Fra onsdag den 21. oktober
10:30 –
lokale: Capital Foyer

Postere med foredrag er listet under Session 14, Session 15, Session 16

173. Functional outcome and patient satisfaction following implant removal in patients treated for a clavicle fracture.
Andreas Saine Granlund, Ilija Ban, Anders Troelsen
Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre

Background: Implant related discomfort (soft-tissue irritation, pain and cosmetics) are often seen in patients with a clavicle fracture treated surgical. Even the newer low profile and precontoured plates are associated with a high discomfort rate as close to 30% of these plates are removed. Whether implant removal results in improved functionality and patient satisfaction is unknown.
Purpose / Aim of Study: Primary aim was to investigate whether plate removal following clavicle fracture treatment had a desired effect and satisfaction according to the patient. Secondary aim was to assess functionality and complications following implant removal.
Materials and Methods: 97 patients, (73 males, mean age 43 years) had between 2007 and 2014 a clavicle plate removed at our institute. A purpose made questionnaire was used to assess self-perception of cause of implant removal, remission, complications and overall satisfaction. Functionality was assessed using the short version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH). Assessment was primarily by phone interview.
Findings / Results: 74% of the plates that were removed were primarily used to treat midshaft fractures, with the rest used for lateral fractures. Pain or soft tissue irritation was indication in 52% of all cases with another 11% caused by cosmetic deficits. 58% of all patients were available for phone interview with a minimum of 1 year follow-up. 75% reported satisfaction with plate removal. 29% had complete remission in symptoms. Another 46% had partially remission, 14% had no remission and 11% reported worsening. Mean QuickDASH was 8 [range 0 to 91]. 67% reported no complication with 19% complaining of larger scar tissue.
Conclusions: Clavicle plates causing nuisance to the patient can be removed expecting satisfying results with close to normal functionality and few complications.

174. Eighty-seven patients operated due to Herniated Disc. No correlation between the presence of Modic changes and Propionibacterium Acnes.
Anne Hansen, Laura Mathiesen, Thomas Bender, Peter Lemcke, Søren Fruensgaard, Malene Laursen
Spine , CPK, Regionshospitalet Silkeborg, HEM; Spine, CPK, Regionshospitalet Silkeborg, HEM

Background: A recent systematic review has found moderate evidence for a correlation between the presence of p. acnes and back pain and/or Modic changes in patients with disc herniation. Further studies are needed to determine whether these findings are results of contamination or represent a low grade infection.
Purpose / Aim of Study: To investigate the presence of propionibacterium acnes in patients operated due to disc herniation. Further, to examine a hypothesised association within the presence of Modic changes and bacteria.
Materials and Methods: Eighty-seven patients undertaking an open MIS approach due to disc herniation. During operation, a total of six disc-tissue samples, using separate sterile single use instruments were obtained. Five samples were inoculated into thioglycolate agar tubes and long-time incubated (14 days) and observed for growth. Positive samples were interpreted according to the Kamme & Lindberg definition, the “standard” used for discrimination between contamination and true infection. One sample was stored for later PCR. Modic changes were examined on MRI scans (preoperatively).
Findings / Results: Modic changes were seen in 51% of patients. 5 patients (6%), had disc tissue infected by p. acnes. 2 of the 5 patients with disc infection had no Modic changes.
Conclusions: A low incidence of p. acnes in herniated discs (6%) was found using an open MIS approach combined with a tissue-handling technique am. Kamme. No correlation was found between the presence of Modic changes and p. acnes. The low incidence of infection might be due to a low contamination-rate i.e. the peroperative sample handling-technique am. Kamme and/or an open surgical technique versus scopic techniques.

