Session 2: Traume I
Ondag den 21. oktober
09:00 – 10:30
Lokale: Stockholm/Copenhagen
Chairmen: Ilija Ban / Bjarke Viberg
Ciea Grønlund, Thomas Sandholdt Andreasen, Line Hernæs Husby, Morten Schultz Larsen, Michael Brix
Ortopædkirurgisk Afdeling O, University Hospital of Odense
Background: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures (DFNF) in elderly patients (>70 years). The use of uncemented stems remains controversial. Few studies report data about the setting in which the results is achieved.
Purpose / Aim of Study: Our outcome is overall reoperation rate and the rate of major complications; deep infections, periprosthetic fractures, dislocations, hip pain or loosening of the implant. We describe the setting in which the results have been achieved, and whether surgical treatment was according to the standard treatment algorithm for the department.
Materials and Methods: A retrospective study including all consecutive patients who had sustained DFNF and had been operated with an uncemented hydroxyapatite coated hemiarthroplasty (Corail, Depuy) from 2009-1-1 to 2012-31-12 at OUH. Patients were identified using the nationwide patient record system. Data was extracted from patient records. X-rays were examined by a younger doctor and a senior consultant.
Findings / Results: 318 patients, median age 83 years. Standard treatment algorithm was followed in all cases. A minor fracture occurred during surgery in 6 cases. 1 patient died within 48 hours after surgery. The rate of complications leading to reoperation was: Dislocation; 3,1%, deep infection; 2,2%, periprosthetic fracture; 5,0%, hip pain; 0,9%, stem loosening; 0%. Reoperation rate didn’t differed even though more than 90 surgeons performed the surgeries, 213 by younger doctors, 105 by an attendant or above.
Conclusions: We find reoperation rates acceptable and comparable to other studies. Stem loosening seems to be non-existing. It seems safe that the surgeries are performed by younger doctors under supervision. Forward focus should not only be on cemented vs. uncemented stems, but also on the setting in which the surgeries are being performed.
Ortopædkirurgisk Afdeling O, University Hospital of Odense
Background: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures (DFNF) in elderly patients (>70 years). The use of uncemented stems remains controversial. Few studies report data about the setting in which the results is achieved.
Purpose / Aim of Study: Our outcome is overall reoperation rate and the rate of major complications; deep infections, periprosthetic fractures, dislocations, hip pain or loosening of the implant. We describe the setting in which the results have been achieved, and whether surgical treatment was according to the standard treatment algorithm for the department.
Materials and Methods: A retrospective study including all consecutive patients who had sustained DFNF and had been operated with an uncemented hydroxyapatite coated hemiarthroplasty (Corail, Depuy) from 2009-1-1 to 2012-31-12 at OUH. Patients were identified using the nationwide patient record system. Data was extracted from patient records. X-rays were examined by a younger doctor and a senior consultant.
Findings / Results: 318 patients, median age 83 years. Standard treatment algorithm was followed in all cases. A minor fracture occurred during surgery in 6 cases. 1 patient died within 48 hours after surgery. The rate of complications leading to reoperation was: Dislocation; 3,1%, deep infection; 2,2%, periprosthetic fracture; 5,0%, hip pain; 0,9%, stem loosening; 0%. Reoperation rate didn’t differed even though more than 90 surgeons performed the surgeries, 213 by younger doctors, 105 by an attendant or above.
Conclusions: We find reoperation rates acceptable and comparable to other studies. Stem loosening seems to be non-existing. It seems safe that the surgeries are performed by younger doctors under supervision. Forward focus should not only be on cemented vs. uncemented stems, but also on the setting in which the surgeries are being performed.
David Lunde Hatfield, Mohammed Sherif, Peter Kraglund, Morten Schultz Larsen, Michael Brix
Dept. of Orthopaedics and Traumatology, Odense University Hospital, Syddansk Universitet; Orthopaedic surgery, Odense University Hospital, Denmark
Background: Current standard treatment of tibia fractures involves a high rate of unwanted complications and non-unions. Therapy with ASLS is introduced later and is now widely used in Denmark. At present time there is little published clinical clinical data in the relevant literature. Several biomechanical studies have been carried out showing positive results and capacities of the ASLS.
Purpose / Aim of Study: The aim of the study was to present early and mid-term clinical results of intramedullary nailing combined with angular stable locking system (ASLS) in distal and diaphyseal tibial fractures. The study was done with these following core parameters: Time to healing, union rate, secondary loss of reduction as well as rate and causes of reoperation
Materials and Methods: A consecutive series of 107 patients with distal tibialfractures were treated with Synthes Expert Tibial Nail combined with ASLS between September 2009 and June 2014. All fracture types AO42 and AO43 were included except AO43 B2,B3 and C3. One patient was lost to follow up. The patients were followed up postoperatively with radiographs and clinical control every 6 weeks until healing.
Findings / Results: We found a union rate of 100% with an average of 5,1 months to healing and a low rate of complications. In particular, a low rate of infection (one patient) was found. No patients had non-union. 37 patients were re-operated; 34 patients because of hardware removal and three patients because of major complications.
Conclusions: Intramedullary nailing combined with ASLS in distal tibial fracture provides a high rate of union and low rate of major complications. This suggests that the treatment is safe and capable of achieving favourable clinical results.
