Posterudstilling
Fra onsdag den 23. oktober
10:30 –
lokale: Capital Foyer
139. No increased risk of elevated metal ions and pseudotumour formation when using modular neck-stems bilaterally
Peter Revald, Claus Varnum, Poulsen Thomas K., Per Kjærsgaard-Andersen
Department of orthopaedic surgery, Vejle Hospital
Background: Lately, potential corrosion/fretting and metal
ion release from the neck-stem taper
junction of modular total hip arthroplasty
(THA) has been in focus.
Purpose / Aim of Study: The aim of this study was to compare blood
levels of metal-ion and abnormal soft tissue
reactions in patients having a modular neck-
stem in one or both hips.
Materials and Methods: All patients having implanted a
cementless THA with modular neck-stem
(ABG2 stem and Trident cup) were
examined. The patients underwent
surgery from May 2009 to November
2011. In total, 39 unilateral and 7 bilateral
operated patients were included
corresponding to 53 THAs. All had metal-
on-HXL polyethylene bearings with a
head diameter of 36 mm. At follow-up,
plasma chrome and cobalt ion levels
were measured, and a MRI of the hip
was performed. The Wilcoxon rank-sum
test was used to compare metal ions
levels between uni- and bilaterally
operated patients. Chi-test was used to
compare proportions.
Findings / Results: The mean age at surgery was 65.6
years.70% were males. The overall
mean follow-up was 2.3 years. In the
unilateral group, the median chrome
plasma value was 14.7 nmol/l, and the
median cobalt level was 51.2 nmol/l. In
the bilateral group, the median values
were 16.5 nmol/l for chrome and 54.6
nmol/l for cobalt. There was no difference
in chrome (p=0.26) or cobalt levels
(p=0.60) between the two groups. Five
patients (13.5%) in the unilateral group
and one (14.3%) in the bilateral group
had elevated plasma cobalt values (>119
nmol/l) (p=0.89). There were no elevated
chrome values (>134.5 nmol/l) in either
group. Four (10.3%) cystic type 2
pseudotumours were found on MRI in the
unilateral group, none in the bilateral
group (p=0.32).
Conclusions: No increased risk of elevated metal ions or
pseudotumour formation could be noticed
when operated with modular neck-stems in
THA in both hips.
140. Body composition preoperatively has no impact on clinical outcome after hip arthroplasty - A cohort study of 102 patients 1year after surgery
Anette Liljensøe, Jens Ole Laursen, Kjeld Søballe , Inger Mechlenburg
Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedics, Hospital Southern Jutland
Background: Previous studies indicate that knee
arthroplasty patients preoperative BMI
is a predictor of the clinical effect
postoperatively. A high BMI increases
the risk of quality of life (QoL) and
physical function. However, the
association between obesity and
outcome after THA is controversial.
Purpose / Aim of Study: To investigate whether there is an
association between the preoperative
body composition of patients
undergoing THA and their QoL and
physical function 1 year after surgery.
Materials and Methods: 102 patients scheduled for THA
participated in a 1-year follow-up
study. Body composition (fat and
muscle mass) was measured with Dual
Energy X-ray Absorptiometry (DXA)
preoperatively and 1-year after
surgery. The outcome measures were
patient reported questioners: SF-36
and Hip disability and Osteoarthritis
Outcome Score (HOOS).
Findings / Results: Mean percentage of fat (%fat) for
females were 40(23-53)% and for
males 31(15-46)%. Mean percentage
of muscle mass for females were 58
(46-74)%, males 66(52-82)%. We
found no statistically significant
association between body composition
and any of the SF-36 and HOOS sub-
scales. For %fat and Physical
component score (PCS) odds ratio
(OR)=0,98 (p=0,4), %fat and Mental
component score (MCS) OR=0,99
(p=0,6), muscle mass and PCS
OR=1,03 (p=0,4), muscle mass and
MCS OR=1,02 (p=0,6).
Conclusions: Our findings indicate that overweight
and obesity has no impact on the QoL
and the self-assessed physical
function for THA patients 1year after
surgery.
141. 3 year Follow-up of a Long-term Registry-based Multicenter study on Vitamin E Diffused Polyethylene in Total Hip Replacement
Nanna H. Sillesen, Meridith E. Greene, Audrey K. Nebergall, Anders Troelsen, Peter Gebuhr, Henrik Malchau
Harris Orthopaedic Laboratory, MGH + Department of Orthopedics, Hvidovre Hospital. , Massachusetts General Hospital, Boston, MA, USA. + Copenhagen University Hospital, Hvidovre, Denmark; Harris Orthopaedic Laboratory, MGH, Boston, Massachusetts General Hospital, Boston, MA, USA.; Department of Orthopedics, Hvidovre., Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
Background: Preclinical studies of vitamin E diffused
highly cross-linked polyethylene (VEPE)
have shown improved material and wear
properties due to the antioxidative properties
of the vitamin E.
Purpose / Aim of Study: To document both early and long-term clinical
outcome of VEPE in order to ensure that
there are no detrimental effects of the new
developments and to evaluate the materials
performances from clinical use.
Materials and Methods: 977 patients from 17 centers in USA and
Europe are enrolled into a prospective
10year outcome study. Patients received
either Porous Titanium Coated or Porous
Plasma Sprayed acetabular shells with
either VEPE liners or medium cross-linked
(XLPE) liners. At each follow-up, 3
radiographs were obtained, 5 PROMs
were completed (Harris hip score, case
mix indicator, UCLA, SF-36, EQ-5D).
Radiographs were measured for cup and
stem position, as well as femoral head
penetration into the liner. Postoperative
complications and revisions were also
collected.
Findings / Results: Mean age at surgery was 62±9 years. At
3year follow-up there were 15 dislocations
in 11 patients and 13 revisions (4
periprosthetic fracture, 1 sepsis, 6 instability,
and 2 implant mismatch at surgery). Five
patients died due to causes unrelated to the
operation. Wear analysis of AP pelvis films
with Martell method from post-op to 3year
showed a penetration rate at 0.01 mm/year
for XLPE and a penetration rate of 0.003
mm/year for VEPE with no significant
difference between them (p=0.43).
Improvement was seen in all PROMs pre-op
to 3years postop (p<0.0001).
Conclusions: Early follow-up of VEPE liners provide
encouraging results with few intra- and
postoperative complications. PROMs indicate
improvement after THA in functionality and
quality of life across the centers. We have
not observed any early adverse effects
from diffusing the liners with vitamin E.
142. Effect of early progressive resistance training compared to home based exercise after fast track total hip replacement. -A randomised controlled trial.
Lone Ramer Mikkelsen, Inger Mechlenburg, Kjeld Søballe, Søren Mikkelsen, Thomas Bandholm, Mette Krintel Petersen
Elective Surgery Centre, Silkeborg Regional Hospital ; Department of Orthopaedics, Aarhus University Hospital; (1)Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Physiotherapy, (2, Copenhagen University Hospital, Hvidovre; (1)Department of Physiotherapy- and Occupational Therapy, (2)Centre of Research in Rehabilitation (C, (1)Aarhus University Hospital, (2)Institute of Clinical Medicine, Aarhus University
Background: After Total Hip Replacement (THR) deficits in
muscle strength and physical function
persist. There is lack of evidence concerning
which rehabilitation strategy is most
effective and the amount of rehabilitation
needed after fast track THR.
Purpose / Aim of Study: To investigate the effect of supervised
progressive resistance training in the early
rehabilitation phase after fast track THR in
improving muscle strength and functional
performance.
Materials and Methods: 73 THR patients with preoperative self-
assessed disability (HOOS ADL
score≤67) were randomly assigned to a
control group (CG, home based exercise
7 days/week) or intervention group (IG,
home based exercise 5 days/week and
resistance training of hip and thigh
muscles 2 days/week). The IG trained
with loads of 10 repetition max from
week 1 to 10 after THR . Before surgery
and after the intervention, performance
was evaluated by; leg extension power
(primary outcome), isometric strength
(hip abduction + flexion), sit-to-stand test
(STS), stair test and 20 meter walking
speed.
Findings / Results: 62 patients completed the trial (31 in each
group). Leg extension power improved
significantly in both groups, with no between
group difference: IG (difference baseline to
follow up): 0.28 [0.1;0.3] Watt/kg, CG: 0.26
[0.0;0.5] Watt/kg, p=0.91. 20 m walk
performance improved more in IG: 2.98
[1.8;4.2] sec than CG: 1.58 [0.8;2.4] sec,
p=0.05. No significant differences were
found in the other outcomes, yet borderline
significance (p=0.06-0.09) was seen in
favour of IG in STS and isometric muscle
strength.
Conclusions: 7 days/week of home based exercise was
equally effective as 5 days/week of home
based exercise plus 2 days/week of
supervised progressive resistance training
in improving leg extension power after THA.
For some of the secondary outcomes,
trends were in favour of resistance training.
143. 3 months home-training by a standardized program improves walking distance and knee extension strength in old patients 1-7 years after surgery with dual-mobility THA following femoral neck fracture.
Christina Frølich, Inger Mechlenburg, Sara Birch, Lone Lundager, Torben Bæk Hansen, Maiken Stilling
Department of Orthopaedics, Regional Hospital Holstebro; Department of Physiotherapy, Regional Hospital Holstebro
Background: Dual-mobility total hip arthroplasty
(THA) has become the treatment
choice for displaced femoral neck
fracture (FNF) at our institution.
However, ambulatory follow-up has
revealed poor gait function and leg
strength increasing the fall-risk in many
of these patients.
Purpose / Aim of Study: To test the effect of a standardized
home-based resistance training
program.
Materials and Methods: 31 patients (27 women) at mean 82
(60-96) years were included at mean 3
(1-7) years past dual-mobility THA
after FNF. Patients trained daily for 3
months, with 1 weekly physiotherapist
supervision, and kept a training-diary.
Criteria for study participation were:
dementia score > 7, STS10 > 30sek,
TUG > 12sek, and NMS < 8. Patients
were examined at baseline and at 3
months follow-up with spatio-temporal
parameters during 3 functional tests:
timed-up and go(TUG), 10m walk, sit-
to-stand(STS), and block-step test
(BST). Also, 6 minute walk test(6WT)
and sit-to-stand in 30 seconds(STS30)
was performed. Oxford Hip Score
(OHS) was collected. Leg muscle
mass was measured by DXA, and
muscle strength was tested by hand-
held dynamometer(HHD). Activity was
monitored by a 3-axial accelerometer.
Findings / Results: Between baseline and 3 months follow-
up 6WT improved by 19m (p=0.01).
TUG, STS30, and OHS was
unchanged (p>0.20). Knee extension
strength improved in the operated leg
(p=0.03) but not in the contralateral leg
(p=0.74). Muscle mass did not improve
(p>0.06). 92% were satisfied with the
training program and wished to
continue. Analysis of spatiotemporal
parameters and activity are ongoing.
Conclusions: Initial data assessment revealed
improved walking distance and knee
extension strength after a standardized
3 months home-based resistance
training program in old and fragile
patients 1-7 years THA after femoral
neck fracture.
144. Preoperative planning in cementless total hip arthroplasty - Accuracy of digital templating
Mikkel Krüger Jensen, Søren Solgaard
Ortopædkirurgisk afdeling, Gentofte hospital
Background: Choosing the correct implant size and
determining the correct femoral cut is
important for the optimal result after THA.