175. The use of Quantitative Sensory Testing as predictive measure of surgical outcome in Lumbar Disc Herniation
Christian Støttrup, Søren O'Neill, Mikkel Andersen
Center for Spine Surgery and Research - Middelfart, Lillebaelt Hospital - University of Southern Denmark; Rygmedicinsk Afdeling - Middelfart, Lillebaelt Hospital

Background: Lumbar disc herniation (LDH) is associated with great morbidity and significant socio- economic impact in many parts of the world. Patients where pain and disability is unacceptable, surgical intervention provides effective clinical relief in many cases. Unfortunately, 10-20% of patients who undergo surgery have little or no effect of the intervention. Currently the selection of patients suited for surgery is based on clinical workup and surgeon experience.
Purpose / Aim of Study: The aim of this study is to evaluate if quantitative sensory testing (QST) can be used as a preoperative tool for identifying patients with higher chance of favorable outcome following surgical intervention.
Materials and Methods: Patients with first-time LDH found eligible for surgery were included in an ongoing study and tested using a standardized protocol for QST preoperatively and 6 weeks post-op. Patient reported outcome measures; EQ5D, VAS-leg and -back were also collected. All patients followed normal surgical and post-operative regime.
Findings / Results: Preliminary data on 16 patients were used in these analysis. A correlation of 0.59 was found between the preoperative result of a cold pressor test (CPT) and the 6 weeks post-operative change in EQ5D, with a significance level of 0.01. A correlation of 0.43 was found for CPT and change in VAS- leg with a significance level of 0.10. There seems to be a correlation between pressure pain response and surgical outcome, however current data does not provide significant results.
Conclusions: Preoperative cold pressor test results seems to be correlated with post-operative PROMs, and current data also suggest correlation between other parameters in quantitative sensory testing and prediction of surgical outcome in LDH. Quantitative sensory testing may have potential as a preoperative predictive tool of patient outcome.

176. Noises from total hip arthroplasty and patient-reported outcome (PRO)
Claus Varnum, Alma B. Pedersen, Per Kjærsgaard-Andersen, Søren Overgaard
Department of orthopaedic surgery, Vejle Hospital; Department of clinical epidemiology, Aarhus University Hospital; Department of orthopedic surgery and traumatology, Odense University Hospital

Background: Noises from total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) and metal-on- metal (MoM) bearings have been described in small series of patients – but not with comparison to metal-on-polyethylene (MoP) bearings.
Purpose / Aim of Study: We aimed to describe the frequency of patient reported noises from THA with CoC, MoM, and MoP bearings and compare PRO scores from patients having noisy THA to PRO scores from patients having silent MoP THA.
Materials and Methods: We identified 3,762 patients from the Danish Hip Arthroplasty Registry operated from 2002 to 2009 and with no revision, who received the following PROs: The hip disability and osteoarthritis outcome score (HOOS), the EQ-5D, the UCLA activity score, and a questionnaire about noises from the THA. 145 patients were excluded due to confirmed revision, and 3,082 patients responded (response rate 85%). Multivariate linear regression was used to compare mean values of PRO scores within the noisy THAs with the 3 types of bearings to silent MoP THA.
Findings / Results: Among responders, 1,393 (45%) had CoC, 512 (17%) MoM, and 1,177 (38%) MoP THA. 27% of patients with CoC, 29% of patients with MoM, and 12% of patients with MoP bearings had experienced noises from the THA. Significantly lower mean scores of all HOOS subscales, EQ-5D index, and EQ-5D VAS were shown for patients experiencing noises from the CoC, MoM or MoP THA compared to patients having silent MoP THA. Only for the ULCA activity score, no difference was found for noisy CoC THA compared to silent MoP THA, but patients having noisy MoM and MoP THA had significantly lower mean UCLA activity scores when compared to patients having silent MoP THA.
Conclusions: The frequency of noises was high and even present in MoP THA. Patients with noises from CoC, MoM, and MoP THA had lower PRO scores than patients without noises from their MoP THA.

177. Malformation is a risk factor for osteoarthritis in young THA patients - a prospective multicenter cohort study
Dennis Karimi, Anders Troelsen, Jakob Klit
Orthopedic Surgery, Copenhagen University Hospital of Hvidovre

