
disease is feasible but challenging.
Surgery should extend distally to the
ileum. Correction should aim at complete
restoration of balance. Complications
and reoperations should be expected. It
has been a taxing but rewarding
endeavour for the surgeons and for
most patients. We now plan more
patients for the procedure.
168. The physical and mental outcome of 100 patients having a Percutaneous Vertebroplasty because of pathological vertebral fractures.
Søren Lykke Lorentzen, Rikke Rousing, Stephan Hummel
ortopædkirurgisk afdeling, Kolding; Sector for Spine Surgery and Research, Region of southern Denmark , Vejle Sygehus
Background: Percutaneous vertebroplasty (PVP) is a
therapeutic procedure performed to
reduce pain in pathological vertebral
fractures. PVP has been performed since
the eighties and a lot of clinical
studies have confirmed the benefit of
the operation. Lately two double blind
randomised studies have questioned the
pain relieving effect compared to
conservative treatment. To test this
statement a new double blind study is
performed at the Sector for Spine
Surgery and Research, Region of Southern
Denmark. PVP is still performed on
patients not attending this study
because of exclusion criteria. The
effect on mental and physical health is
documented in DaneSpine, the Danish
database for spine operated patients.
Purpose / Aim of Study: The aim of this study is to describe the
quality of life and the physical and
mental outcome of the first 100 patients
having a PVP at the Sector for Spine
Surgery and Research, Region of southern
Denmark due to painful pathological
fractures.
Materials and Methods: All patients are operated by specialists
in spine surgery. The data is collected
in DaneSpine. STATA is used for
statistical work.
Well-known and validated questionnaires
are used for assessment of mental and
physical health and for quality of life,
SF-36, ODI, and EuroQol. VAS is used for
pain estimation.
Findings / Results: The mental and physical health has
improved significantly one year after
surgery based on the mental and physical
score of SF-36. The VAS score for back
pain is lowered significant and the
quality of life estimated by EuroQol,
has improved significantly one year
after surgery.
Conclusions: PVP relieves the pain for patients with
pathological vertebral fractures and the
patients improve in mental and physical
health. Further conclusions on PVP may
be made after the ending of the
double-blind randomised study.
172. Artificial Meniscal scaffold Implantation and Meniscal Allograft Transplantation.
Martin Rathcke, Peter Lavard, Michael Krogsgaard
Dept. of orthopaedics, Bispebjerg Hospital
Background: Loss of meniscal function alters the
pressure distribution within the knee joint
leading to increased cartilage wear
Restoration of meniscal function with
artificial meniscal scaffold implantation
(AMSI) or meniscal allograft
transplantation (MAT) might prevent this.
Indication for AMSI was pain with intact
meniscal horns and rim.
Purpose / Aim of Study: To present two years of experience
using AMSI and MAT, including our
treatment algoritm.
Materials and Methods: Eigthteen knees (8 /10 ) in seventeen
patiens fullfilled the indication for either
AMSI or MAT. 4 had a history of discoid
meniscus.
In eleven knees AMSI was primarily
implanted, 6 medial and 5 lateral. 7 had
earlier ACL reconstruction. Until now 5
have failure of AMSI and were changed
to MAT, including 4 of the ACL
reconstructed patients.
In seven knees MAT was primarily
implanted, 2 medial and 5 lateral, but
none with ACL reconstruction. In further
five knees MAT was secondary
implanted, 4 medial and 1 lateral. In all 12
MAT, plus one revision.
Findings / Results: Nearly all patients showed initially
reduction in pain at 3 month. In the AMSI
group a large number of patients were
revised. Earlier ACL reconstruction
seems to be a negative prognostic
factor. Contraindications, timing and a
learning curve might also influence
results.
Nearly all patients showed improvement
in pain and function at postoperative
controls. The one MAT revision was due
to under sizing of the transplanted graft.
Conclusions: Biological joint preservation with AMSI or
MAT is now a possibility in Denmark. The
patients often have a long complicated
surgical history, and in many patients
additional procedures are needed.
History with ACL reconstruction have a
high failure rate in AMSI, and MAT
should be considered as the primary
operation.
173. Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain? long term results of a randomized controlled trial
Per Hölmich, Kristian Thorborg, Per Nyvold, Jakob Klit, Michael Bachmann Nielsen, Anders Troelsen
Artoskopisk Center Amager, Amager-Hvidovre Hospital; Ortopædkirurgisk afdeling, Amager-Hvidovre Hospital; Radiology, Rigshospitalet; Ortopædkirurgisk, Amager-Hvidovre Hospital
Background: Adductor-related groin pain and bony
morphology such as femoroacetabular
impingement (FAI) or hip dysplasia can co-
exist clinically. A previous RCT, in which
athletes with adductor-related groin pain
underwent either passive (PT) or active
(AT) treatment, showed good results in the
AT group.
Purpose / Aim of Study: The primary purpose of the present study
was to evaluate if radiological signs of FAI
or hip dysplasia, seem to affect the clinical
outcome, initially and at 8-12 year follow-
up.
Materials and Methods: Forty-seven patients (80%) were available
for follow-up. The clinical result was
assessed by a standardised clinical
outcome, combining patient-reported
activity, symptoms and physical
examination. Anterior-posterior pelvic
radiographs were obtained and the center-
edge angle of Wiberg, alpha angle,
presence of a cross-over sign and Tönnis
grade of osteoarthritis were assessed by a
blinded observer, using a reliable protocol.