Purpose / Aim of Study: In the present study we investigated the
accuracy of pre-operative digital templating
in uncemented THA compared to the actual
implanted component size (cup and stem)
and furthermore we evaluated the
discrepancy in leg-length pre-
and post-operatively.
Materials and Methods: 150 patients undergoing uncemented THA
during the period from 1/1-2011 until 31/12-
2012 were retrospectively reviewed. Four
experienced surgeons performed the
operations. Component size and difference
in leg-length data were registered pre-
operative, per-operative and 3 months post-
operative. Leg-length was measured
radiographically. Data was stratified in
relation to gender, age and surgeon.
Findings / Results: Overall the pre-operative templated cup-
size was predicted correctly in 59% of
the cases. If +/- 1 cup-size was included
the precision increased to 95%. The pre-
operative templated stem-size was
correctly predicted in 61% of the cases.
If +/- 1 stem-size was included the
precision increased to 97%.
The mean pre-operative leg-length
difference was -2,1mm(+/- 6,4mm)
compared to a mean leg-length
difference post-operative of 1,7mm(+/-
6,7mm).
18(12%) out of 150 included patients had
a difference in leg-length >10mm pre-
operative. 18 out of 150 patients still had
a difference in leg-length >10mm post-
operative.
Only 2 patients had a discrepancy of
more than 20 mm.
Conclusions: It can be concluded from the present study
that digital preoperative templating is safe
and reliable.
There was an overall trend towards
increased leg-length of the operated leg.
Equal leg-length within 10mm was achieved
in 88% of the patients.
145. Timing of preoperative prophylactic antibiotics for knee arthroplasties. A quality study after the introduction of the WHO checklist with a standard “time-out” before skin incision.
Arne Svensson, Lars Peter Jorn
Department of Orthopaedic Surgery., Regionshospitalet Viborg
Background: A slight increase in revisions for
infected joint arthroplasties has been
observed in the Nordic countries since
2000 and the reasons for this are not
clear. The most commonly used
antibiotics have a short half-life, and it
has been documented that administration
more than 60 min preoperatively is
associated with higher risk of surgical
infection. It has been considered optimal
to start the infusion 45 – 15 min before
inflation of the cuff for the blood less
field.
Purpose / Aim of Study: To evaluate our current routine, where
antibiotic infusion is scheduled to start
when the patient has arrived at the
operation theater, and before further
anesthetic procedures are initiated.
Materials and Methods: 118 consecutive patients operated
during 2011 at our Hospital with primary
knee prosthesis had their anesthetic
journal evaluated retrospective. Time
markings of the start of the antibiotic
infusion, of the inflation of the cuff for
the blood less field (in-BLF) and the
closure of the wound were recorded for
each patient.
Findings / Results: All patients did receive preoperative
prophylactic antibiotic. Mean time of
infusion before in-BLF was 37 min
(range 5min – 230min). 82 (70%) of the
patients received antibiotics at the
optimal time interval. 6 (5%) of the
patients received antibiotic more than 60
min before in-BLF, and 26 (22%)
patients more than 45 min before in-
BLF. 10 (8%) patients received antibiotic
later than 15 min before in-BLF. Mean
time from in-BLF till wound closure was
80 min (range 50min – 145min), and 44
(37%) patients did receive antibiotics
more than 120 min before wound
closure.
Conclusions: Our findings are in accordance with
reports from a national Swedish survey
from 2011, and leave room for
improvements. Detailed instructions as to
when the antibiotics should be given in
relation to the start of the operation might
improve timing.
146. No correlations between radiological angles and self-assessed Quality of Life in patients with Hip Dysplasia at 2-13 years of follow up after periacetabular osteotomy
Sara Birch, Anette Liljensøe, Charlotte Hartig-Andreasen, Kjeld Søballe, Inger Mechlenburg
Department of Physiotherapy and Occupational Therapy, Herning Regional Hospital; Department of Orthopedic Surgery, Aarhus University Hospital
Background: Only few studies have described the
patients' health-related Quality of Life
(QoL) after periacetabular osteotomy
(PAO). Thus, there is a lack of data on
the self-assessed outcome of patients
operated with PAO, and none of the
existing studies correlate the results
from SF-36 with the radiological
parameters.
Purpose / Aim of Study: The aim of this study was to investigate
the health-related QoL for patients with
hip dysplasia operated with PAO and
investigate whether QoL is associated
with the acetabular angles or hyper
mobility.
Materials and Methods: Out of 388 patients, 228 patients (mean
age of 40.5 years, mean follow-up of
7.1 years) returned the SF-36 and
Beighton questionnaires. The patients'
QoL was compared to reference data
from a Danish population. Center-Edge
(CE) and Acetabular Index (AI) angles
were measured before and after PAO
and the association with the patients'
QoL was tested with logistic regression.
Findings / Results: For both males and females the SF-36
score was significantly lower than for
the reference data for a Danish
population, especially for those
dimensions concerning physical health.
No association was found between the
patients' CE- or AI-angles before or after
PAO and their subsequent QoL.
Significant associations were found
between both Physical Component
Score (PCS) and Physical Function (PF)
and follow-up time after the operation.
The adjusted OR for a PCS≥50 was 0.87
(95% CI: 0.76-0.99) and for a PF≥85
0.81 (95% CI: 0.71-0.91). No association
between hyper mobility and PCS, PF or
Bodily Pain (BP) was found.
Conclusions: The results suggest that physical
function after PAO decreases with
longer follow-up time. Neither the
acetabular angles nor hyper mobility is
associated with the physical
components of QoL.
147. Removal of mobilisation restrictions following primary THR does not increase risk of early dislocation.
Kirill Gromov, Anders Troelsen, Kristian Stahl Otte, Thue Ørsnes, Henrik Husted
Orthopedic, Hvidovre Hospital
Background: Currently, many rehabilitation protocols
following total hip replacement (THR)
surgery include mobilisation restrictions to
reduce early postoperative dislocation,
especially if a posterolateral approach has
been used. In this study we hypothesize
that removal of such functional restrictions,
as a part of rehabilitation, will not increase
the risk for early postoperative dislocation.
Purpose / Aim of Study: We investigated if removal of functional
restrictions following primary THR resulted
in a higher dislocation rate.
Materials and Methods: The study was performed as a non-
inferiority retrospective cohort study.
Functional restrictions were removed
from the rehab protocol at our institution
in august 2010. A total of 685 primary
THRs were performed following that
date. Risk of early dislocation (within 30
and 90 days) was calculated, together
with risk of revision surgery due to
dislocation. Data were compared to the
dislocation risk of 985 patients operated
with primary THR prior to removal of
functional restrictions. Alle patients were
operated using posterolateral approach
Findings / Results: The two groups were comparable regarding
age and sex (p-values: 0.42 and 0.35). Risk
of dislocation within 30 and 90 days before
and after restriction removal from
postoperative mobilisation was: 2.1% vs
2.3% within 30 days and 3.4% vs 3.1%
within 90 days. Risk of revision surgery due
to dislocation, for patients with early
dislocation, before and after restriction
removal was 1.7% and 1.0% respectively.
The inferiority hypothesis with a 50%
increase could be discarded.
Conclusions: Removal of mobilisation restrictions following
primary THR with posterolateral approach
does not seem to increase risk of early
dislocation.
148. Block-step asymmetry 5 years after large-head MOM THA is related to lower muscle mass and leg power on the implant side.
Mette Holm Hjorth, Maiken Stilling, Nina D Lorenzen, Stig Storgaard Jakobsen, Kjeld Søballe, Inger Mechlenburg
Orthopædkirurigsk, Aarhus Universitetshospital
Background: Large-head metal-metal (MoM) articulations
mimic the human hip anatomy and presumably
lower dislocation rates and increase range-
of-motion.
Purpose / Aim of Study: To measure the muscle mass and power in
the legs and investigate their influence on
spatio-temporal gait parameters and self-
reported function.
Materials and Methods: In July-August 2012, 28 patients (7
women) at a mean age of 45 (23-63)
years participated in a 5-7 year follow-
up. All patients had received the same
type of unilateral large-head MoM THA
and all articulations were well-
functioning at follow-up. Mean muscle
mass was estimated by total-body DXA
scans and muscle power was measured
in a Leg Extensor Power Rig. An Inertial
Measurement Unit (IMU) monitored the
spatio-temporal gait parameters and
asymmetry in a 20 m gait test and a
block-step test. Self-reported function
was assessed by the Hip Disability and
Osteoarthritis Outcome Score (HOOS).
Findings / Results: We found a significant difference between
mean muscle mass of the implant-side leg and
the non-implant-side leg in hip, thigh and calf
areas (p<0.008) and a significant difference
in mean muscle power (p=0.025) between
legs. Correlations between mean muscle
mass and mean muscle power were
significant for both the implant-side leg
(r=0.451, p=0.018) and the non-implant side
leg (r=0.506, p=0.007). The difference
between legs in mean muscle power were
correlated with asymmetry around a medial-
lateral axis measured from the block-step
test, both in ascending (r=0.398, p=0.047)
and descending (r=0.528, p=0.006) steps
Conclusions: Patients had a lower muscle mass and lower
muscle power in the implant-side leg. The
greater difference between legs in muscle
power, the greater was the medial-lateral
axis asymmetry found by block-step test
when ascending and descending.
149. No clinical important increase in perioperative bleeding during total hip replacement in users of serotonergic antidepressants
Annie Primdahl, Frank Damborg, Tine Nymark, Michael Dall, Jesper Hallas
Department of Orthopaedic Surgery, Odense University Hospital; Department of Gastroenterology/ Research Unit of Clinical Pharmacology, Odense University Hospital/ University of Southern Denmark
Background: Eventhough it is well know that selective
serotonin reuptake inhibitors (SSRIs)
inhibit platelet aggregation, it is still
controversial whether use of SSRIs can
cause clinically important bleedings
during surgery.
Purpose / Aim of Study: Our objective was to determine a
possible association between use of
serotonergic antidepressants (SA) and
perioperative bleeding during total hip
replacements (THR).
Materials and Methods: We conducted a retrospective study
between 1 January 2007 and 30 June
2012 among patients that underwent a
primary unilateral uncemented THR.
Information was collected on the actual
blood loss and the need for blood
transfusions among this group. We
compared the blood loss between users
of SAs, users of non-serotonergic
antidepressants and non-users.
Findings / Results: We indentified 1318 patients who
underwent a THR at either Odense
University Hospital or Kolding Hospital
during the study period. The adjusted
difference in blood loss among
respectively, users of SAs and non-
serotonergic antidepressants were 92.6
(38.1 - 147.2) ml and -49.9 (-125.0 -
25.2) ml compared with non-use.
Conclusions: Use of SAs was associated with an
increased blood loss compared to non-
users. The amount of increased blood
loss has - in our opinion - no clinical
consequences. The results support the
well established hypothesis that SAs
impair the haemostasis.
150. Initial Hip Model
Tina Skytte, Lars Pilgaard Mikkelsen, Stig Sonne-Holm, Christian Wong
Orthopeadic, Hvidovre Hospital; Wind Energy, DTU
Background: Others have previously constructed and
validated finite element (FE) models of the
hip joint. However, all of those models were
constructed either post mortem or with a
contrast agent injected in the hip capsule.