Background: In Denmark, 120.988 total hip arthroplasties (THA) has been registered from 1995 to 2012. Twenty % are younger than 60 years. The indication is in 79.2% primary idiopathic osteoarthritis (OA). OA is a multifactorial disease correlated to age and hip malformations like CAM-deformity. In population studies this deformity has been identified in 17–24% of men and in 4% of women. Still it is uncertain why young adults develop primary idiopathic OA.
Purpose / Aim of Study: Our aim was to assess the correlation between hip malformations and OA in a cohort of younger patients undergoing THA by analyzing distribution and type of hip malformations.
Materials and Methods: In this consecutive multi-center cohort study, 96 consecutive patients (107 hips) met the inclusion criteria. One observer performed radiographic measurements for malformations and radiographic OA defined by Tönnis-grade on a dichotomous scale. Inter- and intraobserver variability was measured. Data is presented as prevalence and OR.
Findings / Results: Male/female prevalences of hip malformations were; CAM-deformity 60.4%/28.3%, coxa profunda 34.9%/26.4%, acetabula dysplasia 11.3%/3.8%, acetabular retroversion 34%/27.4%. Concomitant hip malformation was 100%. The Tönnis grade was 22.2% and 77.4%. No association were found, all OR<1 for malformations and the Tönnis grade.
Conclusions: All patients showed malformations. CAM- deformity was more than three times as frequent as in population studies. Acetabular deformities were coxa profunda and acetabular retroversion. Hip dysplasia was less typical. In conclusion, our observations showed a high prevalence of hip malformations in young OA patients, supporting the emerging consensus that hip malformations lead to OA in a young age. Focus on hip malformations for correct registration and referral to joint-preserving surgery is essential.

178. The association between preoperative symptoms of obesity in knee and hip joints and the change in quality of life after laparoscopic Roux-en-Y gastric bypass
Ida Birn, M.Sc, Inger Mechlenburg, M.Sc, PhD, Anette Liljensøe, M.Sc, PhD, Kjeld Soballe, MD, DMSc, Professor, Jens Fromholt Larsen, M.D, PhD
(1) Department of Orthopaedic Surgery , (2) Department of Physiotherapy and Occupational Therapy, (1) Aarhus University Hospital, Denmark, (2) Aarhus University Hospital, Denmark ; (1) Department of Orthopaedic Surgery, (2) Centre of Research in Rehabilitation (CORIR), Department , (1) Aarhus University Hospital, Denmark, (2) Hospital and Aarhus University, Denmark); Department of Orthopaedic Surgery , Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Bariatric Surgery , Mølholm Private Hospital, Denmark

Background: Weight loss after bariatric surgery is shown to reduce knee and hip pain in the majority of the severely obese. Studies indicate that with a reduction in musculoskeletal symptoms quality of life (QoL) will improve. The group of severely obese with knee and hip symptoms might, therefore have potential for a large improvement in QoL after a bariatric surgery.
Purpose / Aim of Study: to assess the association between the degree of knee and hip symptoms before a laparoscopic Roux-en-Y gastric bypass (LRYGB) and the improvement of QoL, one year after the surgery, in severely obese.
Materials and Methods: This study is a historical cohort study based on data collected consecutively at the private hospital Mølholm, Denmark. Before LRYGB surgery 4,548 severely obese completed a questionnaire on knee and hip symptoms of obesity and QoL. One year after surgery, 2,862 (62.9%) of the participants answered the same questionnaire again.
Findings / Results: 81.6% of the participants with knee symptoms and 74.5% of participants with hip symptoms experienced a reduction of these after the LRYGB surgery. Participants with moderate or severe knee or hip symptoms, before the surgery, experienced a statistically significantly larger improvement of their QoL, compared to participants without symptoms before the surgery. Furthermore, an association between the reduction of knee and hip symptoms and the improvement in QoL was found.
Conclusions: Severely obese with moderate or severe preoperative knee and hip symptoms experienced a larger improvement of their QoL after a LRYGB compared to participants without symptoms before the operation.

179. Clinical and radiological improvement after trochleoplasty in patients with patellar dislocation secondary to trochlea dysplasia. A pilot study.
Isabel Maria Nyring, Philip Hansen, Mikael Boesen, Peter Lavard, Anette Holm Kourakis, Michael Rindom Krogsgaard
Department of Orthopaedic Surgery, Bispebjerg Hospital; Department of Radiology, Frederiksberg Hospital

