Postersession III
Onsdag den 22. oktober
11:00 – 12:00
Lokale: Helsinki/Oslo
Chairmen: Jeannette Ø. Penny / Anders Troelsen
165. Does an intensive alcohol cessation intervention at the time of fracture surgery induce spontaneous smoking cessation? - The Scand-Ankle study
Erika Wernheden, Marianne Aalykke, Bolette Pedersen, Julie W. M. Egholm, Hanne Tønnesen
WHO-CC, Frederiksberg Hospital; Clinical Health Promotion Centre, Lund University; Syddansk Universitet, Sygehus Sønderjylland
Background: Patients with high alcohol consumption
are at greater risk of developing
postoperative complications than patients
with low/no alcohol consumption. Other
risk factors are smoking, overweight,
malnutrition and physical inactivity.
Preoperative alcohol and smoking
cessation programs have been found
effective in reducing postoperative
morbidity, but it remains unknown
whether these induce a general change
of lifestyle.
Purpose / Aim of Study: The aim of this study was to find out
whether the gold standard alcohol
intervention programme (GSP-A) used in the
Scand-Ankle study, affected smoking,
overweight, malnutrition and physical
inactivity.
Materials and Methods: 64 patients with high alcohol consumption,
who underwent ankle fracture surgery,
were randomized to the GSP-A or usual
care (control). The two groups were
compared at baseline and 6 weeks follow-
up regarding changes in lifestyle factors.
Data were analyzed on an intention to treat
(ITT) basis using non-parametric statistics. A
per protocol analysis of whether alcohol
cessation, regardless of study group,
affected lifestyle risk factors after 6 weeks
was also performed.
Findings / Results: The ITT-analysis showed no significant
differences between the GSP-A and control
group regarding lifestyle risk factors other
than alcohol. The per protocol analysis
showed that alcohol cessation regardless of
study group did not influence the other
lifestyle risk factors.
Conclusions: The GSP-A, which has been proven
effective on short-term alcohol
cessation, does not affect smoking,
overweight, malnutrition and physical
inactivity. Thus, a potential effect of the
GSP-A on postoperative complications
will likely be due to the effect on alcohol
intake and not to a general change in
lifestyle. The findings suggest that
multiple lifestyle interventions are
required, e.g. combined alcohol and
smoking cessation.
166. Compression in Anklefracture Treatment, the CAT-study
Rikke Winge, Stig Sonne-Holm, Camilla Ryge , Hans Gottlieb, Lasse Bayer
Orthopedic Surgery, Nordsjællands Hospital
Background:
Malleolar fractures in Denmark has an
incidence of 107/100.000 person, making
it one of the most common fracture types
in the country. In Denmark 6000 malleolar
fractures are operated each year.
Studies have shown increased
complication rates in the elderly,
diabetics, smokers, patients on
immunomodulating medication, alcoholics,
and patients with osteoporosis and
peripheral neuropathy.
Nordsjællands Hospital has decided, to
implement a standard regime of elevation,
Flowtron Hydroven 3™ and Coban™ 2
lite, to prevent oedema formation and
blistering. The decision came after
clinicians having observed a high
incidence of oedema, blistering and
wound healing problems in this cohort of
patients, often forcing surgeons to
postpone surgery and prolonging
inpatient stay, resulting in a long and
cumbersome rehabilitation for the patient.
Purpose / Aim of Study: To perform a randomized, controlled
cohort study, to evaluate the effect of
Flowtron Hydroven3™ and Coban2 lite™
on the incidence of complications
(infection, wound dehiscence, prolonged
healing, skin necrosis, exposed
hardware, DVT, amputation and death)
after operation for mono-, bi- and
trimalleolar fractures at Nordsjællands
Hospital.
Materials and Methods: 156 Patients with an unstable malleolar
fracture, included and randomized in the
ED.
Intervention: Compression therapy in the
form of Flowtron Hydroven3™ and
Coban2 lite™compression bandage.
Controle: Elevation of the ankle on a
Braun frame.
Follow-up: 6 weeks.
The project manager will note any wound
healing problems (infection, wound
dehiscence, skin necrosis, visible
osteosynthesis material).
Findings / Results: By the time of the DOS-congress, the
authors are ready to present the preliminary
data, concerning the first 78 patients (50%
of expected)
Conclusions: Awaiting analysis of preliminary data.