Purpose / Aim of Study: The aim of this study was to construct a FE
model of a child’s hip joint from an ordinary
clinical CT scan. With this approach it will
hopefully become possible to carefully
analyze the surgical procedure
preoperatively.
Materials and Methods: Due to a subluxated hip, a CT scan of the
pelvic region on a patient was recorded. The
normal side was picked as the basis for the
FE model. From the CT it was not possible
to segment the cartilage; instead cartilage
was modeled as a hyper-elastic interaction
between acetabulum and the femoral head
with a constant thickness of 3.1 mm. The
model was analyzed and compared with the
findings from previous combined FE and
experimental studies.
Findings / Results: Firstly the distribution of von Mises
stress in the pelvis was considered.
While others have reported stresses of
up to 6 MPa, we found regions of higher
stresses reaching 10 MPa. Regions of
highest stresses are in accordance with
one of the previous studies, while
another study revealed a different
distribution of the stresses.
Secondly, the model reported cartilage
contact pressure in the acetabulum of
around 0-10 MPa. This is in accordance
with previous findings. Regions of peak
forces are slightly different, but within
what are considered acceptable, since
large variations among subjects have
been reported previously.
Conclusions: We have developed a FE model of the hip
joint from a preoperatively CT scan.
Compared to previous models, this simpler
model reveals contact forces in the
acetabulum that is deemed adequate.
Further works are however still needed to
improve the response in the bony region.
151. Collateral Ligament Reconstruction of the Chronic Thumb Injury with Biotenodesis Screw Fixation
Robert Gvozdenovic, Michel Boeckstyns
Department of Orthopaedic Surgery, Hand Surgery Unit, Gentofte Hospital
Background: Numbers of techniques have been
introduced for the management of
chronic insufficiency of the collateral
ligaments of the thumb. Fixation of the
tendon graft in order to establish good
stability of the reconstruction, avoiding
stiffness of the MCP-joint and loss of
the pinch strength remains a
challenge. The potential advantages of
using interference screws for fixation of
the tendon graft is its ability to stabilize
the reconstruction during the healing,
allowing a short immobilization time.
Purpose / Aim of Study: The purpose of this review was to
analyse short-term results of a
consecutive series of 18 collateral
ligament reconstructions of the thumb
using the 4 x 10 mm Bio-Tenodesis
screw for fixation the tendon graft of
Palmaris Longus.
Materials and Methods: Seven men and 11 women with
posttraumatic instability, pain and
dysfunction of the thumb were
treated.The mean follow-up period was
26 months (range 12-43 months). We
measured active flexion of the MCP-
and IP-joints, abduction of the thumb
as well as the grip and pinch strength
of the injured and contralateral
(control) hand, sick-leave, pain score
(VAS) and Quick DASH score. For
statistical analysis, t-test for paired
data has been used.
Findings / Results: The mean active range of motion in the
MCP-joint of the operated thumbs was
90% of the contralateral side. The
main active range of motion in the IP-
joint was 96% of the contralateral side.
There was no reduction of the
abduction. Neither was there any
difference in grip strength between
operated and non-operated sides.
Pinch strength (pure or tip pinch) of the
operated thumb was the same as of
the contralateral side.
Conclusions: Our procedure had short
immobilization and rehabilitation time,
minimal loss of motion of the MCP-
and IP- joints, no loss of hand and
pinch strength, permitting early return
to work.
152. Partial Scaphoid Implant (APSI). A Seven Years Follow-up
Nina Vendel, Lene Jensen, Niels H. Søe Søe, Lars B. Dahlin
Department of Anesthesiology, Intensive care and Operation, Gentofte Hospital; Department of Orthopedic Surgery, Occupational Section, Gentofte Hospital; Department of Orthopedic Surgery, Hand Section, Gentofte Hospital; Department of Orthopedic Surgery, Malmø, Lunds University, Sweden
Background: The treatment of scaphoid fracture non-
union with a small proximal fragment
with or without avascular necrosis or
radioscaphoid arthrosis is difficult and
may lead to more aggressive
treatment. PRC, midcarpal arthrodesis
with scaphoid excision, and wrist
arthrodesis are the usual options.
Purpose / Aim of Study: To show that the Adaptive Partial
Scaphoid Implant ( APSI) is a reliable
alternative to other treatments of
proximal scaphoid fracture non-unio
Materials and Methods: This is a prospective study of 25
artroplasties with painful Scaphoid
pseudartrosis after failed treatment
and proximal avascular necrosis
confirmed by X-ray and MR scan.
There were 25 patients with an
average age of 42 years (range 24-64)
and the average length of follow-up
was 7.7 years (range 4-13 y). None of
the patients had progressive carpal
collapse (SNAC). Clinical assessment
included range of motion, pain at rest
(VAS) and the worst pain last week
(VAS), Mayo wrist score and
satisfaction.
Radiographs were evaluated for
implant position, alignment,
subsidence and carpal high ratio.
Findings / Results: None of the patients had luxation or
subluxation of the implant and there
were no change in carpal height ratio.
No DISI or VISI deformity was seen
before and after the operation. One
patient had a re-operation to change
the size of the prosthesis. Necrosis of
the proximal scaphoid bone was
confirmed by pathology. The average
pain at rest (VAS) was decreased from
34 to 0. The average Mayo wrist score
was increased 50 %.
Conclusions: The scaphoid spacer implant seems to
be a reliable technique provides good
pain relief and good ROM. The
methods serve as a supplement to
other methods after failed treatment of
proximal scaphoid fractures without
excluding these procedures as the final
treatment.
153. Volar dislocation of the second and third carpometacarpal joint following a soccer tackle -a case story of a missed diagnosis in a 15 year old boy.
Anne Mørup-Petersen, Camilla Ryge, Dorte Engelund
Ortopædkirurgisk Afdeling, Nordsjællands Hospital, Hillerød
Background: Volar dislocations of the second and third
carpometacarpal joints are extremely rare
and like other carpometacarpal dislocations
almost always a result of high-energy
traumas such as motor vehicle accidents.
Purpose / Aim of Study: As we present a missed case of volar
dislocation of the second and third
carpometacarpal joints, which was
uncharacteristically caused by a low-
energy trauma, we wish to describe this
extremely unusual injury and its signs of
recognition.
Materials and Methods: Based upon a case story, we explored the
current literature on carpometacarpal
dislocations with special emphasis on volar
dislocations of the second and third
metacarpal base.
Findings / Results: A boy aged 15 was injured falling on his left
hand following a soccer tackle. As seen in
other cases of carpometacarpal
dislocation, the injury was initially
overlooked, probably due to an ipsilateral
forearm fracture. The hand injury remained
undiagnosed for three months, until a CT
scan revealed a total volar dislocation of
the second metacarpal base along with a
subluxation of the third metacarpal base.
Retrospectively this was visible already in
the primary lateral x-rays. Open reduction
was necessary and the reduction was
maintained with Kirchner wires for nine
weeks. On two years follow-up the patient
had lost 20% of his grip strength. He no
longer experienced pain or paresthesia,
however based on the damage seen on the
articular surfaces during operation,
arthrosis is likely to develop later on.
Conclusions: This case story highlights that volar
dislocations of the second and third
carpometacarpal joints are a possible
consequence of low-energy trauma. The
story also emphasizes the importance of
thorough examination when patients
present with paresthesia and marked hand
swelling that cannot be explained by other
injuries.
154. Erythropoietin elicits a dose-dependent osteogenic effect on human mesenchymal stem cells
Jan Duedal Rölfing, Anette Baatrup, Maik Stiehler, Helle Lysdahl, Cody Bünger
Orthopaedic Research Laboratory, Aarhus University Hospital; Department of Orthopaedics and Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at Technische Universität Dresden
Background: Erythropoietin (EPO) is a pleiotropic growth
factor. Of interest for orthopaedics, EPO
increases bone formation and angiogenesis.
However, accommodating safety concerns,
physiological dosing of EPO is a perquisite
before clinical translation can be considered.
Purpose / Aim of Study: The aim of this study was to establish a
dose-response relationship and to determine
the lowest effective osteogenic dose of
continuous EPO stimulation on human
mesenchymal stromal cells (MSCs).
Materials and Methods: MSCs from two donors were cultured at
13500 cells/cm2. A wide range of EPO
concentrations (0–100 IU/ml) was
continuously applied. The primary outcome
measurement was Arsenazo mineralization
assay after 14 and 21 days. Secondary
outcome measurements were an alkaline
phosphatase (ALP) and cell viability assay
after 2 and 7 days. The positive control was
osteogenic medium and proliferation medium
served as negative control. Results were
normalized to cell number. Statistics
consisted of one-way ANOVA and post hoc
testing for linear trend and EPO
concentration against positive control with
Fisher's LSD.
Findings / Results: The observed proportional dose-response
relationship can be adequately described
with the slope of a fitted line. The effect size
corresponds to this slope, which declined
from 0.35 to 0.09 between day 14 and 21
(p<0.001). The lowest effective dose of 20
IU/ml increased mineralization to 146 ±17%
after 14 days relative to positive control
(p=0.002). EPO also increased cell viability
and ALP (p<0.01).
Conclusions: EPO increased osteogenic differentiation of
MSCs in a dose-dependent manner. In vivo,
the lowest effective dose of 20 IU/ml should
be used to prevent adverse effects. Ex vivo,
the highest dose of 100 IU/ml could
overcome the major limitation of cell-based
tissue engineering, namely vascularization
and bony ingrowth into 3D scaffolds.
155. The influence of hemostatic agents on bone healing after sternotomy in a porcine model
Rikke Falsig Vestergaard, Annemarie Brüel, Jesper Skovhus THomsen, Ellen Margrethe Hauge, Kjeld Søballe, John Michael Hasenkam
Dept. of Ortopeadic surgery , Hospitals Enheden Horsens; Department of Biomedicine – Anatomy, Aarhus University; Department of Rheumatology, Aarhus University Hospital, Nørrebrogade; Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade; Department of Cardio-Thoracic and Vascular Surgery and Department of Clinical Medicine, Aarhus University Hospital, Skejby
Background: Sternotomy is the preferred access to
the mediastinum. During sternotomy
trabecular bone is exposed, which
often results in bleeding. Mechanical
hemostatics are used to diminish this
bleeding; however, their influence on
the sternal healing process is relatively
unexplored.
Purpose / Aim of Study: The aim of the present study was to
investigate the influence of two
hemostatics, bone wax (BW) and a
water-soluble polymer wax, Ostene
(WSW), on the mechanical properties
and histological characteristics of
healing sternal bone.
Materials and Methods: Twenty-four pigs underwent
sternotomy and were randomized into
three groups: WSW, BW, or no
hemostatic treatment (control). The
animals were sacrificed 6 weeks after
surgery and bone samples were
obtained. In all, 42 bone samples
underwent mechanical testing and 44
histological sections were evaluated
microscopically.
Findings / Results: Fracture strength in the BW group was
32% lower than in the control group
(p<0.05), and maximum stiffness was
56% lower in the BW group than in
control group (p<0.05). The
mechanical properties did not differ
between the WSW and BW groups.