Background: Trochlear dysplasia is an important risk factor for patellar instability. Trochleoplasty is a surgical procedure which reshapes the trochlea groove. Previous studies in smaller series shows encouraging results after trochleoplasty.
Purpose / Aim of Study: To evaluate the quantitative changes in radiological measures and clinical outcome after trochleoplasty as a pilot study.
Materials and Methods: Since August 2009, 54 patients (59 knees) with recurrent patellar instability underwent a Bereiter-type trochleoplasty. Except for three knees, the procedure was combined with an additional procedure according to the underlying etiological cause of patellar dislocations. Based on availability of pre- and postoperative MRI we selected 9 knees for evaluation of the patella-femoral joint. Clinical condition was evaluated preoperatively and one year postoperatively with the Kujala score. We compared the sulcus angle, patellar tilt, tibial tuberosity- trochlea groove distance (TTTG), patellar- trochlear index (PTTI) and modified Insall- Salvati index in pre- and postoperative MRI scans.
Findings / Results: Postoperatively, mean Kujala score increased (Mean Difference (MD): 16.11, Confidence Interval (CI): 6.6-25.62; P=0.005). The sulcus angle (MD: 11.43°, CI: 4.02-18.85°; P=0.007) and the patellar tilt (MD: 12.19°, CI: 7.60-16.77°; P<0.001) decreased postoperatively. No difference was found between TTTG (MD: 4.39 mm, CI: -2.57-11.35 mm; P=0.184), PTTI (MD: 0.05, CI: -0.14-0.24, P=0.542) or modified Insall-Salvati index (MD: 0.12, CI: -0.02- 0.26; P=0.075) postoperatively.
Conclusions: After trochleoplasty the Kujala score demonstrated clinical improvement. There was a marked change in some radiological measures demonstrating improvement of trochlear morphology and patellar tracking after trochleoplasty. We await the analysis of the complete cohort.

180. MCL as a pulley in MPFL reconstruction
Jens-Christian Beuke, Jens Christian Pörneki , Kristine Bollerup Arndt , Bjarke Viberg
Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital Kolding

Background: Treatment of lateral patellar instability is complex, usually requiring a surgical reconstruction of the medial patellofemoral ligament (MPFL).
Purpose / Aim of Study: The study aims to describe the postoperative outcomes and patient reported outcome measures (PROMs) when using a new type of MPFL reconstruction with the knee’s medial collateral ligament (MCL) as a pulley.
Materials and Methods: From 2011 to 2015, 44 knees (38 patients; 24 females/14 males) underwent an MPFL reconstruction with the MCL as a pulley due to serious patellar instability. Patient records were reviewed for minor and major complications. 32 patients (38 knees) responded to the following PROMs: Kujala and Tegner-Lysholm knee scoring scales, and EuroQol EQ-5D-3L.
Findings / Results: The data collected showed that 38 knee operations (86.4%) had a postoperative course without complications. 4 knees (9.1%) were registered with minor complications (2 superficial infections and 2 suture problems). Major complications (e.g. re- dislocation) resulted in re-treatment for 3 knees (6.8%). The mean Kujala score was estimated to 82.4 ± 10.4 SD, whilst the Tegner-Lysholm score was 84.7 ± 15.6 SD. The EQ-5D-3L showed to be 0.87 ± 0.15 SD. 24 patients (75.0%) described the result of their operation as “splendid or very good”. Only 2 patients (6.3%) communicated their disappointment at the result of the reconstruction. Furthermore, 28 patients (87.5%) stated that they would choose the applied MPFL surgery again. 30 of the patients (93.8%) no longer used analgesic due to their knee.
Conclusions: Using the MCL as a pulley in MPFL reconstruction is very promising in the treatment of patellar instability. However, despite reporting successful reconstruction in 93.2% of cases, further studies and especially a long-term analysis is recommended.

181. Two case reports on the use of negative pressure wound therapy with instillation ( NPWTi ) as adjuvant treatment of infected total hip replacements.
Jörg Dominik Adam, Jens Jørgen Elmer Christensen, Rene´ Kirchhoff-Jensen, Xiaohui Chen Nielsen
Department of Orthopaedics, , Køge Hospital; Department of Clinical Microbiology, Slagelse Hospital; Department of Orthopaedics, Køge Hospital

Background: Negative pressure treatment has been combined with instillation of cleansing solutions (NPWTi ) in cases of complicated infected wounds with promising results. Two patients having infected total hip replacements treated with this new technique are reported, which to our knowledge is the first Scandinavian report describing the use of this technique.
Purpose / Aim of Study: we want to describe first results in treating infected total hipreolacements with this new technique .
Materials and Methods: we are describing 2 cases where NPWTii was applied to treat deep infection in total hipreplacements.
Findings / Results: . It was our hope that this supplementing treatment could help us in retaining the hip replacement in the case of early chronically infected arthroplasties and improve our chances for success in treating acutely infected hip replacements. In both cases macroscopically healthy looking wounds were seen after few days of NPWTi treatment. After wound closure, however, both patients were suffering from wound healing problems with defects, secretion and elevated infection parameters. In case 1 it seems that a deep E. coli infection was successfully eradicated; however, a secondary infection made regular 2 stage revision necessary.
Conclusions: Treatment results seemed non-inferior to standard regimens. Optimization of technique and selection of patients that may benefit from this treatment have to be elucidated.