167. Characteristics of non-participants in orthopaedic research – A study of patients undergoing ankle fracture surgery and declining participation in a randomized clinical trial
Marianne Aalykke, Erika Wernheden, Bolette Pedersen , Julie Weber Melchior Egholm, Hanne Tønnesen
WHOCC, Clinical Health Promotion Centre, Frederiksberg Hospital; WHOCC, Clinical Health Promotion Centre and Clinical Alcohol Research, Frederiksberg Hospital and Lund University ; WHOCC, Clinical Health Promotion Centre and Orthopedic Surgery, Frederiksberg Hospital and Sygehus Søndejylland ; WHOCC, Clinical Health Promtion Centre and Clinical Alcohol Research, Frederiksberg Hospital and Lund University
Background: Clinical experience indicates that patients
declining participation in randomized clinical
trials (RCTs) are older, less healthy and of
lower social status than participants,
bringing the non-participants in a higher
risk at surgery. Results from studies
investigating non-participants of RCTs in
surgical settings are conflicting, and to our
knowledge none of these studies exist on
patients with risky drinking, who are
already at high risk at surgery.
Purpose / Aim of Study: The aim of this study was to investigate
characteristics and outcomes of patients
undergoing ankle fracture surgery with
risky drinking declining participation in the
Scand-Ankle RCT.
Materials and Methods: The Scand-Ankle study is an on-going
RCT, that investigates the effect of a 6-
week gold standard alcohol intervention
(GSP-A) on postoperative complications in
patients drinking >21 units/week and
undergoing ankle fracture surgery.
This retrospective study included eligible
patients that declined to participate in the
Scand-Ankle RCT, but gave informed
consent to follow-up in their medical record
(N=67). Their perioperative patient
characteristics and 6-week complication
rate were obtained from their medical
record material and the characteristics
were compared to the patients enrolled in
the study so far (N=61).
Findings / Results: The analyses on patient characteristics are
on-going. 34% of the non-participants had
complications, and the most frequent
complication was wound infections.
Conclusions: A complication rate at 34% indicates that
patients drinking > 21 units/week are at
high risk at ankle fracture surgery, and the
analyses on patient characteristics will
show if the non-participants are at even
greater risk.
168. Early Complications of Ankle Fractures Following Treatment with Ilizarov External Fixator or Open Reduction Internal Fixation
Josefin Roslund , Matilda Svenning, Michael Brix, Morten Schultz Larsen
Orthopaedic Surgery, Odense University Hospital
Background: Objective: Open reduction and internal
fixation (ORIF) is the standard surgical
treatment for ankle fractures in Denmark. In
cases of compromised soft tissue, the
Ilizarov external fixator (IEF), might be a
safer alternative when fixation is needed.
Purpose / Aim of Study: The aim of this study is to analyse the short
term complications following treatment of
ankle fractures using IEF or ORIF.
Materials and Methods: Method: The study population consisted of
122 consecutive patients who were
surgically treated for ankle fractures at
Odense University Hospital (OUH) during the
time period 01.05.2012 – 31.04.2013.
Patients were divided into groups based on
surgical treatment method (IEF or ORIF). Pre-
defined outcomes, predisposing factors and
other variables of interest were registered
from medical records and x-rays.
Findings / Results: Results: 23 patients received IEF treatment
and 99 received ORIF. Among the
predisposing factors the variable
“hypertension and/or hyperlipidemia” varied
significantly, occurring more often in the IEF
group, whereas the rest of the predisposing
factors did not. Among the defined
postoperative outcomes secondary loss of
reduction showed a significant higher rate in
the IEF group. Infection and reoperation did
not differ significantly between the groups.
No case of compartment syndrome or
amputation occurred in any of the groups.
Conclusions: Conclusion: Even though the patients in the
IEF group were generally considered to be in
poorer condition prior to operation (higher
age and rate of predisposing factors), the
only outcome that was significantly different
was secondary loss of reduction. This is
consistent with the theory that IEF might be a
good alternative for patients with less
desirable preoperative conditions.
174. Knee Joint Loading Indices Before and 3 Months after Arthroscopic Partial Medial Meniscectomy
Jonas B. Thorlund, Mark W. Creaby, Martin Englund, Nis Nissen, L. Stefan Lohmander, Anders Holsgaard-Larsen
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; , Australian Catholic University, Brisbane, Australia; Department of Orthopedics, Lillebaelt Hospital, Kolding; Department of Clinical Science and Department of Orthopedics and Traumatology, University of Southern Denmark and Odense University Hospital
Background: Increased knee adduction moment (KAM) is
considered an important biomechanical
marker of medial compartment loading in
knee osteoarthritis (OA) research.