Dept. of Orthopaedics and Traumatology, Odense University Hospital, Syddansk Universitet; Orthopaedic surgery, Odense University Hospital, Denmark
Background: Current standard treatment of tibia fractures involves a high rate of unwanted complications and non-unions. Therapy with ASLS is introduced later and is now widely used in Denmark. At present time there is little published clinical clinical data in the relevant literature. Several biomechanical studies have been carried out showing positive results and capacities of the ASLS.
Purpose / Aim of Study: The aim of the study was to present early and mid-term clinical results of intramedullary nailing combined with angular stable locking system (ASLS) in distal and diaphyseal tibial fractures. The study was done with these following core parameters: Time to healing, union rate, secondary loss of reduction as well as rate and causes of reoperation
Materials and Methods: A consecutive series of 107 patients with distal tibialfractures were treated with Synthes Expert Tibial Nail combined with ASLS between September 2009 and June 2014. All fracture types AO42 and AO43 were included except AO43 B2,B3 and C3. One patient was lost to follow up. The patients were followed up postoperatively with radiographs and clinical control every 6 weeks until healing.
Findings / Results: We found a union rate of 100% with an average of 5,1 months to healing and a low rate of complications. In particular, a low rate of infection (one patient) was found. No patients had non-union. 37 patients were re-operated; 34 patients because of hardware removal and three patients because of major complications.
Conclusions: Intramedullary nailing combined with ASLS in distal tibial fracture provides a high rate of union and low rate of major complications. This suggests that the treatment is safe and capable of achieving favourable clinical results.
Ilija Ban, Anders Troelsen, Morten Tange Kristensen
Orthopaedics and Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre; Physical Medicine and Rehabilitation Research –Copenhagen (PMR-C), Dept. of Physiotherapy, Copenhagen University Hospital Hvidovre
Background: Despite being a frequent injury, the optimal treatment of clavicle fractures is still debatable. Constant score (CS, 0-100 points) has been the primary endpoint in all recent randomized studies concerning clavicle fractures. However, CS was not developed to asses patients with clavicle fractures and the psychometric properties (reliability, validity and responsiveness) have not been evaluated on these patients
Purpose / Aim of Study: To examine the interrater reliability, agreement and internal consistency of the Danish version of CS on patients with a clavicle fracture
Materials and Methods: Based on sample size, 34 patients (29 males, mean age 41.3 years) with clavicle fractures (2 medial, 21 midshaft and 11 lateral) had standardized CS assessment done by two independent and experienced raters, 5-8 weeks following injury. Interrater reliability and agreement of the overall CS was determined . The interclass correlation coefficient (ICC2.1), standard error of measurement (SEM), minimal detectable change (MDC) and Cronbach´s Alpha coefficient were used to evaluate data
Findings / Results: The interrater reliability of the total CS in patients with clavicle fractures was excellent (ICC=0.94; 95%CI 0.88-0.97) and with no systematic difference between the two raters (p=0.75). The SEM, representing the measurement error on group level, was 4.94, while the MDC; the smallest change needed to indicate a real change for an individual patient was 13.69. Internal consistency of the 10 CS items was good as Cronbach´s Alpha was 0.85
Conclusions: The CS is a reliable tool when assessing patients with clavicle fractures and with a small measurement error at a group level. The responsiveness and whether the CS results reflect the functional deficit of patients with clavicle fractures when evaluated with other outcome measures is still unknown
Orthopaedics and Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre; Physical Medicine and Rehabilitation Research –Copenhagen (PMR-C), Dept. of Physiotherapy, Copenhagen University Hospital Hvidovre
Background: Despite being a frequent injury, the optimal treatment of clavicle fractures is still debatable. Constant score (CS, 0-100 points) has been the primary endpoint in all recent randomized studies concerning clavicle fractures. However, CS was not developed to asses patients with clavicle fractures and the psychometric properties (reliability, validity and responsiveness) have not been evaluated on these patients
Purpose / Aim of Study: To examine the interrater reliability, agreement and internal consistency of the Danish version of CS on patients with a clavicle fracture
Materials and Methods: Based on sample size, 34 patients (29 males, mean age 41.3 years) with clavicle fractures (2 medial, 21 midshaft and 11 lateral) had standardized CS assessment done by two independent and experienced raters, 5-8 weeks following injury. Interrater reliability and agreement of the overall CS was determined . The interclass correlation coefficient (ICC2.1), standard error of measurement (SEM), minimal detectable change (MDC) and Cronbach´s Alpha coefficient were used to evaluate data
Findings / Results: The interrater reliability of the total CS in patients with clavicle fractures was excellent (ICC=0.94; 95%CI 0.88-0.97) and with no systematic difference between the two raters (p=0.75). The SEM, representing the measurement error on group level, was 4.94, while the MDC; the smallest change needed to indicate a real change for an individual patient was 13.69. Internal consistency of the 10 CS items was good as Cronbach´s Alpha was 0.85
Conclusions: The CS is a reliable tool when assessing patients with clavicle fractures and with a small measurement error at a group level. The responsiveness and whether the CS results reflect the functional deficit of patients with clavicle fractures when evaluated with other outcome measures is still unknown
Jesper Stork-Hansen, Tamim Ahmad Haidari, Roland Knudsen, Rune Dueholm Bech, Bjarke Viberg
Dept. of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Classification of malleolar fracture is important when deciding for surgical or conservatively treatment, and the literature have provided several classification systems concerning the stability of the fracture.