Findings / Results: No significant between-group differences
regarding the distribution of radiological
morphologies were found. There was a
decrease over time in clinical outcome in
the AT group with alpha angles >55°
compared to those with alpha angles <55°
(p=0.047). In the AT group there was no
significant difference in the distribution of
Tönnis grades between hips that had an
unchanged or improved outcome
compared with hips that had a worse
outcome over time (p=0.145).
Conclusions: No evidence was found that bony hip
morphology related to FAI or dysplasia
prevents successful outcome of the
exercise treatment programme with results
lasting 8-12 years. The entity of adductor-
related groin pain in physically active adults
can be treated with AT even in the
presence of morphological changes to the
hip joint.
174. Custom-made orthotics decrease medial foot loading during drop jump and single-leg squat in individuals with patellofemoral pain
Michael Rathleff, Camilla Richter, Jesper Bencke, Thomas Bandholm, Per Hölmich, Kristian Thorborg
Orthopedic Surgery Research Unit, Aalborg Hospital; A-Physiotherapy, Solrød Strand; Gait Analysis Laboratory, Hvidovre Hospital; Physical Medicine and Rehabilitation Research (PMR-C), Orthopedic Department, Clinical Research Cent, Hvidovre Hospital; Arthroscopic Centre Amager, Orthopedic Departement, Hvidovre Hospital; Arthroscopic Centre Amager, Physical Medicine and Rehabilitation Research (PMR-C), Orthopedic Depart, Hvidovre Hospital
Background: We have previously shown that
individuals with PFP have a more
medially directed foot-loading pattern (20-
30%) compared to healthy individuals
during high load activities. This may
increase lateral forces acting on the
patella.Foot orthotics may be a simple
approach to help normalise foot loading.
However, no one has yet investigated
the effect of foot orthotics on foot
loading patterns during jumping and
squatting in individuals with PFP.
Purpose / Aim of Study: To investigate the effect of foot orthotics
on medial-to-lateral plantar forces during
drop jump and single-leg squat in
individuals with PFP.
Materials and Methods: 23 young adults with PFP were tested
before and after a custom-made orthotic
was inserted into both a standard shoe
(Le coq Sportif).The order of testing
was random. Foot loading (plantar
pressure distribution) was collected
from the most painful side during drop
jump and single-leg squat using
pressure sensitive Pedar insoles.
Primary outcome was the medial-to-
lateral peak force under the forefoot
during drop jump. Mean forces under the
forefoot were analysed using the same
approach. Test-retest reliability for this
procedure was substantial, with no
systematic bias from test to retest.
Findings / Results: Orthotics caused a relative reduction in
peak force of 7% (p=0.01), during drop
jump, while mean forces were reduced
by 10%, p<0.01. Peak force was
reduced by 12%, (p=0.08) during single-
leg squat, and mean forces were
reduced by 20%, p=0.03.
Conclusions: Foot orthotics decrease medially
directed foot loading among individuals
with PFP, which may decrease lateral
forces acting on the patella. However,
the orthotics did not normalise medial
foot-loading patterns completely
suggesting that strategies such as
medial foot wedges or movement
corrective exercises may be relevant to
consider.
175. DHAR the Danish Hip Arthroscopy Register
Bent Lund, Søren Winge, Otto Kraemer, Svend Erik Christiansen, Martin Lind
Dept. of Sportstraumatology, University Hospital of Aarhus; , Københavns Privathospital
Background: Hip arthroscopy as a treatment modality
was included in the Danish Board of Health
speciality plan in 2010 as a regional function.
Purpose / Aim of Study: The background was to make sure that
surgeons performed a sufficient number of
procedures to be proficient in this
demanding type of surgery. 10 departments
and clinics were allowed to perform hip
arthroscopy. The Danish Society for
Sportstraumatology and Arthroscopy
(SAKS) supported the establishment of a
national clinical registry for hip arthroscopy
to be able monitor development and
outcome of hip arthroscopy surgery. The
purpose of present study is to present the
Danish Hip Arthroscopy Register and data
from the registry.
Materials and Methods: The registry opened February 1st 2012.
Surgeons enter data on radiology and
operative procedures. These are CE-angle,
Alfa angle, labral and cartilage surgery, CAM
and Pincer surgery, OR- and traction time,
antibiotics and DVT prophylaxis.
Extraarticular procedures and complications
are noted. Patients enter Patients Related
outcome Measures (PROM) preoperatively
and at 1, 2 and 5 years follow-up. The
following PROM are used: pain score at rest
and after 15 min. Walk, iHOT12, HAGOS,
EQ5D and HSAS score.
Findings / Results: Data from 554 procedures are included. 8
out of 10 departments have reported their
operations. Mean number of surgeries was
77. Mean OR-time was 95 minutes and
mean traction time 56 minutes. Mean CE-
angle was 33 (15-65) and mean Alfa-angle
69 (30-108). 487 patients had a labral tear
and 471 had labral surgery performed. The
labrum was reinserted in 384 patients. The
depth of bumpectomy for CAM was
recorded (mean 4,4 mms) and extent of the
rimtrimming was 3,7 mm.
Conclusions: This descriptive report about the Danish Hip
Arthroscopy Register shows that a National
Register can give valuable details about hip
arthroscopy surgery.