Patients undergoing arthroscopic partial
medial meniscectomy (APMM) are at
increased risk of developing medial
compartment knee OA. APMM may contribute
to altered knee joint loading patterns.
However, this is currently unknown.
Purpose / Aim of Study: The aim of this study was to determine
the short-term changes in knee joint
loading indices from before to after
medial APMM.
Materials and Methods: We investigated indices of knee joint
loading (peak KAM and KAM impulse) using
3D gait analysis in 23 middle-aged
patients (17 men, 46.3 yrs (SD 6.4), BMI
25.8 kg/m2 (3.4) before and 3 months
after APMM for a degenerative tear.
Patients had no radiographic knee OA
(i.e. Kellgren & Lawrence grade 0 or 1)
in the leg undergoing APMM or in their
uninjured control leg prior to surgery.
Data were collected during barefoot gait
at self-selected walking speed (± 5% at
follow-up). Paired t-tests were used to
test for differences at baseline and
differences in change over time between
operated and control legs.
Findings / Results: No differences were observed between the
operated and uninjured control leg in
peak KAM (p=0.42) or KAM impulse
(p=0.14) before APMM. No difference in
change from before to 3 months after
APMM were observed between operated and
uninjured control legs in peak KAM (0.17
[95% CI, -0.13-0.49] Nm/BW*HT%), whereas
a border line significant increase was
observed in the APMM leg in KAM impulse
(0.09 [95% CI, -0.01-0.19] Nms/BW*HT%).
Conclusions: Knee joint loading indices - as
indicated by the KAM - do not appear to
substantially increase in the operated
leg compared with the uninjured control
leg from before to 3 months after APMM
in middle-aged patients with
degenerative meniscal tears.
177. Outcome and risk of revision after shoulder replacement in patients with osteoarthritis: 1,209 cases from the Danish Shoulder Arthroplasty Registry
Rasmussen Jeppe, Anne Polk, Anne Kathrine Belling Sørensen, Bo Sanderhoff Olsen, Stig Brorson
Orthopaedic Surgery, Herlev Hospital
Background: Hemiarthroplasty (HA) including
resurfacing hemiarthroplasty (RHA) and
stemmed hemiarthroplasty (SHA)are
widely used in Denmark but the efficacy
in comparison to that of total shoulder
replacement (TSA) is poorly documented.
Purpose / Aim of Study: In this study we used patient reported
outcome and risk of revision to compare
HA and TSA in patients diagnosed with
osteoarthritis and secondly to compare
SHA and RHA.
Materials and Methods: We included all patients reported to the
Danish Shoulder arthroplasty registry
(DSR) between January 2006 and
December 2010. 1209 arthroplasties in
1109 patients were eligible. Western
Ontario Osteoarthritis of the Shoulder
index (WOOS) was used to evaluate
patient reported outcome 1 year
postoperatively. For simplicity of
presentation, the raw scores were
converted to a percentage of a maximum
score. Revision rates were calculated
by checking reported revisions to DSR
until December 2011. WOOS and risk of
revision were adjusted for age, gender,
previous surgery and type of
osteoarthritis.
Findings / Results: There were 113 TSA and 1096 HA (837
RHA and 259 SHA). Patients treated
with TSA had a statistically better
WOOS, exceeding the predefined
minimal clinically important difference, at
one year (mean difference 10, P<0.001).
RHA had a statistically significant better
WOOS compared to SHA (mean
difference 5, P=0.024) but the difference
did not exceed the minimal clinically
important difference. There were no
statistically significant differences in
revision rate or adjusted risk of revision
between any groups.
Conclusions: Our results are in accordance with the
results from other national shoulder
registries and the results published in
systematic reviews favoring TSA in the
treatment of osteoarthritis.
181. Biomechanical symmetry of a hip joint altered by Perthes’ disease
Remel Salmingo, Tina Skytte, Marie Sand Traberg, Kaj-Åge Henneberg , Klaus Hindsø, Christian Wong
Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark; Department of Orthopaedics, Hvidovre Hosptial
Background: Perthes is a disease characterized by a
loss of blood supply of the hip joint
resulting to malformation of the femoral
head. Until now, the underlying
biomechanical changes of Perthes’
disease need to be further elucidated.
Purpose / Aim of Study: The objective of this study was to
investigate the changes specifically the
biomechanical symmetry of a unilateral
Perthes’ hip.