Purpose / Aim of Study: To assess the reproducibility of malleolar fracture in Lauge-Hansen (LH), AO/Weber (AO), ankle stability assessment (SA) and operative decision (OD) in adult patients with primary malleolar fractures.
Materials and Methods: A historical cohort was retrieved from the county database using ICD10 diagnoses for malleolar fractures (DS824-DS828). The study period was 01/01/2010 to 01/08/2011 in order to reach the calculated sample size (489). 692 patients x-ray images were reviewed for inclusion and the final cohort consisted of 496 malleolar fractures. The included x-ray images were reviewed 2 times with minimum 14 days interval by 2 medical students, 2 residents and 1 consultant in orthopaedic traumatology. All x-ray images were measured independently and any patient identifiers were removed. The raters were blinded to each other and own results. Unweighted kappa statistics were used to assess reproducibility.
Findings / Results: Overall mean (95 % confidence interval – CI) interrater kappa results for the classifications systems were 0.65 (0.64;0.68) for LH, 0.62 (0.60;0.63) for AO, 0.61 (0.57;0.62) for SA, and 0.70 (0.68;0.72) for OD. The intrarater results ranged from a mean kappa of 0.64-0.80 for the medical students, 0.65-0.81 for the residents, and 0.82-0.84 for the consultant.
Conclusions: There do not seem to be any difference in the reproducibility of any of the classification systems, stability assessment or operative decision.
Dept. of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background: Classification of malleolar fracture is important when deciding for surgical or conservatively treatment, and the literature have provided several classification systems concerning the stability of the fracture.
Purpose / Aim of Study: To assess the reproducibility of malleolar fracture in Lauge-Hansen (LH), AO/Weber (AO), ankle stability assessment (SA) and operative decision (OD) in adult patients with primary malleolar fractures.
Materials and Methods: A historical cohort was retrieved from the county database using ICD10 diagnoses for malleolar fractures (DS824-DS828). The study period was 01/01/2010 to 01/08/2011 in order to reach the calculated sample size (489). 692 patients x-ray images were reviewed for inclusion and the final cohort consisted of 496 malleolar fractures. The included x-ray images were reviewed 2 times with minimum 14 days interval by 2 medical students, 2 residents and 1 consultant in orthopaedic traumatology. All x-ray images were measured independently and any patient identifiers were removed. The raters were blinded to each other and own results. Unweighted kappa statistics were used to assess reproducibility.
Findings / Results: Overall mean (95 % confidence interval – CI) interrater kappa results for the classifications systems were 0.65 (0.64;0.68) for LH, 0.62 (0.60;0.63) for AO, 0.61 (0.57;0.62) for SA, and 0.70 (0.68;0.72) for OD. The intrarater results ranged from a mean kappa of 0.64-0.80 for the medical students, 0.65-0.81 for the residents, and 0.82-0.84 for the consultant.
Conclusions: There do not seem to be any difference in the reproducibility of any of the classification systems, stability assessment or operative decision.
Kristine Bollerup Arndt, Anders Jordy, Bjarke Viberg
The department of Orthopaedic Surgery, Lillebaelt Hospital Kolding
Background: Surgery of malleolar fractures are often delayed due to oedema of the ankle. The use of intermittent pneumatic compression (IPC) is thought to reduce oedema of the fracture site and thereby time to surgery in patients with internal fixated malleolar fractures.
Purpose / Aim of Study: To investigate the influence of IPC on time from admission to surgery in adult patients with acute primary malleolar fractures treated with open reduction and internal fixation.
Materials and Methods: February 1st 2013 IPC was introduced as a standard procedure for all patients admitted with a malleolar fracture. Data was retrieved from the county database 2 years prior and after the introduction date. The search was based on a combination of ICD10 diagnoses and procedure codes (DS826-8 and NHJ60-61). The groups were statistically compared using Wilcoxon signed rank test.
Findings / Results: 195 patients were included, 82 with IPC and 113 without IPC treatment. There were 104 female and 91 male with a median age (interquartile range – IQR) of 53.5 (39.7-64.5). Time to surgery was median (IQR) 20.5 hours (7.5-41.6) with IPC treatment and 24.6 hours (10.8-46.9) without IPC treatment. There were no statistically difference between the two groups (p<0.117).
Conclusions: There does not seem to be any benefit from IPC on time to surgery in patients with acute primary malleolar fracture.
The department of Orthopaedic Surgery, Lillebaelt Hospital Kolding
Background: Surgery of malleolar fractures are often delayed due to oedema of the ankle. The use of intermittent pneumatic compression (IPC) is thought to reduce oedema of the fracture site and thereby time to surgery in patients with internal fixated malleolar fractures.
Purpose / Aim of Study: To investigate the influence of IPC on time from admission to surgery in adult patients with acute primary malleolar fractures treated with open reduction and internal fixation.