The fraction of granulomatous tissue
was 379% higher in the BW group than
in the WSW group (p<0.001) and
582% higher than controls (p<0.001).
There was 117% more calcified tissue
in controls than in BW pigs (p<0.05).
Conclusions: In a porcine model, BW was found to
significantly inhibit sternal healing and
was associated with chronic
inflammation and reduced mechanical
integrity. Animals treated with WSW
demonstrated bone healing
characteristics similar to those of the
control group, and WSW is thus a
compelling alternative to BW when a
mechanical hemostatic is needed.
156. Topographical microstructures increase proliferation of human primary chondrocytes in vitro.
Natasja Leth Jørgensen , Anna Nielsen, Ole Zoffman Andersen, Morten Foss, Martin Lind, Helle Lysdahl
Institut for Klinisk Medicin, Ortopædisk Forsknings Laboratorium, Aarhus Universitets Hospital ; Interdisciplinary Nanoscience Center, Aarhus Universitet; Idrætsklinikken, Aarhus Universitets Hospital
Background: Chondrocyte-based cartilage repair
techniques require control of autologous
articular chondrocyte expansion and
differentiation in vitro. Culture surface
topography might be a tool to control
chondrocytes behavior.
Purpose / Aim of Study: In this study we aimed at identifying
topographical structures that stimulated the
proliferation of human primary
chondrocytes (HPCs) in vitro.
Materials and Methods: HPCs were isolated from patients
undergoing anterior cruciate ligament
reconstruction from the inter-condylar
groove in the distal femur. HPCs were
isolated and 10.000 cells/cm2 seeded upon
the BioSurface Structure Assay (BSSA) for
4 days. Subsequently, the cells were
stained with DRAQ5 for detection of
proliferation using infrared imaging. The
BSSA consisted of distinct topographical
patterns organized in 10 different series (A-
J) each series with 16 unique combinations
of pillars with variable of dimension X =
pillar size and Y = inter-pillar gap size and a
non-structured control. Interactions
between the independent variables were
investigated using two-way ANOVA. The
level of significance was p < 0.01.
Findings / Results: The systematic screening of topographies
identified that inter-pillar gap size Y, and to
a smaller extent pillar size X, had a clear
systematic effect on proliferation of HPCs.
The structure dimensions (X=2, 4 μm) and
(Y=1 μm) resulted in the most significant
increasing in proliferation comparable to the
unstructured control, while the dimension
(Y=6 μm) had the lowest proliferation effect.
Conclusions: Screening of different topographies
identified structures with specific pillar size
and inter-pillar gap size, which increased
the proliferation capacity of HPCs
compared to planar structures. Use of
topography could be an alternative
culturing method for laboratory ex vivo
expansion of HPCs for clinical application.
157. Dental Pulp Stem Cells Seeded on Modified Polycaprolactone Scaffolds Promotes Osteogenic Differentiation in Vitro
Jonas Jensen, Helle Lysdahl, David Kristian Evar Kraft, Jan Rölfing, Cody Bünger
Orthopaedic Research Lab, Aarhus University Hospital; Intitute for Odontology, Aarhus School of Dentistry, Aarhus University
Background: Dental pulp cells (DPSCs) have been
hypothesized as an alternative source of
stem cells for bone tissue engineering.
Purpose / Aim of Study: The aim was to determine their efficacy on
three different polycaprolactone (PCL)
scaffolds.
Materials and Methods: PCL was plotted into a three-dimensional
grid structure (PCL scaffold). A modified
scaffold was created by infusing the pure
PCL scaffold with hyaluronic acid + TCP
followed by yophilization to create a micro-
porous hydrophilic coating (HT-PCL
scaffold). Another scaffold was developed
by infusing a homogenous mixture of PCL,
water and dioxane and afterwards perform a
thermal induced phase separation (TIPS)
followed by lyophilization. This NSP-PCL
scaffold was structurally graded with micro-
and nanopores. A total of 132 scaffolds
(Ø=10mm, h=5mm) were used. DPSCs
were cultured using proliferation medium for
7 days and thereafter osteogenic medium.
After day 1, 7, 14 and 21, 10 scaffolds were
collected for further analysis. Following
analyses were performed to validate cell
viability: Scaffold cellularity by quantifying the
amount of dsDNA, ALP activity, Ca++,
live/dead staining (confocal microscopy),
histology, SEM, RNA extraction and RT-
PCR (GAPDH, Ubiquitin, ALP, Collagen type
I, BMP-2, Runx2 and bone sialoprotein
/osteocalcin).
Findings / Results: The HT-PCL and NSP-PCL scaffold
promoted osteogenic differentiation
compared with pure PCL scaffold evident by
high calcium deposition.
Cell proliferation and migration into the
scaffold was best facilitated on the HT-PCL
scaffold compared to both the pure PCL
scaffold and the NSP-PCL scaffold, making
this a promising scaffold for further in vivo
studies.
Conclusions: DPSCs seeded on three morphologically
different scaffolds intended for bone repair,
resulted in osteogenic differentiation. DPSCs
could be an alternative stem cell line for
bone repair.
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
patient’s 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.
162. Severe fractures after Segway related accidents in an amusement park
Morten Knudsen, Svend-Erik Heiselberg, Ole Brink
Orthopaedic, Aarhus University Hospital
Background: In 2001 the Segway was introduced as
a new and revolutionary vehicle. Since
then, the Segway has found use as a
professional mean of transportation,
for example by the police and security
guards, but it has also been used for
entertainment purposes. A Segway is
an electrically powered one-axle
vehicle, which can reach a top speed
of 20 km per hour
Purpose / Aim of Study: The aim of this study is to describe a
new injury mechanism related to the
use of Segway in Denmark, and the
severity of the injuries
Materials and Methods: Case study of 8 patients, who were
injured during the use of Segway, and
were admitted to Aarhus University
Hospital during a one year period for
fracture surgery
Findings / Results: During Jan-Dec 2012, five men and
three women were admitted for acute
surgery. Two with displaced hip
fractures, one tibial condyle, one ankle
fracture, one humeral fracture, one
comminute radial neck fracture and
two distally radial fractures
Conclusions: Few international studies has
systematically examined this injury
type, but in general, these studies has
shown very severe injuries.
A Segway cannot be directly compared
to other means of transportation,
leading to difficulties with classifying it
in the Road Traffic Act. In Denmark,
the Segway was initially classified as a
scooter, but as part of a pilot scheme it
is now classified as a bike. However
the driver must be at least 16 years old.
All injuries occurred in an amusement
park, with focus on safety. When
serious injuries still occur, it should
give rise to further reflection on
accident prevention.
The number of trauma with a Segway
are unknown I Denmark, but recently a
specific code for this accident type,
have been available. With a carefully
registration it will be possible to
determine the incidence. Based on this
study, we recommend increased focus
in Denmark on accident with the
Segway
163. Tibia intramedullary nailing - comparison of physical activity and pain with or without secondary surgery
Katrine Borum, Peter Toquer Jessen
Department of Orthopedic Surgery, Slagelse Sygehus; Department of Orthopedic Surgery , Slagelse Sygehus
Background: Little research is done on the long term
course of patients treated with tibia nail and
effect of secondary surgery. Removal of
tibia nails to alleviate pain has been found
limited. The effect on activity level and social
performance is uncertain.
Purpose / Aim of Study: Study the long-term postoperative course of
patients treated with a tibia nail comparing
patients without secondary surgery with
patients going through secondary surgery
hence total amotio or screw amotio. Hereby
analyzing level of physical activity and pain
in work and sparetime.
Materials and Methods: The study includes all patients with crus
fractures treated with a primary insertion of
a tibia nail in the period of 2009 to 2011 by
using the hospitals register of diagnose
codes. Excluded patients were dead,
suffering from dementia, moved abroad or
could not be contacted. We enrolled 52
patients of which 9 were excluded. This
gave us 43 patients for data collection, by
sending out multiple choice questioners and
telephone consultations.
Findings / Results: Before the fracture in general most patients
were able to run and had a job. After the
fracture and tibia nailing most patients lost
the ability to run, but could still stand and
walk. After years most patients still have
pain or discomfort, especially with
increasing weight bearing regardless of
having secondary surgery or not. Most
patients that went through secondary
surgery tended to increase their level of
physical activity, but tended to have an
unchanged level of pain. They felt it was
worth it, beneficial and would recommend
amotio to other patients.
Conclusions: The crus fracture and tibia nailing reduces
ability to run, decreases level of physical
activity, increases level of pain over years
and might result in loss of job. Amotio might
help patients increasing activity level but
with the same level of pain.
164. Tibia intramedullary nailing - secondary surgery - rate, indications and contexts.
Katrine Borum, Toquer Jessen Peter
Department of Orthopedic Surgery, Slagelse Sygehus; Department of Orthopedic Surgery , Slagelse Sygehus
Background: Little research is done on the long term
course of patients treated with tibia nail and
indications for secondary surgery. Removal
of tibia nails to alleviate pain has been found
limited.
Purpose / Aim of Study: Study the long-term postoperative course of
patients treated with a tibia nail concerning
any context between different variables and
the rate of secondary surgery.
Materials and Methods: The study includes all patients with crus
fractures treated with a primary insertion
of a tibia nail in the period of 2009 to
2011 by using the hospitals own register
of diagnose codes. Excluded patients
had their primary operation elsewhere
and operation before or after the study
period. We examined the rate of
secondary surgery - both screw removal
and complete nail removal. We looked at
variables like: age, side, open fracture,
coexisting fibula fracture, level of
fracture on the tibia, comminute
fractures, surgeons level, doctors delay
and surgical approach. In the
postoperative course we looked at
indications for amotio atellae. We enrolled
55 patients of which 3 were excluded.
This gave us 52 patients for data
collection.
Findings / Results: We found statistically evidence of a context
between age and sex of the patients on the
rate of total nail removal but not on screw
removal alone. All nail removals (no 12)
where done on patients younger than 60
years, out of these patients 11 were men
and 1 woman. The rate of secondary
surgery was 44,2%. The rest of the
variables did not have an impact on the rate
of secondary surgery. The main indication
for secondary surgery was mechanical
discomfort from the osteosynthesis.
Conclusions: As a rule the tibia nails were removed on
men younger than 60 years. The result might
help us in the future to give our patients
better advice on risk of secondary surgery.
165. Complication rates in unstable trochanteric fractures when type of osteosynthesis is dictated by the preference of the surgeon
Eske Brand, Jakob Klit
Orthopedic Department, Holbaek Hospital
Background: In contemporary literature strict
algorithms is recommended as a tool to
decrease complication rates in hip
fractures. In unstable trochanteric
fractures (Evans type 4 and 5) an
intermedullary nail (IMN) is
recommended. At our department unstable
trochanteric fractures is
osteosynthesised with either a Sliding
Hip Screw (SHS) or IMN dictated by the
preference of the surgeon.
Purpose / Aim of Study: To compare the complication rates for
SHS and IMN when used for osteosynthesis
in unstable trochanteric fractures and
to compare our complication rates with
contemporary literature.