182. Persistent pain following surgically treated distal radius and malleolar fractures
Kristian Christensen, Kirill Gromov, Lone Knudsen, Michael Brix, Anders Troelsen, Lone Nikolajsen
Department of Anesthesiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Danish Pain Research Center, Aarhus University; Department of Orthopedic Surgery, Odense University Hospital

Background: Persistent pain is a well-recognized problem after various types of surgery, such as amputation, thoracotomy, and inguinal hernia repair. Less is known about persistent pain after fracture-related surgery
Purpose / Aim of Study: We investigated the prevalence, characteristics of, and risk factors for persistent pain one year after following surgically treated distal radius and malleolar fractures
Materials and Methods: Between June 2014 and March 2015, a postal questionnaire was sent to 599 patients who had undergone surgery one year previously at Hvidovre and Odense University Hospitals, Denmark, and whose surgical data were registered in the Danish Fracture Database. The questionnaire contained questions about 1) pain in the operated wrist or ankle (intensity (numeric rating scale (NRS, 0-10)), impact of pain on daily activities), 2) signs of Complex Regional Pain Syndrome (CRPS), 3) quality of life (EQ-5D), and 4) psychological aspects (PCS)
Findings / Results: 328 patients returned the questionnaire (response rate: 54.7 %). 193 patients were operated at Hvidovre University Hospital (ankle fracture, n=87; wrist fracture, n=104) and 137 were operated at Odense University Hospital (ankle fracture, n=65; wrist fracture, n=72). Overall, 62 patients (18.9%) experienced persistent pain in the operated extremity one year+/-6 weeks after surgery [NRS 6 (5-8)]. Patients with ankle fracture were more likely to report persistent pain compared with patients with wrist fracture [23.7% (CI 16.8-30.5) vs. 14.8% (CI 9.5-20.1) P=0.04]. 12 patients (3.6%) fulfilled the diagnostic patient-reported research symptoms for CRPS
Conclusions: A substantial number of patients reported pain in the operated extremity. Patients should be informed of the high risk of persistent pain

183. Evidence for performance of implants used for proximal femoral fractures in Denmark
Anne Marie Nyholm, Henrik Palm, Henrik Malchau, Anders Troelsen, Kirill Gromov
Orthopedic Department, Hvidovre Hosptial

Background: So far trauma implants has been evaluated by sporadic publications on limited study populations. Currently no registry exist that continuously monitors performance of trauma related implants.
Purpose / Aim of Study: To present the evidence of survival of the implants currently used for proximal femoral fractures in Denmark.
Materials and Methods: PubMed was searched for clinical studies on primary proximal femoral fractures (AO 31A and 31B) with follow up of ≥12 months, reporting implant related failure and evaluating one of following sliding hip screws (SHS) or nails: DHS, CHS, HipLoc, Gamma3, IMHS, InterTan, PFN, PFNA or PTN. Limits were English language and publication date after 1st of January 1990.
Findings / Results: All studies were evidence level II or III. 30 publications for SHS were found: 13 of CHS, 15 of DHS and 2 of HipLoc. Only two included >200 patients, both retrospective studies of DHS. In total CHS was evaluated in 1110 patients (900 prospectively), DHS in 2486 patients (567 prospectively) and HipLoc in 251 patients (all prospectively). 54 publications for nails were found: 13 of Gamma3, 7 of IMHS, 5 of InterTan, 10 of PFN, 24 of PFNA and 0 of PTN. One study of each InterTan, IMHS and PFNA included >200 patients. In total Gamma3 was evaluated in 1088 patients (829 prospectively), IMHS in 1543 patients (210 prospectively), InterTan in 595 patients (585 prospectively), PFN in 716 patients (557 prospectively), PFNA in 1762 patients (1018 prospectively) and PTN in 0 patients.
Conclusions: The clinical evidence behind the current implants for proximal femoral fractures is weak considering the number of implants used worldwide. Sporadic evaluation is not sufficient to identify long term problems. A systematic post market surveillance of implants used for fracture treatment, preferable by a national register, is necessary in the future.