Materials and Methods: February 1st 2013 IPC was introduced as a standard procedure for all patients admitted with a malleolar fracture. Data was retrieved from the county database 2 years prior and after the introduction date. The search was based on a combination of ICD10 diagnoses and procedure codes (DS826-8 and NHJ60-61). The groups were statistically compared using Wilcoxon signed rank test.
Findings / Results: 195 patients were included, 82 with IPC and 113 without IPC treatment. There were 104 female and 91 male with a median age (interquartile range – IQR) of 53.5 (39.7-64.5). Time to surgery was median (IQR) 20.5 hours (7.5-41.6) with IPC treatment and 24.6 hours (10.8-46.9) without IPC treatment. There were no statistically difference between the two groups (p<0.117).
Conclusions: There does not seem to be any benefit from IPC on time to surgery in patients with acute primary malleolar fracture.
Lisa Lethan, Henrik Palm, Nicolai Bang Foss, Thomas Kallemose, Anders Troelsen, Peter Tengberg
Ortopædkirurgisk Afdeling, Copenhagen University Hospital Hvidovre
Background: Hip fractures and the surgery that follows is known to cause a large blood loss that in turn causes anaemia and the need for transfusions. To our knowledge it has not been established whether surgical blood loss within the normal range has any impact on mortality after hip fracture surgery.
Purpose / Aim of Study: To investigate whether surgical blood loss, total blood loss and red blood cell transfusion has an impact on mortality.
Materials and Methods: Retrospectively review of all patients who were admitted and subsequent operated at our institution for an extra- capsular fracture of the hip using a short intramedullary nail between 1st of January 2011 to 31st of December 2013. Primary endpoint was mortality related to Surgical Blood Loss (SBL). Secondary outcomes were mortality related to Total Blood Loss (TBL), Red Blood Cell (RBC) transfusions and Massive transfusions (MT).
Findings / Results: We identified 320 patients operated using an IMN. The mean SBL for all patients was 235 mL (20-2200 mL) and the mean TBL was 2006 mL (213-7615 mL). A logistic regression analysis was performed on 30-day and 90-day mortality in relation to SBL, TBL and units of RBC transfusions. All associations were insignificant except for the association between units of RBC transfusions and increased 90-day mortality. It showed that there was significant increased risk of death within 90 days of 15% per transfused unit (OR 1,152, CI = 1,002:1,325, p = 0,048).
Conclusions: our study has proven no significant relationship between greater SBL or TBL and mortality within a normal range of blood losses. We did find a 15 % elevation in 90-day mortality risk for every RBC transfusion. The study design did not allow us to make any conclusions whether this was a result of the transfusion itself or from the patient being in the physiological state of needing a transfusion (PANT).
Ortopædkirurgisk Afdeling, Copenhagen University Hospital Hvidovre
Background: Hip fractures and the surgery that follows is known to cause a large blood loss that in turn causes anaemia and the need for transfusions. To our knowledge it has not been established whether surgical blood loss within the normal range has any impact on mortality after hip fracture surgery.
Purpose / Aim of Study: To investigate whether surgical blood loss, total blood loss and red blood cell transfusion has an impact on mortality.
Materials and Methods: Retrospectively review of all patients who were admitted and subsequent operated at our institution for an extra- capsular fracture of the hip using a short intramedullary nail between 1st of January 2011 to 31st of December 2013. Primary endpoint was mortality related to Surgical Blood Loss (SBL). Secondary outcomes were mortality related to Total Blood Loss (TBL), Red Blood Cell (RBC) transfusions and Massive transfusions (MT).
Findings / Results: We identified 320 patients operated using an IMN. The mean SBL for all patients was 235 mL (20-2200 mL) and the mean TBL was 2006 mL (213-7615 mL). A logistic regression analysis was performed on 30-day and 90-day mortality in relation to SBL, TBL and units of RBC transfusions. All associations were insignificant except for the association between units of RBC transfusions and increased 90-day mortality. It showed that there was significant increased risk of death within 90 days of 15% per transfused unit (OR 1,152, CI = 1,002:1,325, p = 0,048).
Conclusions: our study has proven no significant relationship between greater SBL or TBL and mortality within a normal range of blood losses. We did find a 15 % elevation in 90-day mortality risk for every RBC transfusion. The study design did not allow us to make any conclusions whether this was a result of the transfusion itself or from the patient being in the physiological state of needing a transfusion (PANT).
Lotte Gerholt, Haider Karim Abd-El-Redda, Anna Gaki Lindestrand, Kasper Gosvig, Ilija Ban, Henrik Palm
Hip Fracture Unit, Department of Orthopaedic Surgery , Copenhagen University Hospital Hvidovre; Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre; Hip Fracture Unit, Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre
Background: Posterior tilt in Garden I-II femoral neck fractures is debated as a predictor of reoperations following osteosynthesis. We hypothesized that a new method first published in 2009, based on angulation measurement between the outer cortex-surfaces of the femoral head sphere and neck cylinder, would be more reliable than the eye-estimation or trabecular- angulation previously used in literature.
Purpose / Aim of Study: To examine the reliability of these three different methods.