Materials and Methods: Through local database search we
identified 101 patients operated for a
trochanteric fracture in 2012. Follow-up
were conducted through systematic review
of regional journals, radiographs and
the nationwide e-journal. Forty-three
patients had an unstable trochanteric
fracture. Mean age 79.5 years. Female
n=23. Thirteen patients died during
follow-up. In this retrospective setting
we compared complication rates between
SHS and IMN in unstable trochanteric
fractures. All patients were followed
from surgery until 20.06.2013, and
included for analysis.
Findings / Results: Of the 43 unstable trochanteric
fractures 34 were osteosynthesised with
SHS and 9 with an IMN. The two groups
showed the same distribution regarding
age, sex and level of the surgeon.
Complications leading to reoperation
were seen in 4/34 SHS and in 1/9 IMN.
Conclusions: In this small retrospective study we
find no difference in complication rates
between SHS and IMN in unstable
trochanteric fractures and the
complications rates is at the level of
what is reported in contemporary
literature, when strict algorithms is
used. This may raise the hypothesis that
SHS should be used more often,
considering the facts, that it is
cheaper and can be performed with a
lower level of expertise.
166. Do Radiographic technical success, improved cosmesis, and Trunk shift of the Spine corroborate with patient-reported outcomes in Lenke 1C Adolescent Idiopathic scoliosis?
Shallu Sharma, Cody Eric Bunger, Thomas Andersen, Ebbe Stender Hansen
Deparment of Othropedics, Aarhus Univeristy Hospital , Noerrebrogade
Background: Findings, that scoliosis surgery
decreases the deformity magnitude and
risk of curve progression are widely
reported. However clear data on how
these choices translate into clinical
cosmesis, and patients’ long-term
satisfaction with management, self-image
and overall health is lacking.
Purpose / Aim of Study: To determine the correlation between the
postoperative radiographic and -cosmetic
improvements in Lenke 1C AIS with the
self-rated outcomes of health and
disability at follow-up as determined by
scoliosis research society
questionnaire, Oswestry disability index
score and EQ-5D
Materials and Methods: 24 Lenke 1C scoliosis patients (16.5
years), treated with posterior pedicle
screw only construct were included. The
coronal profile indices
(radiographic-cosmetic) of spine
deformity and trunk were measured
preoperatively, postoperatively and at
follow-up.Posterior Trunk Symmetry Index
(POTSI) was also measured. Pearson's
correlation analysis determined the
association between the radiographic-
cosmetic indices and patient outcomes
Findings / Results: Mean follow-up was 4.4 years. Thoracic
apical vertebra-T1 horizontal distance
(AV-TI) correction had significant
correlation with function-, self-image-,
and mental health scores (>0.55).
Similarly, thoracic apical vertebra
horizontal translation from central
sacral vertical line (AV-CSVL)
correction at follow-up had significant
correlation with self-image and
managements domains (>0.50). Follow-up
POTSI correlated well with SRS and EQ-5D
scores (>-0.54). Postoperative
trunk-shift did not influence the
outcomes; significant spinal realignment
was evident in follow-up resulting in
physiologic balance and acceptable outcomes.
Conclusions: Measures of trunk balance (AV-CSVL,
AV-T1 correction, POTSI) corroborate
with SRS scores. However thoracic Cobb
correction does not correlate with any
outcome
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.
169. Evaluation of stratified surgical intervention based on the Aarhus Spinal Tumor Algorithm
Miao Wang, Cody Eric Bünger, Kristian Høy, Peter Helmig, Ebbe Stender Hansen, Haisheng Li
Department of Orthopaedic E, Aarhus University Hospital NBG
Background: Treatments choices for spinal metastatic
patients is still a challenge for spine surgeons.
There is no gold standard for surgical
treatments. Aarhus Spinal Metastases
Algorithm has been designed based on
Tokuhashi scoring system and Tomita
classification. Aarhus Spinal Tumor Database
started to collect spinal metastatic patients’
data since 1992.
Purpose / Aim of Study: To evaluation the clinical outcome of surgical
treatments based on Aarhus Spinal
Metastases Algorithm.
Materials and Methods: This study consists of 569 surgically treated
spinal metastasis patients from Dec 1992 to
Jun 2012 in Spine Department Aarhus
University Hospital NBG.
We retrieved all the patients’ data from
prospective Aarhus Spinal Tumor Database,
Various questionnaires were used to collect
patients’ data before and after surgery.
Survival analysis was performed in all surgical
groups.
Findings / Results: The median survival of the entire study
population is 7.9 months. Female patients
have a median survival period of 15.3 months.
This is significantly longer (Log-rank test, p=
0.0001) compared with male patients’ median
survival time of 6.1 months. The surgery
related post-operative 30 days mortality rate
was 7.2%.The mean operation time was 3.2 ±
1.7 hours. The mean Blood loss during the
surgery was 1682.3 ml. 142 patients (40.1%)
got improved neurological function, 174
patients (50.1%) remained the same
neurological status, and 31 patients (8.9%)
had decreased neurological function.
Conclusions: Female spinal metastatic patients have a
significant longer survival time (p=0.0001)
compared with male patients. Patients
underwent surgical treatments based on
Aarhus Spinal Metastases Algorithm could
achieve longer survival period compared with
preoperative life expectancy. The surgical
intervention could improve or maintain the
postoperative neurological function.
170. The epidemiology of surgically treated spinal fractures in Eastern Denmark
Thomas Pensbo-Madsen, Kiran Anderson, Corrado Lucantoni, Santhana Rambabu, Martin Gehrchen, Benny Dahl
Rygsektionen, Rigshospitalet
Background: The epidemiology of spinal fractures is of relevance to monitor the
impact of this injury and if possible initiate preventive measures.
Few studies are representative of a complete population, and can
therefore be affected by referral bias. In October 2010 the first
SpineUnit in Denmark with neurosurgical and orthopaedic spine
surgeons was established. Consequently, all patients operated for
a spinal fracture in Eastern Denmark were operated in one facility.
Purpose / Aim of Study: The purpose of the present study was to compare the
epidemiology of surgically treated spinal injuries in a consecutive,
representative population of Eastern Denmark with data reported
in the literature.
Materials and Methods: The purpose of the present study was to compare the
epidemiology of surgically treated spinal injuries in a consecutive,
representative population of Eastern Denmark with data reported in
the literature.
Findings / Results: A total of 275 patients were included. The average age was 52 years
and 68% of the patients were men. The incidence of surgically
treated spinal injuries was 4.9/100.000/year and the incidence of SCI
was 0.9/100.000/year. The incidence of SCI was significantly higher
in cervical injuries compared to the other regions of the spine (P <
0.05). There was no significant difference in number of SCI’s
between primary treated patients and patients who were secondarily
transferred.
Conclusions: To our knowledge this is the first study on the epidemiology of
surgically treated spinal injuries in a Danish trauma population. The
incidence of SCI is lower than most other reports, requiring further
studies.
171. Satisfactory Curve Correction Using Ultra Low Profile Segmental Pedicle Screw Implant in AIS
Martin Gehrchen, Jonas Walbom, Lars Valentin Hansen, Benny Dahl
Spine Unit Department of Orthopaedic Surgery, National University Hospital Rigshospitalet, Copenhagen, Denmark; National University Hospital Rigshospitalet, Copenhagen, Denmark, National University Hospital Rigshospitalet, Copenhagen, Denmark
Background: Satisfactory correction and
maintenance of scoliotic curves by
segmental pedicle screw
instrumentation have been reported,
but there has been no report of curve
correction published using an ultra low
profile implant system
Purpose / Aim of Study: The immediate curve correction in a
prospective cohort study was analyzed
comparing preoperative Cobb and
postoperative Cobb angles in patients
operated with an ultra low profile
implant system.
Materials and Methods: A total of 51 consecutive patients
(median age: 15 years) underwent a
posterior spinal fusion with segmental
pedicle screw instrumentation. The
implant used was an ultra low profile
system with 5.5 CoCr rods and uni-
planar screws facilitating the curve
correction with supplemental direct
vertebral rotation when necessary.
Findings / Results: Median number of instrumented levels
was 10. Mean operating time was 242.7
minutes. The mean preoperative Cobb
angle of 59 degrees was reduced to a
Cobb angle of 20 degrees immediate
postoperative.
Conclusions: The results correspond to previous
findings in series of patients operated
with traditional pedicle screw implants
and support the use of ultra low profile
pedicle screw systems. This is indeed
beneficial in patients wit low body mass
index.
References
Kim YJ et al. Spine;29(18):2004-2048
Yilmaz G et al. J Pediatr Orthop
2012;32:490-499
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 Š) 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 mm’s) 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.
176. Tendon and skeletal muscle matrix gene expression and functional responses to immobilization and rehabilitation in young males: Effect of growth hormone administration
Anders Ploug Boesen, Kasper Dideriksen, Peter Schjerling, Christian Couppe, Michael Kjaer, Henning Langberg
Deptartment Ortopaedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital and Center for Healthy Aging, Faculty ; Department of Public Health, Faculty of Health and Medical Sciences , CopenRehab, University of Copenhagen, Denmark
Background: Counteracting the loss of muscle and
tendon function during periods of
immobilization and recovery of this
during rehabilitation represents a
challenge in clinical medicine
Purpose / Aim of Study: The aim of the study was to examine the
effect of growth hormone (GH) on
connective tissue of tendon and skeletal
muscle during immobilization and
retraining in humans
Materials and Methods: Young men (20-30 years; n=20) were
randomly assigned to daily recombinant
GH (rhGH) (33-50µg/kg/d) or placebo
(Plc), and had one leg immobilized for
two weeks followed by six weeks of
strength training. Cross sectional area
(CSA), maximal isometric muscle
strength (MVC) and biomechanical
properties of m.quadriceps and patellar
tendon were determined. Muscle and
tendon biopsies were analysed for
mRNA of collagen (COL 1A1/3A1),
insulin-like growth factors (IGF-1Ea/Ec)
and lysyloxidase (LOX).
Findings / Results: In skeletal muscle the CSA and MVC
declined with immobilization, and
recovered with rehabilitation similar in
both groups. Likewise, both groups
increased in IGF-1Ea/Ec and COL
1A1/3A1 expression in muscle during
retraining after immobilization compared
to baseline, and the rise was more
pronounced when subjects received
rhGH (p<0.05). The tendon CSA did not
change during immobilization, but
increased in both groups during six
weeks of rehabilitation (GH: +17%, Plc:
+11, p<0.05). A decline in tendon
stiffness after immobilization was
observed only in Plc (p<0.05), and an
increase during six weeks rehabilitation
was observed only in GH (p<0.05). IGF-
1Ea and COL 1A1/3A1 mRNA increased
with immobilization in the GH group only
(p<0.05), and LOX mRNA was after
immobilization higher in the GH group vs.
Plc (p<0.05).
Conclusions: In conclusion, GH stimulates collagen
expression in both skeletal muscle and
tendon and abolishes the normal
inactivity related decline in tendon
stiffness and in tendon LOX, and results
in an increased tendon CSA and
stiffness during rehabilitation. GH has a
matrix stabilizing effect during periods
with inactivity and rehabilitation in
humans.
177. Outcomes of acute fixation of chondral lesions following patellofemoral dislocation
Knud Gade Freund, Lene Guldberg Hansen , Peter Kraglund Jacobsen
Department of Orthopedic Surgery, Hospital of South West Jutland, Esbjerg, Denmark; Department of Radiology, Hospital of South West Jutland, Esbjerg, Denmark
Background: Patellofemoral dislocation is often
complicated by chondral lesions in the area
of the lateral condyl or on the patella.