184. Patient-reported quality of life and hip function after revision of total hip arthroplasty due to chronic periprosthetic infection: An analysis of one-stage revision and a comparison of one-stage and two-stage revision
Ninna Rysholt Poulsen, Kjeld Søballe, Inger Mechlenburg, Jeppe Lange
Orthopaedic Research and on behalf of the CORIHA Research group, Aarhus University Hospital, Denmark; Orthopaedic Research, Aarhus University Hospital, Denmark

Background: Two-stage revision is currently regarded the gold standard treatment in chronic hip periprosthetic joint infections (PJI). However, one-stage revision is assumed to benefit the patient. There are currently no studies comparing patient-reported outcome measures of cementless one-stage versus two-stage revision, and little is known on how the patients perceive either treatment strategy.
Purpose / Aim of Study: To investigate the health-related quality of life (HRQOL) and patient reported hip function after cementless one-stage revision. Further, to compare HRQOL and patient-reported hip function for patients treated with either one-stage or two-stage revision of a chronic hip PJI.
Materials and Methods: The patients in the one-stage revision group had a prospective two-year follow-up on an outpatient basis, where they completed three questionnaires; EQ-5D, SF-36 and OHS. The patients in the two-stage group were identified retrospectively in the National Patient Register and were contacted by mail with the questionnaires EQ-5D and OHS.
Findings / Results: In the one-stage group the improvement in HRQOL appeared in the first six months after surgery, reached a plateau, and for most parameters decreased slightly again. The largest improvements over two years were OHS with effect size (ES) on 1.3 and SF-36’s physical role limitation as well as bodily pain with ES on 1.1. The mean scores (CI 95%) for one-stage revision were significantly higher compared to the two- stage revision group on EQ-5D VAS 12.9 (2.4;23.3 p=0.02) and OHS 5.9 (0.5;11.2 p=0.03).
Conclusions: Two years after one-stage revision, HRQOL and hip function increased significantly. Patients receiving one-stage revision obtain higher HRQOL and hip function compared to two-stage revision. However the comparison of the two groups can be questioned, due to difference in follow-up.

185. Metacarpophalangeal Joint Silicone Artroplasty – A Review Of Sugery Performed At Aarhus University Hospital In The Period 2007-2012
Peter Birk
Ortopedic Department T, HEM, Regional Hospital Viborg

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease. RA leads to the destruction of the joints. In particular, peripheral joints and tissue are affected resulting in bone erosion and destruction of the articular cartilage. This is seen in particularly severe degree in the metacarpophalangeal (MCP) joints resulting in loss of joint integrity and disability in everyday life for the RA patient.
Purpose / Aim of Study: The aim of this study is to describe if there has been a change in the number of MCP-joint artroplasty (MCP-JA). Our a´priori theory is that the new array of non-surgical treatment modalities introduced over the last decades, including DMARD and biological medication, have contributed to improved disease control. Subsequent reduced joint destruction and therefore less demand for surgery.
Materials and Methods: Descriptive study based on a review of surgery carried out by the Devison of Hand Surgery, Ortopedic Department, AUH in the period 2007-2012. Inclusion criteria was primary silicone MCP-JA on basis of joint destruction caused by RA.
Findings / Results: In the period 49 patients were offered surgical treatment with MCP-JA of the affected joints. Demographics: 42 female: Mean age 59 years (range 36Y- 85Y). 7 male: Mean age 60 years (range 45Y- 78Y). By exponential regression analysis, we found no significant change in surgery over time (R2 ≈ 0,007)
Conclusions: In regard to patient characteristics we found that 85 % of the patients were femal, with a peak age for surgery from 50 Y - 70 Y accounting for 57% of the overall surgery for the females. In the period 2007- 2012 we have found no significant decrease in the number of MCP-JA surgery. Further studies with a longer timespan would be needed to determine the changes in MCP-JA sugery on the basis of RA.