Materials and Methods: All 51 consecutive patients with a Garden I-II femoral neck fracture admitted to our institution in 2013 were retrospectively included. Preoperative axial radiographs were used to assess posterior tilt by the three different methods. Assessments were performed twice minimum 8 weeks apart, by 5 doctors with varying charge, given 5 radiographs of training. Radiographs were randomly shuffled and type of operation blinded. SPSS statistical software was used to calculate Pearson correlation coefficient (PCC) between methods and inter- and intraclass correlation coefficients (ICC) between observers.
Findings / Results: The 51 assessments took mean 17 minutes (range 9-30) by use of eye-estimation, 28 min (12-50) by trabecular-angulation and 120 (57-183) min by the new cortex-surface method. The mean PCC for same observer using the new cortex-surface method versus the eye-estimation and trabecular- angulation was 0.77 (range 0.67-0.87) and 0.76 (0.72-0.85) respectively, compared to 0.86 (0.71- 0.93) between the latter two. The mean inter- and intra-observer ICC’s were 0.77 (range 0.66–0.85) and 0.90 (0.78–0.95) for eye-estimation, 0.77 (0.63– 0.88) and 0.91 (0.84–0.96) for trabecular-angulation and 0.88 (0.78–0.95) and 0.92 (0.89–0.97) for the new cortex-surface method.
Conclusions: This new cortex-surface method is time-consuming, but appears to be more reliable.
Hip Fracture Unit, Department of Orthopaedic Surgery , Copenhagen University Hospital Hvidovre; Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre; Hip Fracture Unit, Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre
Background: Posterior tilt in Garden I-II femoral neck fractures is debated as a predictor of reoperations following osteosynthesis. We hypothesized that a new method first published in 2009, based on angulation measurement between the outer cortex-surfaces of the femoral head sphere and neck cylinder, would be more reliable than the eye-estimation or trabecular- angulation previously used in literature.
Purpose / Aim of Study: To examine the reliability of these three different methods.
Materials and Methods: All 51 consecutive patients with a Garden I-II femoral neck fracture admitted to our institution in 2013 were retrospectively included. Preoperative axial radiographs were used to assess posterior tilt by the three different methods. Assessments were performed twice minimum 8 weeks apart, by 5 doctors with varying charge, given 5 radiographs of training. Radiographs were randomly shuffled and type of operation blinded. SPSS statistical software was used to calculate Pearson correlation coefficient (PCC) between methods and inter- and intraclass correlation coefficients (ICC) between observers.
Findings / Results: The 51 assessments took mean 17 minutes (range 9-30) by use of eye-estimation, 28 min (12-50) by trabecular-angulation and 120 (57-183) min by the new cortex-surface method. The mean PCC for same observer using the new cortex-surface method versus the eye-estimation and trabecular- angulation was 0.77 (range 0.67-0.87) and 0.76 (0.72-0.85) respectively, compared to 0.86 (0.71- 0.93) between the latter two. The mean inter- and intra-observer ICC’s were 0.77 (range 0.66–0.85) and 0.90 (0.78–0.95) for eye-estimation, 0.77 (0.63– 0.88) and 0.91 (0.84–0.96) for trabecular-angulation and 0.88 (0.78–0.95) and 0.92 (0.89–0.97) for the new cortex-surface method.
Conclusions: This new cortex-surface method is time-consuming, but appears to be more reliable.
Mads Terndrup, Thomas Giver Jensen, Søren Kring, Martin Lindberg-Larsen
Department of Orthopaedic Surgery, Bispebjerg Hospital
Background: Burying of K-wires after metacarpal and phalangeal fracture osteosynthesis may reduce risk of infection, but it might also complicate later removal.
Purpose / Aim of Study: To examine infection and reoperation rates after metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires.
Materials and Methods: 597 metacarpal and phalangeal fractures treated with K-wire osteosynthesis at Bispebjerg Hospital from 1st of January 2009 to 1st of February 2015 were identified retrospectively. Excluded were cases requiring simultaneous osteosynthesis of other fractures, Ishiguro procedures, cases with K- wire removal in other hospitals and cases where it could not be identified whether K-wires were buried or not. The final study population included 444 procedures in 331 metacarpal, 109 phalangeal and 4 mixed fractures. In all cases surgical and patient records ¡Ü90 days postoperatively were examined.
Findings / Results: The K-wires were buried in 337 (75.9%) cases and exposed in 107 (24.1%). A total of 14 (4.0%) cases with buried K-wires presented with later superficial infection versus 7 (6,5%) in cases with exposed K-wires (p=0.311). Overall, none of these infections caused re-operation. In 58 cases (17.2%) buried K-wire removal was not possible in the outpatient clinic and required readmission for removal in the operation theatre. All exposed K-wires could be removed without re-operation.
Conclusions: There was no significant difference in postoperative infection rate between metacarpal and phalangeal osteosynthesis with buried versus exposed k-wires. However, burying lead to unplanned re-operations for K- wire removal in 17.2% calling for reconsideration of surgical strategies.
Department of Orthopaedic Surgery, Bispebjerg Hospital
Background: Burying of K-wires after metacarpal and phalangeal fracture osteosynthesis may reduce risk of infection, but it might also complicate later removal.
Purpose / Aim of Study: To examine infection and reoperation rates after metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires.