Commonly, these lesions are unrecognized
or left untreated, but in rare cases the
avulsed chondral fragment has a size that
makes fixation possible. However, it is still
undisclosed whether this procedure benefits
the patients.
Purpose / Aim of Study: This study aimed to evaluate the outcome of
patients with chondral avulsion of the patella
or the lateral condyl, treated with acute
fixation after initial arthroscopy.
Materials and Methods: During a period of 5 years 10 patients with a
mean age of 18 (range: 11-35) were treated
with fixation. Time from trauma to operation
was an average of 8 days (range: 1-24).
Fibrin glue (Baxter, Deerfield, IL, USA) and
resorbable nails (Smart Nail, ConMed, Utica,
NY, USA) were used for fixation. Cross
sectional evaluation of clinical status was
performed using KOOS score and Lysholm
Tegner score. In addition, fragment healing
(cartilage height above 25% of normal) was
assessed by MRI.
Findings / Results: Outcome evaluation was performed on 8
patients at an average of 54 month (range:
8-77) after surgery. Two patients declined to
participate. In 6 patients (75%) clinical status
was satisfactory and this was associated
with fragment healing assessed by MRI.
Conclusions: Data suggest that acute fixation of chondral
lesions after patellofemoral dislocation may
be beneficial preventing complications and
improving patient outcome.
178. Trochleaplasty in the treatment of severe patellofemoral instability
Peter Lavard, Anette Hollm Kourakis, Michael Rindom Krogsgaard
Sportstraumatology M51, Bispebjerg Hospital
Background: Severe patellofemoral instability
defined as a chronic dislocation or
recurrent dislocations of patella
combined with severe trochlear
dysplasia result in deterioration of knee
function. It seems logical to restore
biomechanics of the patellofemoral
joint (PFJ) to prevent this, but there are
only few reports to support this.
Purpose / Aim of Study: In these patients our strategy since
August 2009 is to identify all
biomechanical pathologies of
importance for PFJ function and
restore each of them. We report our
experience in patents who had a
trochleaplasty (TP).
Materials and Methods: All patients defined as above had
trochlea dysplasia and patella height
measured on x-rays and TTTG
distance, patellar tilting and PF
cartilage condition visualized by MRI.
37 knees in 31 patients were
scheduled for TP. In 8 cases it was
decided peroperatively not to perform
TP, in one because of cartilage
degeneration and in 7 because
dysplasia was less severe than
expected. 29 had TP, 3 bilaterally. 24
also had a reconstruction of MPFL, 13
a medialisation and/or a distalisation of
the tibial tuberosity and 2 a varus
femoral osteotomy. Follow-up in 18
knees after 1 year and 11 after 2 years
with Kujala score and MRI.
Findings / Results: Median age 23 y (range 15-39). 2/5
knees without MPFL reconstruction
(MPFLR) had redislocations. After
MPFLR was perfored the dislocations
resolved. Three has arthroscopic lysis
after 3-6 months because of
arthrofibrosis. Mean Kujala score
increased from 38 preoperatively, to 78
after 1 year and 87 after 2 years. MRI
at 1 and 2 years showed normal signal
of the trochlear cartilage in all cases. In
2 knees with permanent patellar
dislocation this resolved completely.
Conclusions: The results were encouraging after 1
and 2 years with minimal complications
and no sign of degeneration of the
trochlear cartilage.
179. Incidence of arthroscopy-identified cartilage injuries of the knee and proportion leading to repair procedures– A nationwide Danish cohort study 1996-2011
Anil Mor, Miriam Grijota, Mette Nørgaard, Jonas Munthe, Martin Lind, Alma Becic Pedersen
Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; Orthopaedic Surgery, Institute of Clinical Medicine, Aarhus University Hospital
Background: Data on the incidence of knee cartilage
injury and time trend are sparse.
Purpose / Aim of Study: To validate the methods of identification of
knee cartilage injury patients through
arthroscopy procedure codes, and to
estimate the incidence of arthroscopy-
identified cartilage injuries and proportion of
cartilage injuries leading to repair procedure.
Materials and Methods: We identified patients aged 15-60 years
with incident knee arthroscopy from
1996-2011, without knee osteoarthritis
using Danish National Registry of
Patients (DNRP). Among these, we
identified patients with knee cartilage
injury based on procedure codes. Using
the description of arthroscopy findings in
medical records as gold standard, we
computed the positive and negative
predictive value (PPV and NPV) of
procedure codes for knee cartilage injury
in the DNRP. We calculated the
incidence of arthroscopy-identified knee
cartilage injury per 100,000 person-years
(py) and proportion of these leading to
repair.
Findings / Results: We identified 21,392 patients with knee
cartilage injury. The PPV and NPV of knee
cartilage injury codes were 88% and 99%,
respectively, compared with description of
arthroscopy findings. The overall incidence
of knee cartilage injury was 40/100,000 py
during 1996-2011. In total, 17% of cartilage
injuries lead to repair procedures. We saw
an increase in cartilage injury incidence over
the 15 years time period especially for
patients over 40 years. The age-
standardized (to the 1996 population) annual
incidence increased from 22/100,000 py in
1996 to 61/100,000 py in 2011.
Conclusions: The arthroscopy procedure codes in the
DNRP are valuable source to identify knee
cartilage injury patients. Incidence of knee
cartilage injuries increased substantially
during 1996-2011. Only one out of six
patients with knee cartilage injury procedure
code had repair procedure.
180. The influence of Patellar and Trochlear lesions on the results of anteromedial tibia tubercle osteotomy
Andreas Kiilerich Andresen, Jens Kristinsson
Department of Orthopaedic Surgery, Hjørring hospital
Background: Patellofemoral pain can be a diagnostic and
therapeutic challenge to any physician
because the findings observed with or
without the use of arthroscopy is not
always the source of pain. Knowledge of
the anatomy and biomechanics of the joint is
essential to make a correct diagnosis and
optimal treatment.
Purpose / Aim of Study: The aim of the study was to find the
correlation between articular lesion in patella
and trochlea with the outcome after
anteromedial tibia tubercle osteotomy.
Materials and Methods: All patients who have been treated with
Fulkerson osteotomy at our clinic in 2009-
2011 were included. 67 patients (71
knees) met the criteria for this
retrospective study with a mean follow-
op of 23 months. The average age at
time of surgery was 33 years. Clinical
assessment, radiographic studies and
arthroscopy was used to evaluate
malalignment and patellofemoral
arthrosis. Detailed operative description
and classification according to ICSR of
the cartilage in patella and trochlea were
available. The follow-up included
Lysholm score, Kujala score and VAS
score. The patients were asked about
their pain and working capacity had
decreased, unchanged or worsened
after surgery and whether they would
chose the same operation again.
Findings / Results: Overall 24(50%) of the patients said they
would have the procedure done again. 44 %
of the patients said that their knee pains
were less than before the operation. 26%
had no change in pains efter surgery, and
30% had a worse pain outcome than before
surgery.
Statistical analysis of the Kujala knee score
and Lysholm score showed no significant
differences between the different groups of
patellar cartilage lesions.
Conclusions: We have not been able to show any
statistical significant correlation between
articular lesion in patella and trochlea with
the outcome of anteromedial tibia tubercle
osteotomy.
181. Comparison of Two Humeral Head Resurfacing Implants. 2 year Results of a Randomized Controlled Clinical Trial
Inger Mechlenburg, Thomas Klebe, Kaj Døssing, Kjeld Søballe, Maiken Stilling
Orthopaedic Research, Aarhus University Hospital; Orthopaedic Department, Regional Hospital Silkeborg
Background: Humeral head resurfacing implants
(HHRI) are used to preserve bone
stock and restore normal anatomy in
the osteoarthritic shoulder joint.
Purpose / Aim of Study: To examine the clinical results, implant
migration and bone density changes in
proximity of the Copeland (Biomet Inc.)
and the Global C.A.P. (DePuy Int)
HHRI.
Materials and Methods: 31 patients (12 females) mean age of
63 (39-82) years with shoulder
osteoarthritis were randomly allocated
to a Copeland (n=13) or Global C.A.P.
implant (n=18). Post-op, 6, 12, 24
weeks 1 and 2 years migration of the
implants was measured with
radiostereometry (RSA). Bone mineral
density (BMD) was measured with
DXA. Pre-op, 3,6,12 and 24 months
Constant Shoulder Score (CSS) and
Western Ontario Osteoarthritis of the
Shoulder Index (WOOS) were
recorded.
Findings / Results: 2 patients were lost to follow-up and 5
implants were revised (3 Copeland, 2
Global C.A.P.)
At 2 years total translation (TT) was
0.60mm (SD 0.41) for the Copeland
and 1.01mm (SD 0.66) for the Global
C.A.P. (p=0.18). Between 1 and 2
years TT for the Global C.A.P.
increased (p=0.02) whereas the
Copeland HHRI had no significant
migration (p=0.15).
At 6 months BMD had decreased from
0.59 to 0.42 g/cm2 (p=0.01) around the
Copeland implant and from 0.44 to
0.37 g/cm2 (p=0.21) around the Global
C.A.P. No differences between groups.
Copeland: CSS increased from 57, 61,
71, 72, 77 and WOOS improved from
939, 645, 296, 295, 113. Global C.A.P:
CSS increased from 35, 51, 65, 73, 73
and WOSS improved from 1088, 568,
383, 381, 300. Both groups improved
significantly over time (p<0.01) with no
differences between the groups.
Conclusions: No difference in TT between the
groups. Bone was lost in proximity of
both implants. Patient-assessed
scores improved comparably in both
Groups.
182. Clinical implications of positive cultures in revision shoulder arthroplasty
Thomas Falstie-Jensen, Janne Ovesen, Viggo S. Johannsen
Orthopaedic, Aarhus University Hospital
Background: During the recent years
proprionibacterium acne is reported to
be an common pathogen in shoulder surgery.
We reviewed our revisions to judge if
any change in diagnostic approach was
needed
Purpose / Aim of Study: The aim of the study was to
retrospectively evaluate the prevalence
of positive cultures obtained at
revision shoulder arthroplasty.
Materials and Methods: From January 2009 to December 2012 we
revised 104 shoulder arthroplasties
because of pain, stiffness and
functional limitations. In 69 patients
biopsies were cultured either because of
suspected deep infection or as a routine
precaution.
All results from cultures and
preoperative blood samples were recorded.
Findings / Results: Cultures were positive in 31 out of the
69 sample sets. The most frequent
pathogen was Proprionibacterium Acnes,
which was identified in 19 of the
31sets. In the remaining cultures a
variety of pathogens were found,
primarily of low virulence
The main symptoms for patients with
positive cultures especially of the
Proprionibacterium subgroup were pain
and stiffness and very rarely the
classical signs of infection. Blood
samples displayed normal CPR, ESR and
leucocyte counts in many cases
During revision surgery membrane
formation around the prosthetic
components, severe stiffness, cloudy
fluid and osteolysis were associated
with an increased likelihood of infection.