Materials and Methods: Finite Element (FE) modeling was
performed to investigate the
biomechanics of a healthy and
diseased hip of a unilateral Perthes’
case. The image MRI slices were
obtained to segment the bones and
cartilages, and to build the 3D
models. The elastic modulus for the
pelvis, femur, cartilages and necrotic
bone (Perthes’ hip only) were, 5 GPa,
500 MPa, 50 MPa, 20 MPa,
respectively. The most distal part of
the femur was fixed while the pelvis
was displaced to -1.5 mm to simulate
load.
Findings / Results: The result indicates that the symmetry of
the hip joint of the unilateral Perthes’
case was altered biomechanically. The
highest displacement of the healthy hip
occurred at the supero-medial side of
the femoral head. On the other hand, in
Perthes’ hip, the displacement occurred
at the superior part of the femoral head
and gradually reduced towards the distal
part of the femur. Localized contact
pressure and stresses were also found
in the Perthes’ hip.
Conclusions: As a mechanical analogy, the healthy
hip is experiencing bending load
similar to a curved-cantilever beam
where the maximum displacement is
located at the end. The Perthes’ hip
resembles a stacked column structure
where the load is transmitted through
compression. This indicates an
aggravation of Perthes’ disease
because bone overloading by
compression around the proximal part
might occur. The FE method
developed in this study can be used
to estimate the prognosis of the
Perthes' disease.
184. The EOS imaging system: Workflow and radiation dose in scoliosis examinations
Bo Mussmann, Stig Jespersen, Trine Torfing
Department of Radiology, Odense University Hospital; Department of Orthopedic Surgery, Odense University Hospital
Background: The EOS imaging system is a biplane slot
beam scanner capable of full body scans
at low radiation dose and without
geometrical distortion. It was
implemented in our department primo 2012
and all scoliosis examinations are now
performed in EOS. The system offers
improved possibility to measure rotation
of individual vertebrae and vertebral
curves can be assessed in 3D. Leg length
Discrepancy measurements are performed
in one exposure without geometrical
distortion and no stitching. Full body
scans for sagittal balance are also
performed with the equipment after spine
surgery.
Purpose
Purpose / Aim of Study: The purpose of the study was to evaluate
workflow defined as scheduled time pr.
examination and radiation dose in
scoliosis examinations in EOS compared
to conventional x-ray evaluation.
Materials and Methods: The Dose Area Product (DAP) was measured
with a dosimeter and a comparison
between conventional X-ray and EOS was made.
The Workflow in 2011 was compared to the
workflow in 2013 with regards to the
total number of examinations and the
scheduled examination time for scoliosis
examinations.
Findings / Results: DAP for a scoliosis examination in
conventional X-ray was 185 mGy*cm2 and
60.36 mGy*cm2 for EOS.
The scheduled time for scoliosis was 15
minutes in conventional X-ray which
remained unchanged after implementation
of EOS.
The number of scoliosis examinations has
increased from 396 to 1.145 since the
implementation.
Conclusions: The radiation dose for a scoliosis
examination in EOS can be reduced to
approximately 30 % of the radiation dose
in conventional X-ray.
The increased number of scoliosis
examinations is related to increased
referral and not due to optimized workflow.
185. Stand-alone XLIF; 22 Consecutive patients with degenerative scoliosis and foraminal stenosis a 2 year follow-up
Emil Hansen
Sector for Spine surgery and Research, Middelfart Hospital
Background: The extreme lateral approach to the
intervertebral spaces in the lumbar and
thoracic spine is a procedure developed
to allow a larger footprint cage to be
inserted when performing
spondylodesis. In the litterature not many
studies have been made to investigate
the role of the cage as a stand-alone
option for degenerative scoliosis. While
the patients often are fragile and with
poor bone quality, a single surgical
option, preserving the posterior
structures, could be beneficial.
Purpose / Aim of Study: The purpose of the study is to evaluate the
complication rate and clinical/radiological
results in DS patients undergoing
spondylodesis with a XLIF stand-alone
procedure
Materials and Methods: 22 consecutive patients with DS, underwent
surgery with the XLIF stand-alone
procedure, follow-up 24 months. Validated
clinical outcome scores were collected
preoperatively, at 1 and 2 years.
Complications were recorded.
Findings / Results: 22 patients with a mean age of 65 (48-81)
underwent surgery on 49 levels (1-4)
between L1-L5. Visual Analog scores for
leg pain improved from 59,4-34,9 (P<0,05)
and back pain from 59,1-36,8 (P<0,05).
EQ5D scores improved from 0,29-0,62
(P<0,05). 7 patients (31,8 %) underwent
revision surgery. Osseous fusion was
obtained in 53% of the treated levels at 1
year. Anterior thigh pain was recorded in 12
patients postoperatively but only 2 had
consistent sypmtoms at 1 year follow-up.