Materials and Methods: 597 metacarpal and phalangeal fractures treated with K-wire osteosynthesis at Bispebjerg Hospital from 1st of January 2009 to 1st of February 2015 were identified retrospectively. Excluded were cases requiring simultaneous osteosynthesis of other fractures, Ishiguro procedures, cases with K- wire removal in other hospitals and cases where it could not be identified whether K-wires were buried or not. The final study population included 444 procedures in 331 metacarpal, 109 phalangeal and 4 mixed fractures. In all cases surgical and patient records ¡Ü90 days postoperatively were examined.
Findings / Results: The K-wires were buried in 337 (75.9%) cases and exposed in 107 (24.1%). A total of 14 (4.0%) cases with buried K-wires presented with later superficial infection versus 7 (6,5%) in cases with exposed K-wires (p=0.311). Overall, none of these infections caused re-operation. In 58 cases (17.2%) buried K-wire removal was not possible in the outpatient clinic and required readmission for removal in the operation theatre. All exposed K-wires could be removed without re-operation.
Conclusions: There was no significant difference in postoperative infection rate between metacarpal and phalangeal osteosynthesis with buried versus exposed k-wires. However, burying lead to unplanned re-operations for K- wire removal in 17.2% calling for reconsideration of surgical strategies.
Morten Tange Kristensen, Henrik Kehlet
Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department of Physical Therapy a, Hvidovre Hospital, Copenhagen University; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University
Background: One might ask; does it really matter if patients with hip fracture (HF) regain an independent ambulatory status in the acute hospital towards reducing odds of the ultimate fatal event after trauma, death?
Purpose / Aim of Study: To evaluate the importance of the basic mobility status at the time of acute hospital discharge to 1- and 5-year deaths after HF.
Materials and Methods: 491 patients who followed a multimodal fast-track HF program until discharged from an acute orthopedic ward. The median (IQR) age was 81 (74-87) years; 133 men and 358 women; 250 cervical and 241 with a trochanteric fracture. The national hip fracture register Cumulated Ambulation Score (CAS 0-6 points) was used to evaluate the basic mobility status. A CAS=6 point equals an independent basic mobility status.
Findings / Results: 107 (22%) patients with a CAS<6 at time of hospital discharge stayed in the acute ward a median of 22 (15-32) days post-surgery as compared to a median of 11 (8-16) days for those 384 patients who achieved a CAS=6. Overall 1-year mortality was 15%, while it was 11% for those with a CAS=6 and 29% for those with a CAS<6. Corresponding data for 5-year deaths was 38% and 67%. Cox regression analysis demonstrated that the likelihood of not surviving the first year after HF was 2 times higher for those with; a CAS<6, a low prefracture functional level, for men, and for those with an American Society of Anesthesiologists rating of 3-4 points, when adjusted for age and cognitive status.
Conclusions: The regain of basic mobility independency (CAS=6) within the primary acute hospitalization seems highly relevant towards reducing long-term deaths following HF. Enhanced efforts should therefore be instigated to improve the basic mobility status of patients with HF before discharge from the acute hospital.
Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department of Physical Therapy a, Hvidovre Hospital, Copenhagen University; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University
Background: One might ask; does it really matter if patients with hip fracture (HF) regain an independent ambulatory status in the acute hospital towards reducing odds of the ultimate fatal event after trauma, death?
Purpose / Aim of Study: To evaluate the importance of the basic mobility status at the time of acute hospital discharge to 1- and 5-year deaths after HF.
Materials and Methods: 491 patients who followed a multimodal fast-track HF program until discharged from an acute orthopedic ward. The median (IQR) age was 81 (74-87) years; 133 men and 358 women; 250 cervical and 241 with a trochanteric fracture. The national hip fracture register Cumulated Ambulation Score (CAS 0-6 points) was used to evaluate the basic mobility status. A CAS=6 point equals an independent basic mobility status.
Findings / Results: 107 (22%) patients with a CAS<6 at time of hospital discharge stayed in the acute ward a median of 22 (15-32) days post-surgery as compared to a median of 11 (8-16) days for those 384 patients who achieved a CAS=6. Overall 1-year mortality was 15%, while it was 11% for those with a CAS=6 and 29% for those with a CAS<6. Corresponding data for 5-year deaths was 38% and 67%. Cox regression analysis demonstrated that the likelihood of not surviving the first year after HF was 2 times higher for those with; a CAS<6, a low prefracture functional level, for men, and for those with an American Society of Anesthesiologists rating of 3-4 points, when adjusted for age and cognitive status.
Conclusions: The regain of basic mobility independency (CAS=6) within the primary acute hospitalization seems highly relevant towards reducing long-term deaths following HF. Enhanced efforts should therefore be instigated to improve the basic mobility status of patients with HF before discharge from the acute hospital.
Pia Kjær Kristensen, Theis Muncholm Thillemann, Kjeld Søballe, Søren Paaske Johnsen
Department of Orthopedic Surgery , Regional Hospitalet Horsens; Department of Orthopedic Surgery, University hospital Aarhus; Department of Clinical Epidemiology, Aarhus University Hospital
Background: High mortality rates after hip fracture among elderly patients is of concern. Unfortunately, studies concerning the association between performances measures and 30 day mortality are lacking.