Conclusions: Proprionibacterium Acnes is a very
common pathogen in revision shoulder
arthroplasty and should be suspected in
painful and stiff shoulders. Suspicion
of deep infection is of clinical
importance in decision making regarding
prosthesis retention or removal and
close collaboration with a microbiology
department is important in detecting and
treating these infections. . Selection
of appropriate antibiotics treatment
should take into consideration that
propionibacteriae are among the most
common pathogens.
183. Translation and validation of Western Ontario Osteoarthritis of the Shoulder Index (WOOS) – The Danish Version
Jeppe Rasmussen, John Jakobsen, Stig Brorson, Bo S Olsen
Department of Orthopaedic Surgery, Herlev University Hospital
Background: The Western Ontario Osteoarthritis of
the Shoulder index (WOOS) is a patient-
reported disease-specific questionnaire
for measurement of the quality-of-life in
patients with osteoarthritis.
Purpose / Aim of Study: The purpose of this study was to
describe the process used to translate
WOOS into Danish and to test the
translation in a Danish population in
terms of validity, reliability and
responsiveness.
Materials and Methods: The translation of WOOS was done
according to international standardized
guidelines. The psychometric properties
were tested in 20 consecutive patients.
The eligibility criteria were a diagnosis of
osteoarthritis without rotator cuff
arthropathy treated with primary
shoulder replacement. Patients were
excluded only in case of other pathology
of the upper extremity or in case of
cognitive or linguistic impairment
compromising the ability to complete the
questionnaires.
Findings / Results: The Pearson’s correlation coefficient
between WOOS and Constant-Murley
Score (CMS) preoperatively was 0.62, P
= 0.004 and the correlation in change of
score between WOOS and CMS was
0.73, P<0.001. The correlation
coefficient between WOOS and CMS,
SF-36 and Oxford Shoulder Score
postoperatively was 0.82, P<0.001; 0.48
P = 0.03; and 0.82, P<0.001 respectively.
There were no floor and ceiling effect.
Cronbach Alpha was 0.98. Intra Class
Correlation between test and retest was
0.96. The Standardized Response Mean
was 1.41 and Effect Size 2.32.
Conclusions: We have shown that the Danish version
of WOOS, translated according to
international standardized guidelines,
has substantial statistical and clinical
psychometric properties at the same
level as described for the original
version.
184. Construct validity and responsiveness of functional measures used in subjects following an outpatient prosthetic rehabilitation program after a major lower limb amputation
Kajsa Lindberg, Joanne Boelskifte, Jimmy Johansson, Mie Rinaldo, Morten Tange Kristensen
Rehabilitation Center Vanløse, Community of Copenhagen; Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical Therapy and, Copenhagen University Hospital Hvidovre
Background: Subjects surviving a major lower limb
amputation (LLA) are quite often
provided with prosthesis for optimised
function in daily life, but there is a lack
of knowledge about the effect of
rehabilitation programs, as to which
tests to be used to show progress.
Purpose / Aim of Study: To examine construct validity and
internal responsiveness of
performance-based measures of
functional mobility and endurance after
LLA.
Materials and Methods: Eighteen subjects with a recent below
knee amputation (BKA), and 15 with
an above knee amputation (AKA), 6
women and 27 men with a mean age
of 63.6 (SD, 12.4). All subjects
followed a rehabilitation program (twice
weekly), focused at improving balance,
strength and prosthetic function, and
performed the Timed Up and Go
(TUG), the 10 meter fast speed
walking test (10MWT) and 2 minute
walking test (2MWT) at baseline and at
end of the program. Pearson´s r
assessed construct validity, while
internal responsiveness was assessed
by calculating the effect size I (ESI) as
the mean change in performance
scores / by the baseline SD, and effect
size II (ESII) as the mean change in
scores / by the SD of changes.
Findings / Results: The three outcome measures were
highly correlated (r>0.66, P<0.001)
after the program, while effect size was
high to medium; 10MWT (ESI 1.03,
ESII 1.06), 2MWT (ESI 1.0, ESII 1.15)
and TUG (ESI 0.63, ESII 0.94).
Performances improved from 39-99%
and subjects with a BKA performed all
tests significantly faster (P=0.01) than
those with an AKA. Eleven subjects
walked 1.0 m/s or faster at end of
training.
Conclusions: Construct validity and internal
responsiveness of the three measures
were high, and is recommended be
used by other centres. Still, only one
third walked faster than 1m/s,
supporting the need for studies
examining the effect of e.g.
progressive strength training for
improvements.
185. Pneumococcal sepsis-induced Symmetrical Peripheral Gangrene
Taj Haubuf, Klaus Kjær Petersen , Kurt Fuursted, Alex Lund Laursen, Johnny Keller
Orthopedic, Aarhus University Hospital; Microbiology, Aarhus University Hospital; Infectious Disease , Aarhus University Hospital
Background: Symmetrical Peripheral Gangrene -
SPG (also known as Purpura
Fulminans) caused by Streptococcus
pneumonia (SP) is an uncommon,
though very severe and potential lethal
complication to septicemia.
Purpose / Aim of Study: To describe our experience with
patients with SPG.
Materials and Methods: Between 2003 and 2013 eleven
patients SPG due to SP where treated
at Aarhus University Hospital. Patient’s
files were retrospectively studied
regarding clinical status,
predispositions, multi-organ
involvement, days of admission,
surgical treatment and prostheses
status.
Findings / Results: Eleven patients, median age 55 years
(range 38-71 years) admitted with
septicemia developed SPG. Four
patients had earlier undergone
splenectomy and one patient had no
spleen, due to SLE. Six were smokers
and only one patient had no obvious
predisposing conditions. SP sensitive
to penicillin was found in blood
samples in all patients. All had purpura
and eight had skin necrosis of lips and
nose. All patients received high doses
of penicillin and intensive care, three
patients died during hospitalization,
one prior to surgical intervention. Ten
patients required extensive surgical
intervention resulting in four humeral-,
four antebrachium-, 28 digits and hand-
, four femoral-, three through knee-,
eleven crural and one toe amputations.
Nine patients underwent dialysis and
seven received vasopressors. Median
time from onset of symptoms to
amputation was 21,7 days (range 5-
100 days). After a protracted
rehabilitation period six patients were
mobilized on bilateral leg prostheses.
One patient became wheelchair bound.
Conclusions: Symmetrical Peripheral gangrene is a
serious complication to Streptococcus
pneumonia septicaemia with at high
mortality- and complication rate with
risk of extensive amputations, resulting
in long admissions and loss of daily
functions.
186. Ultrasound guided core needle biopsy of peripheral nerve sheath tumors. A retrospective study.
Damgaard Jacob , Hauge Hansen Bjarne , Holmberg Jørgensen Peter , Keller Johnny, Hellfritzch Michel , Baad-Hansen Thomas
Center for Bone and Soft Tissue Sarcomas, Aarhus University Hospital, Denmark; Dept. of Radiology, Aarhus University Hospital, Denmark
Background: Surgical biopsies have until recently been
the preferred method for diagnosis of tumors
arising form peripheral nerve tissue.
Ultrasound guided core needle biopsy
(UGCNB) has within the last few years been
introduced in diagnosis of these tumours.
Fewer complications, less unpleasantness
for the patients, faster recovery, and quicker
diagnostic work-up have been reported.
Purpose / Aim of Study: The aims of the study were to identify
causes of UGCNB complications, to
evaluate diagnostic strength of UGCNB in
terms of grading between benign and
malignant specimens, and finally, to describe
time consumption using this diagnostic
method.
Materials and Methods: We retrospectively reviewed 69 patients
who underwent UGCNB between January
2004 and December 2012. Complications
due to the procedure were assessed.
Sensitivity, specificity; positive predictive
value (PPV) and negative predictive value
(NPV) were calculated based on the current
dataset. Furthermore, time from referral to
final diagnosis was calculated.
Findings / Results: A single patient described mild pain after the
procedure, which resolved after 2 days. No
permanent injuries were reported. In 82% of
the cases, UGCNB was able to distinguish
between malignant and benign material.
Sensitivity was 0.8, specificity was 1.0, PPV
was 1.0, and NPV was 0.97. Mean time from
referral to UGCNB was 7 days (range 0-43
days). Mean time from UGCNB until the final
diagnosis was 7 days (range 1-21 days).
Conclusions: UGCNB of PNST is a safe method.
However, UGCNB cannot stand alone in the
clinical work-up due to the risk of false
negative results. The results shows, that
time from referral to decision of treatment is
acceptable and in accordance with the
National Danish Cancer Patient Pathway for
soft tissue sarcomas.
187. Local Recurrence Rate after Surgical Excision of Desmoid Fibromatosis.
Elinborg Mortensen, Thea Hovgaard, Michael Mørk Petersen
Department of Orthopaedic Surgery, Rigshospitalet, Denmark
Background: Surgical treatment of desmoid
fibromatosis is still the standard
treatment but oncologic treatment with
medicine or radiation therapy is
increasingly applied.
Purpose / Aim of Study: To determine the local recurrence rate
among surgically excised desmoid
fibromatosis.
Materials and Methods: We retrospectively assessed all
tumours (34 patients (F/M = 25/9,
mean age 38 (12 – 67) years)) of the
extremities, spine and trunk wall
(abdominal wall/ other
locations=13/21) with the histology
desmoid fibromatosis surgically
excised at our clinic between 1995 and
2005. Patients primarily operated on in
other clinics or operated on for a local
recurrence were excluded. Data were
extracted from the patient files and
from the Danish National Pathology
Registry (DNPR). Statistics: Data are
presented as mean (range). Kaplan
Meir survival analysis.
Findings / Results: Mean tumor size was 6.1 (2-15) cm
and the surgical margins obtained
were: wide (n=28), intralesional (n=3)
or inconclusive (n=3). 7 patients had a
local recurrence 21.5 (5-51) months
after initial tumour excision (mean
DNPR follow-up for patients without
recurrences was 119 (96-220) months)
corresponding to a probability of 5-year
local recurrence free survival of 79%.
Local recurrences were seen in 6
patients with wide margin and 1 patient
with intralesional margin. The majority
of local recurrences were seen in
patients with tumours of the extremities
and paraspinal location (n=5) and 2
abdominal wall tumour recurred.
Conclusions: Overall the treatment seemed
reasonable with a 79% probability
avoiding local recurrences after 5
years. The recurrences did not seem
to depend on the surgical margin, thus
a less aggressive approach not always
aiming at wide tumour resection could
be considered.
188. Persistent wound drainage after tumor resection and endoprosthetic reconstruction the proximal femur
Peter Horstmann, Werner Hettwer, Tomas Grum-Schwensen, Michael Mørk Petersen
Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denma
Background: Persistent post-operative wound drainage is associated with an increased incidence of periprosthetic infection and occurs in about 4% of conventional total hip arthroplasties. Similar data is not available for endoprosthetic reconstruction of the proximal femur after tumor resection.
Purpose / Aim of Study: To determine the duration of postoperative surgical wound drainage, administration of antibiotics and date of discharge, and to establish if a change in the wound closure routine could improve these variables.
Materials and Methods: We performed a retrospective review of all adult patients (n=41, mean age = 63 (37-86) years) who received a proximal femoral tumor arthroplasty in our department in 2012 and collected similar data prospectively from 2013 (n=5, mean age = 72 (54-86) years), where routine wound closure with staples was substituted with intradermal suture, application of Steristrips and an occlusive skin adhesive (Liquiband Flex).
