Fra onsdag den 23. oktober
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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.