186. Clinical outcome of posterior tibial support brace treatment of isolated or combined posterior cruciate ligament rupture with the PTS Jack bandage
Torsten Grønbech Nielsen, Birgitte Blaabjerg, Randi Gram Rasmussen, Martin Lind
Division of Sports Trauma, Department of Orthopedic Surgery, Aarhus University Hospital ; Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital

Background: Non-operative treatment is the first choice in patients with isolated grade 1 and 2 ruptures of the posterior cruciate ligament (PCL), while grade 3 ruptures are often treated operatively.
Purpose / Aim of Study: To evaluate the clinical outcome of non- operative treatment of PCL using the posterior tibial support brace in combination with physiotherapist supervised rehabilitation.
Materials and Methods: Between January 2013 and January 2015, 34 patients (21 males; mean age 32.6 years; (range 14-65)) were treated conservatively with a posterior tibial support Jack Brace (JB). Patients were diagnosed by MRI and objective PCL instability. Ten patients had isolated PCL injury and 24 had multi-ligament (11 knee luxations) injuries. Mechanism of injury: Sports 59%, traffic accidents 23% and falls 18%. Rehabilitation: Range of motion 0-90 degrees and JB usage for 8- 12 weeks including weekly training sessions. Patients started JB treatment (range 2-52 days), JB treatment period was mean 62 days (range 43-97). Outcome was evaluated using the posterior step off PCL laxity grading system and conversion to PCL reconstruction treatment.
Findings / Results: At baseline, 62% had a PCL laxity ¡Ý grade 2. After brace treatment (8-12 weeks) laxity ¡Ý2 was 36%; 55% of the patients were clinically graded ¡Ý1 at follow up. Five patients (15 %) were converted to operative PCL treatment; four of these had multi-ligament injury after knee luxation.
Conclusions: A total of 85% of patients with PCL injury starting treatment with posterior tibial support brace within 60 days after injury avoided PCL reconstruction surgery. Knee dislocation injury increased the risk of undergoing PCL reconstruction surgery.

187. Ulnar Head Arthroplasty – short term results
Robert Gvozdenovic, Michel Boeckstyns
Department of Orthopedic Surgery, Hand Surgery Unit, Gentofte Hospital

Background: Arthritic changes at the distal radioulnar joint (DRUJ) can lead to pain, worsening of grip strength, and disability. Ulnar head resection may result in destabilizing the wrist as well as forearm. To restore stability and resist the pressure loads, ulna head replacement has been introduced.
Purpose / Aim of Study: To report our experience using distal ulnar head prosthesis in treatment of painful disorders of the DRUJ.
Materials and Methods: 20 ulnar head arthroplasties have been implanted from March 2005 to June 2015. Of these, 13 had a follow-up of at least 6 months, mean 37.8 months. SBI Ulnar Head was used in 10 cases, Eclipse in 3. 7 were combined with total wrist arthroplasty (TWA). There were 5 men, 8 women with mean age of 57, 6 years. The diagnosis was rheumatoid arthritis in 4 cases, degenerative arthritis in 6, posttraumatic arthritis in 2, Kienboeck in 1.
Findings / Results: No intraoperative complications have been recorded. None of the implants have been revised. Mean VAS-score for pain was 66 before operation and 26 at follow-up. Median QuickDASH was 58 before operation and 34 at follow-up. The mean grip strength improved from 15 to 25 kgF. There were no statistically or clinically significant changes in wrist motion or forearm rotation. 10 of the 13 patients were very satisfied or satisfied at follow- up.
Conclusions: Ulnar Head Arthroplasty yielded improvement of pain, grip strength and function at short time follow-up. Longer follow-up studies are desirable.