Findings / Results: In 2012 mean duration of post operative wound drainage was 8 (2-45) days, mean duration of administration of postoperative antibiotics was 8.2 (1-45) days and mean hospital stay was 9.4 (3-45) days. Nineteen (45%) had prolonged wound drainage (7 days or longer). The preliminary first 5 patients, who underwent skin closure with a skin adhesive, all had dry wounds at the first scheduled post operative dressing change (mean 2.9 (2-4) days), mean duration of post operative administration of antibiotics was reduced to 3.6 (2-7) days and mean hospital stay was reduced to mean 6.5 (3-10) days.
Conclusions: Our small sample showed a high prevalence of prolonged drainage from the surgical site. A simple change in the wound closure routine appears to show a promising reduction in wound drainage, postoperative antibiotic administration, and hospital stay. Further studies are warranted.
189. Computer assisted 3D navigation for minimally invasive bone tumor biopsy and resection
Werner Hettwer
Muskuloskeletal Tumor Section, Rigshospitalet
Background: Three dimensional computer navigation
enables the surgeon to intraoperatively
verify and confirm the precise location
of intraosseous bone lesions and helps
achieve adequate, representative tissue
samples and/or resection margins, even
with a minimally invasive approach,
without obvious compromise in patient
safety and surgical accuracy.
Purpose / Aim of Study: To share our initial experience with
computer navigation using the O-arm in
selected muskuloskeletal tumor cases.
Materials and Methods: We performed six minimally invasive
open biopsies and/or resections of
intraosseous musculoskeletal tumors,
using intraoperative 3D computer
navigation (Medtronic Stealth Station and
O-Arm). All lesions were located in
anatomically challenging locations, with
no anatomical landmarks available to
safely and adequately guide a
conventional open procedure.
Of five intraosseus lesions, four were
located in the os ilium and one in the
proximal tibia. The remaining bone tumor
was an osteochondroma of the proximal
fibula in close proximity to all 3
neurovascular bundles, which was
resected in its entirety using navigated
osteotomy.
Findings / Results: All procedures could be successfully
completed through limited, minimally
invasive approaches and conversion to
a larger open approach was not
required in any case. All biopsies yielded
adequate material for pathological
diagnosis and histological examination
confirmed that the desired margin of
resection was achieved in all cases.
Conclusions: Our initial experience with 3D computer
navigation confirms that accurate biopsy
and resection of intraosseous bone
lesions appears feasible through
minimally invasive approaches, without
compromising patient safety and surgical
accuracy, even in anatomically difficult
locations.
190. Testing A New Type Of Osteosynthesis And After Care – In Treatment Of Antebrachium Fractures in Children, Preliminary Result Of A Prospectiv Case-Control Study.
Ture Karbo, Stig Sonne-Holm, Christian Wong
Pediatric orthopaedic section, Hvidovre University Hospital
Background: Fractures of the lower arm in children are
the most common, comprising about
40% of all pediatric fractures. Generally
there is consensus regarding treatment,
but the displaced distal dia-metaphyseal
fractures (DDMF) are there no apparent
adequate surgical option.
A new type of combined internal elastic
nail and external fiksation (MIROS@)
was applied in 10 patients compared with
10, age and fracture type matched,
children.
Purpose / Aim of Study: To compare MIROS@ to the conventional
osteosynthesis methods in treatment of
children with DDMF of the antebrachium.
Materials and Methods: The prospective case-control study
including 20 children, age 4-15, operated on
with standard treatment - with elastic nails /
Kirschner wires or MIROS@ for DDMF.
Follow-up at 3 month after removal of
osteosynthesis material including x-rays of
both antebrachii, systematic testing of
bilateral range of motion, visual analogue
pain scale and strength measurements.
Findings / Results: There were minor differences in clinical and
radiological outcome after 3 month follow up.
Operating for insertion and removal time of
the MIROS was faster with a smaller
surgical incision.
All Miros@ had a plaster-cast-free
aftercare.
Conclusions: MIROS@ is as good as conventional
osteosynthesis methods at 3 month follow-
up, though having advantages – faster
operating time, less surgical scaring, faster
removal, no plaster cast and early
movement of elbow-/wrist-joints.
However, prospective randomized trials
should be performed.
191. Normal distribution of seating balance for healthy Danish children
Line Kjeldgaard Pedersen, Ahmed Abdul-Hussein Abood, Ole Rahbek, Bjarne Møller-Madsen
Department of Children’s Orthopedics, Aarhus University Hospital
Background: Measurement of seating balance is a
promising method for analysis and
evaluation of children’s seating
balance in relation to orthopedic
conditions such as hip dislocation and
scoliosis. Furthermore seating balance
can be used to evaluate postural
control in children with
neurodevelopmental diseases such as
Cerebral Palsy.
Purpose / Aim of Study: To develop a normal distribution of
seating balance in healthy Danish
Children for comparison with children
with orthopedic disorders.
Materials and Methods: Sixty-six children aged 7-14 years from
the 1th, 3 th, 5th and 7th levels were
included at a Danish primary school
after informed consent were obtained.
Tekscan CONFORMat Research was
used and the measurements of seating
position were analyzed with the
Tekscan Sway Analysis Module. Three
consecutive measurements of both
normal seating and seating in up-right
position were used to calculate the
average result for each of the 5
parameters of balance. The
percentage of pressure distribution on
the left and right side were calculated.
Findings / Results: Data were stratified according to age,
weight and height. For the 1th level
(n=15) two of five parameters for
balance showed improvement in the
up-right position (p˂0,0003, p˂0,013)
and primarily for females. Furthermore
a significant correlation was found
between seated balance and both
height and weight. Statistical analysis
with STATA 11 was used, and
Spearman correlation and students t-
test was calculated.
Conclusions: We measured the effect of BMI, age,
gender and back position on seating
balance and have established a
normal distribution for seating balance
in healthy Danish children. This normal
distribution can be used as reference
data for comparison of seating balance
in children with orthopedic disorders in
a clinical setting.
192. Hamstring lengthening in CP patients by needle tenotomy is safe
Lauge Østergaard, Gert Rahbek Andersen
Orthopedic Department U, Rigshospitalet
Background: Crouch gait among CP patients are caused
by hip and knee flexion contractures.
Crouch gait can be treated by lengthening of
the hamstrings. Hamstring lengthening is
usually done by open surgery.
Purpose / Aim of Study: This study examines whether there is any
statistical significant difference between
making hamstring lengthening by open
surgery or by hypodermic needle tenotomy.
Materials and Methods: Data were collected retrospectively by
looking through medical records. 59 patients
(93 limbs) were included in this study and all
the patients had undergone hamstring
lengthening. The population was subdivided
into two groups. Group 1 (44 patients, 65
limbs) had their hamstring lengthened by
tenotomy with a hypodermic needle. Group
2 (15 patients, 28 limbs) had their hamstring
lengthened by open surgical procedure.
Findings / Results: Of the 44 patients in group 1 there was one
adverse effect. This patient had pain
postoperatively in the lateral hamstring on
the operated leg. Of the 15 patients in group
2 there was one adverse effect as well. This
patient experienced pain around the area of
the ischiadic tubercle. In group 1 there was
one relapse in the follow up period and in
four situations the surgical procedure had no
effect. In group 2 there was no effect of the
surgical procedure in two cases.
Conclusions: There was no statistical significant
difference (0,5>p>0,25) between the rate of
complications in the two groups.
Furthermore there was no statistical
difference on the missing effect or relapse of
the surgical procedure between the two
groups.
Hamstring lenthening by hypodermic nedle
tenotomy is safe and outcome is
comparable to open surgery; is easy to
perform in supine position and thus offers
perioperative evaluation of the effectiveness
of the lenthening.
193. Normal distribution of standing balance for healthy Danish children
Line Kjeldgaard Pedersen, Habib Ghasemi, Ole Rahbek, Bjarne Møller-Madsen
Department of Children’s Orthopedics, Aarhus University Hospital
Background: Pedobarographic measurements are
increasingly used in children with
orthopedic disabilities undergoing
surgical procedures. Recent
technology provides usable sway
analysis of balance parameters but a
normal distribution for the standing
balance of healthy children is not
available.
Purpose / Aim of Study: Firstly, to assess standing balance in
healthy Danish children using
pedobarographic sway analysis.
Secondly, to establish a reference for
comparison of balance in children with
orthopedic disorders.
Materials and Methods: Sixty-six children aged 7-14 years from
the 1 th , 3 th, 5th and 7th levels were
included at a Danish primary school
after informed consent was obtained.
The Tekscan F-scan Research was
used and the pedobarographic
measurements were analyzed with
original Sway Analysis Module
software. Three consecutive
measurements on standing
pedobarograms was used to calculate
the average result with eyes open and
eyes closed for each of the 5
parameters of balance. Demographic
data such as age, height and weight
were obtained from each child.
Findings / Results: A positive correlation was observed
between two of five balance
parameters for both Body Mass Index
(BMI) (p˂0,0008) and age (p˂0,0001).
Three of five balance parameters were
significantly worsened with closed eyes
compared to open eyes (p˂0,0000)
especially for the younger levels. In
general females had a significantly
better balance than males with open
and closed eyes.
Conclusions: We measured the effect of BMI, age,
gender and visual information on
standing balance and have established
a normal distribution for standing
balance in healthy Danish children.
This normal distribution can be used
as reference data for comparison with
children with orthopedic disorders.
194. Radiographic results of Dega's Transiliac Osteotomy in children with subluxation and dislocation of the hip joints.
Benjamin Presman, Stig Sonne-Holm
Division of Pediatric Orthopaedic Surgery, Hvidovre University Hospital
Background: Hip dislocation in children with spasticity is a
severe problem associated with pain,
development of severe contractures,
windswept deformity, and scoliosis. The
primary cause of the dislocation is muscle
imbalance. Strong flexors and adductors
across the hip overpower the abductors and
extensors muscles causing the rotational
center of the joint to move from the center of
the femoral head to the lesser trochanter. As
a result, the hip joint is destabilized and is
thus more likely to dislocate.
Here, we report radiographic results of 84
children, most of them with cerebral palsy
who were treated for a hip dislocation or
subluxation. This was done with a soft tissue
release, femoral osteotomy, and the Dega
osteotomy.
This evaluation can be used for adjusting
current interventions concerning subluxation
and dislocation in children.
Purpose / Aim of Study: A detailed analysis of the operational effects
on radiological parameters was measured
before surgery, after surgery, and at follow
up.
Furthermore, we subdivided the Dega
operations in accordance to the release
preformed on the soft tissue in order to
evaluate the effect of these procedures on
the radiological parameters
Materials and Methods: All patients who have undergone pelvic
osteotomies between 1988 and 2013 were
selected. The radiological x-ray
measurements before surgery, days after
surgery, and on the most recent x-ray were
obtained from each patient. X-ray
parameters were assessed using the
picture archiving and communication system
(PACS) computer system. The
assessments were done by the same
person.
Findings / Results: X-ray parameters improved immediately
after the operation.
Conclusions: In conclusion, treatment with soft tissue
release, femoral osteotomy, and the Dega
osteotomy can keep the joint in place and is
a nessity especially in children with cerebral
palsy.