Purpose / Aim of Study: We therefore examined the association between seven evidence based performance measures including; systematic pain assessment, mobilization before 24 hours postoperatively, basis mobility assessment at admission and at discharge, receiving a post discharge rehabilitation program, anti- osteoporotic medication, fall prevention and 30 day mortality among elderly patients with hip fracture.
Materials and Methods: Using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 25,354 patients ¡Ý65 years who were admitted with a hip fracture between March 2010 and November 2013. Each performance measure was analyzed separately. Furthermore we included all performance measures in the same regression model for their mutual adjustment. The outcome was 30-day mortality. For the analysis, we only included patients found eligible for the interventions. Data was analyzed using regression techniques while controlling for potential confounders.
Findings / Results: Overall, the 30-day mortality was 11.2 %. All seven interventions were associated with lower 30 day mortality. The adjusted mortality odds ratios (ORs) ranged from 0.41 (95 % CI: 0.33-0.51) for post discharge rehabilitation program to 0.61 (95% CI: 0.55-0.68) for prevention of future fall accidents. In the mutual adjustment, only mobilization within 24 hours postoperatively and receiving a post discharge rehabilitation program were associated with lower 30 day mortality.
Conclusions: Mobilization within 24 hours postoperatively and discharging patients with a rehabilitation program seems to lower the 30 day mortality among patients with hip fracture.
Department of Orthopedic Surgery , Regional Hospitalet Horsens; Department of Orthopedic Surgery, University hospital Aarhus; Department of Clinical Epidemiology, Aarhus University Hospital
Background: High mortality rates after hip fracture among elderly patients is of concern. Unfortunately, studies concerning the association between performances measures and 30 day mortality are lacking.
Purpose / Aim of Study: We therefore examined the association between seven evidence based performance measures including; systematic pain assessment, mobilization before 24 hours postoperatively, basis mobility assessment at admission and at discharge, receiving a post discharge rehabilitation program, anti- osteoporotic medication, fall prevention and 30 day mortality among elderly patients with hip fracture.
Materials and Methods: Using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 25,354 patients ¡Ý65 years who were admitted with a hip fracture between March 2010 and November 2013. Each performance measure was analyzed separately. Furthermore we included all performance measures in the same regression model for their mutual adjustment. The outcome was 30-day mortality. For the analysis, we only included patients found eligible for the interventions. Data was analyzed using regression techniques while controlling for potential confounders.
Findings / Results: Overall, the 30-day mortality was 11.2 %. All seven interventions were associated with lower 30 day mortality. The adjusted mortality odds ratios (ORs) ranged from 0.41 (95 % CI: 0.33-0.51) for post discharge rehabilitation program to 0.61 (95% CI: 0.55-0.68) for prevention of future fall accidents. In the mutual adjustment, only mobilization within 24 hours postoperatively and receiving a post discharge rehabilitation program were associated with lower 30 day mortality.
Conclusions: Mobilization within 24 hours postoperatively and discharging patients with a rehabilitation program seems to lower the 30 day mortality among patients with hip fracture.
Pia Kjær Kristensen, Theis Muncholm Thillemann, Kjeld Søballe, Søren Paaske Johnsen
Department of Orthopedic Surgery, Regional Hospital Horsens; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Data on the association between performance measures of hip fracture care, length of stay (LOS) and risk of readmission within 30 days of discharge, are lacking.
Purpose / Aim of Study: To examine the association between seven evidence based performance measures; systematic pain assessment, mobilization before 24 hours postoperatively, basis mobility assessment at admission and at discharge, receiving a post discharge rehabilitation program, anti- osteoporotic medication, fall prevention and LOS and readmission within 30 days of discharge among elderly patients with hip fracture.
Materials and Methods: From the Danish Multidisciplinary Hip Fracture Registry, we identified 25,354 patients ¡Ý65 years who were admitted with a hip fracture between March 2010 and November 2013. The association with LOS and readmission within 30 days of discharge was analyzed for the individual performance measures using multivariable regression techniques while controlling for potential confounders.
Findings / Results: Patients who were mobilized within 24 hours postoperatively had a median LOS of 8.1 days compared to 9.8 days for patients mobilized after 24 hours (adjusted relative time = 0.87 (95% CI: 0.86-0.89). For the remaining six performance measures, the differences in LOS were less than 1 day. Furthermore systematic pain assessment (adjusted odds ratio (OR) = 0.80 (95% CI: 0.72-0.89)), mobilization within 24 hours postoperatively (OR=0.84, 95% CI: 0.78-0.92) and antiosteoporotic medication (OR=0.79, 95%CI: 0.70-0.88) were all independently associated with a lower readmission risk.
Conclusions: Receiving mobilization within 24 hours postoperatively was associated with shorter LOS. Receiving systematic pain assessment, mobilization within 24 hours and anti-osteoporotic medication was also associated with a lower risk of readmission among patients with hip fracture.
Department of Orthopedic Surgery, Regional Hospital Horsens; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Data on the association between performance measures of hip fracture care, length of stay (LOS) and risk of readmission within 30 days of discharge, are lacking.