Conclusions: The XLIF stand-alone procedure is a
relatively safe procedure compared with
other surgical alternatives as ALIF and PLIF.
Our results show a significant improvement
in clinical outcome scores during 2 year
follow-up. Stand alone XLIF should only be
advised for single-level and only mild
deformity. In most cases we recommend
posterior instrumentation.
186. Early surgical stabilization of rib fractures using a minimally invasive procedure: a pilot study
Kiran Anderson, Jesper RAvn, Henrik Eckardt
Ortopædkir. afd. , Rigshosptialet; Thoraxkir. afd. , Rigshosptialet; Ortopædkir. afd., Rigshospitalet
Background: In spite of considerable development in
surgical fracture treatment, most
patients with rib fractures are still
treated non-operatively, although the
respiratory consequences of rib
fractures may have severe impact on
the prognosis after severe trauma.
Recently, a number of studies have
suggested that a more active approach
may decrease the number of days on
ventilation as well as reducing long-term
pain in these patients.
Purpose / Aim of Study: The purpose of the present study was
to report our initial experience with early
surgical stabilization using a minimal
invasive procedure of open reduction
and internal fixation of multiple rib
fractures.
Materials and Methods: 12 consecutive patients received in our
level 1-traumacenter with one of the
following inclusion criterias were
operated: flail chest with at least two rib
fractures on two adjacent ribs or four
adjacent dislocated rib fractures. The
basic principles were: A. No
osteosyntesis of costa # 1, 2 or 3.
B. Operative fixation of only dislocated
ribs. In ribs with multiple fractures only
one fracture was stabilized. C. Small
incisions with minimal dissection of
muscle tissue.
Findings / Results: None of the patients had postoperative
infections, seromas or wound problems.
Skin incisions were 10-15 cm. The
average number of costae fixated was
3. Postoperation time in ICU averaged 2,8
days. Postoperative number of days on
assisted ventilation averaged 1,16 days.
Total number of admission days
postoperatively averaged 9,6 days.
Lung function at 3 month was equal to
background population.
Conclusions: Rib fracture stabilization is a safe
procedure that can be performed with
small incisions, without transection of
muscles and with low morbidity. The
intraoperative impression is that
operative fixation provide sufficient
stabilization for unstable chestwalls and
provides a normal lung function.
192. Ewings´sarcoma of the calcaneus treated by limb sparing surgery with calcanectomy and reconstruction with a composite of an allograft and a vascularised osteocutaneous fibula graft.
Werner Hettwer, Lisa Toft Jensen, Michael Mørk Petersen
Musculoskeletal Tumor Section, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen; Department of Plastic Surgery, Rigshospitalet, University of Copenhagen
Background: Primary malignant bone tumours of the
calcaneus are very seldom. Due to poor
possibilities to do surgery with wide margins in
this region and limited options for
reconstruction after calcanectomy many
orthopaedic oncologists use amputation as the
preferred surgical treatment.
Purpose / Aim of Study: We present two cases of Ewings´sarcoma of
the calcaneus treated with limb sparing
calcanectomy and reconstruction with a
composite of an allograft and a vascularised
osteocutaneous fibula graft.
Materials and Methods: Case 1: a girl, almost 6 years old at the time
of calcanectomy of the left calcaneous
August 7th 2012. Case 2: a girl 16 years
old at the time of right calcanectomy
October 16th 2013.
Both patients received pre- and post-
operative chemotherapy because of Ewings
´sarcoma. In both cases removal of the
calcaneus was performed using a
combined medial and lateral incision. In
case 1 a femoral head allograft was fitted to
replace the removed calcaneus, and in
case 2 a calcaneus allograft was used. In
both cases, with the aim of obtaining
arthrodesis, the allograft was fixed to the
talus and cuboid bone with Acutrak titanium
screws. A distally pedicled osteocutaneous
flap was used for reconstruction of soft
tissue, and a 5-6 cm piece of vascularised
fibula bone was fitted into the allograft and
fixed using staples.
Findings / Results: Case 1 was allowed weight-bearing in an
ankle brace after 3½ months and full weight-
bearing with-out brace 8 months
postoperatively, when the arthrodesis between
allograft and talus was considered healed.
Case 2 was allowed increasing weight-bearing
in a ROM walker 7 months postoperatively,
when the arthrodesis between allograft and
talus was considered healed.
Conclusions: Limb sparing calcanectomy was feasible with
reconstruction using a composite of an
allograft and a vascularised osteocutaneous
fibula graft.