Purpose / Aim of Study: To examine the association between seven evidence based performance measures; systematic pain assessment, mobilization before 24 hours postoperatively, basis mobility assessment at admission and at discharge, receiving a post discharge rehabilitation program, anti- osteoporotic medication, fall prevention and LOS and readmission within 30 days of discharge among elderly patients with hip fracture.
Materials and Methods: From the Danish Multidisciplinary Hip Fracture Registry, we identified 25,354 patients ¡Ý65 years who were admitted with a hip fracture between March 2010 and November 2013. The association with LOS and readmission within 30 days of discharge was analyzed for the individual performance measures using multivariable regression techniques while controlling for potential confounders.
Findings / Results: Patients who were mobilized within 24 hours postoperatively had a median LOS of 8.1 days compared to 9.8 days for patients mobilized after 24 hours (adjusted relative time = 0.87 (95% CI: 0.86-0.89). For the remaining six performance measures, the differences in LOS were less than 1 day. Furthermore systematic pain assessment (adjusted odds ratio (OR) = 0.80 (95% CI: 0.72-0.89)), mobilization within 24 hours postoperatively (OR=0.84, 95% CI: 0.78-0.92) and antiosteoporotic medication (OR=0.79, 95%CI: 0.70-0.88) were all independently associated with a lower readmission risk.
Conclusions: Receiving mobilization within 24 hours postoperatively was associated with shorter LOS. Receiving systematic pain assessment, mobilization within 24 hours and anti-osteoporotic medication was also associated with a lower risk of readmission among patients with hip fracture.
Søren Kold, Knud Christensen
Orthopaedic, Aalborg University Hospital
Background: Femoral bone defects might be treated with a bone transport nail.
Purpose / Aim of Study: A retrospective study of the first six consecutive femoral atrophic non-unions.
Materials and Methods: The atrophic non-union site was resected and an osteotomy was performed. A motorized femoral nail capable of combined bone transport and lengthening was inserted.
Findings / Results: Treatment failed in a 51-year-old woman as the sliding screw cut out. Union of the docking site and distraction callus was achieved in three women and two men with a mean age of 49 (23 – 70 years). Mean defect size was 3 (2 - 5 cm), and mean limb length discrepancy was 3 (1 - 6 cm). Mean distraction at the osteotomy site was 6 cm. Minimum distraction at the osteotomy site was 4 cm (3 cm bone transport and 1 cm bone lengthening) and maximum distraction at the osteotomy site was 8 cm (2 cm bone transport and 6 cm bone lengthening). Mean time to union at the docking site was 7 months (3 – 10 months). One patient had a persistent limb length discrepancy of 1 cm. Angular deformity in the coronal plane went from a mean preop. value of 7 (0 - 18 degrees) to a mean postop. value of 1 (0 - 5 degrees). Angular deformity in the sagittal plane went from a mean preop. value of 4 (0 - 20 degrees) to a mean postop. value of 3 (0 - 10 degrees). Angular deformity in the axial plane went from a mean preop. value of 4 (0 - 20 degrees) to a postop. value of 0 degrees in all patients. Patients had full knee extension at the latest follow-up. Knee flexion went from a mean preop. value of 100 (45 – 130 degrees) to a mean value of 120 (90 - 140 degrees) at latest follow-up.
Conclusions: Femoral defects in shortened femurs can be treated by a combined bone transport and lengthening nail. However, failure occurred when the sliding screw in the transport segment was inserted too close to the resection site.
Orthopaedic, Aalborg University Hospital
Background: Femoral bone defects might be treated with a bone transport nail.
Purpose / Aim of Study: A retrospective study of the first six consecutive femoral atrophic non-unions.
Materials and Methods: The atrophic non-union site was resected and an osteotomy was performed. A motorized femoral nail capable of combined bone transport and lengthening was inserted.
Findings / Results: Treatment failed in a 51-year-old woman as the sliding screw cut out. Union of the docking site and distraction callus was achieved in three women and two men with a mean age of 49 (23 – 70 years). Mean defect size was 3 (2 - 5 cm), and mean limb length discrepancy was 3 (1 - 6 cm). Mean distraction at the osteotomy site was 6 cm. Minimum distraction at the osteotomy site was 4 cm (3 cm bone transport and 1 cm bone lengthening) and maximum distraction at the osteotomy site was 8 cm (2 cm bone transport and 6 cm bone lengthening). Mean time to union at the docking site was 7 months (3 – 10 months). One patient had a persistent limb length discrepancy of 1 cm. Angular deformity in the coronal plane went from a mean preop. value of 7 (0 - 18 degrees) to a mean postop. value of 1 (0 - 5 degrees). Angular deformity in the sagittal plane went from a mean preop. value of 4 (0 - 20 degrees) to a mean postop. value of 3 (0 - 10 degrees). Angular deformity in the axial plane went from a mean preop. value of 4 (0 - 20 degrees) to a postop. value of 0 degrees in all patients. Patients had full knee extension at the latest follow-up. Knee flexion went from a mean preop. value of 100 (45 – 130 degrees) to a mean value of 120 (90 - 140 degrees) at latest follow-up.
Conclusions: Femoral defects in shortened femurs can be treated by a combined bone transport and lengthening nail. However, failure occurred when the sliding screw in the transport segment was inserted too close to the resection site.