188. The odds of receiving a knee arthroplasty is higher in patients with a high Pain Catastrophizing score
Sara Birch, Inger Mechlenburg, Stilling Maiken, Bæk Hansen Torben
Department of Physiotherapy and Occupational therapy, Holstebro Regional Hospital, Denmark; Orthopaedic Department, Aarhus University Hospital, Denmark; University clinic for Hand, Hip and Knee surgery, Holstebro Regional Hospital, Aarhus University, Denmark

Background: Psychological factors such as pain catastrophizing is associated with low physical function and pain after knee arthroplasty (KA), but only few studies have described self-reported function and pain catastrophizing in patients referred to the orthopedic outpatient clinic with symptoms of knee osteoarthritis (OA).
Purpose / Aim of Study: To describe self-reported function and pain catastrophizing in Danish patients with symptoms of knee OA and test the hypothesis, that low self-reported function with severe symptoms is associated with receiving KA whereas pain catastrophizing is not.
Materials and Methods: All patients referred with clinical symptoms of knee OA from March - October 2013 completed a set of questionnaires: EuroQol (EQ-5D), Short Form (SF-36 (PF)), Oxford Knee Score (OKS), Pain Catastrophizing Scale (PCS) and expectations to the consultation. In total 431 patients (234 women) mean age 64.6 years were included. Of those, 193 were scheduled for KA directly and additionally 15 within 12 months after the consultation. 48 were scheduled for a knee arthroscopy and 175 were treated conservatively.
Findings / Results: The odds of getting a KA is 2.72 (p= 0.001) if a patient has a high PCS score (>24) compared with patients with low PCS score (<12). 59% of the patients with high PCS score received KA and only 37% of the patients with low score. Low OKS and low SF-36 (PF) score is also associated with getting a KA (OR: 1.98, p= 0.02; OR: 2.20, p=0.006). Furthermore, patients expecting KA as treatment has higher odds for KA compared with patients expecting conservative treatment (OR: 6.81, p<0.001).
Conclusions: Patients selected for KA have lower self- reported physical function but also higher PCS score than patients treated conservatively. Thus, some patients offered KA are at high risk of having postoperative pain and low physical function.

189. DVR® Anatomic volar plating system vs. VA2 Variable Angle LCP Two Column Volar Distal Radius Plate. A comparison of two volar locking plates for treatment of distal radius fractures.
Tord Salomonsen, Bjarke Viberg
Orthopedic surgery, Odense University Hospital, Svendborg Hospital

Background: Fracture of the distal radius (DRF) can require open reduction and internal fixation (ORIF) and there are many different volar locking plates on the marked, but no studies have compared the plates in terms of complications and clinical outcome.
Purpose / Aim of Study: To compare complications and functional outcome after ORIF of dorsally displaced distal radius fractures with the DVR® Anatomic Plate (DePuy) vs. 2.4 mm Variable Angle LCP Distal Radius Plate (VA2) (Synthes) in adults above 50 years.
Materials and Methods: 50 patients were in 2009 treated with the DVR® and in 2013 41 patients were treated with the VA2, and their patient health records were reviewed for complications that required additional surgery within 1 year after primary surgery. In total 67 patients were seen at six months evaluating range of motion (ROM), relative grip strength (fractured wrist compared with un-fractured wrist) and DASH score.
Findings / Results: The median (interquartile range – IQR) age were 70,7 (IQR: 63,7-81,8) and 70,6 (IQR: 65,2-80,1) in the DVR® and VA2 group. There were 8 (16%) complications in the DVR® group and 6 (15%) in the VA2 group. The median (IQR) score for DVR® and VA2 were respectively 9,6 (IQR: 4,3-28,3) and 14,0 (IQR: 6,0–29,0) for the DASH score (p<0.395). There were a statistical better ROM for flexion, extension, supination, pronation, ulnar and radial deviation in the VA2 group (p<0.0012 for all) but this was probably due to interrater measurement bias.
Conclusions: The DVR® and VA2 systems had similar results regarding complications and functional outcome in our setting.

190. The induced membrane technique for healing of bone defects. A review of 9 cases.
Ulrik Kähler Olesen, Anders Wallin Paulsen, Per Bosemark, Henrik Eckardt
Trauma and reconstruction, orthopedic surgery, Rigshospitalet; Orthopedic Surgery, University hospital Lund, Sweden; Orthopedic surgery, University Hospital Basel, Switzerland

Background: Segmental defects of long bones are notoriously demanding to treat. We evaluate nine cases where the Masquelet induced membrane technique to substitute bone loss has been used.
Purpose / Aim of Study: We discuss the method compared to other types of bone reconstruction and share our tips and tricks to reduce treatment time and improve patient comfort.
Materials and Methods: Eight patients (nine injuries) operated between 2011 and 2014 were included. Four were infected. Outcome was time-to weight-bearing, consolidation, complications, bone grafting.
Findings / Results: All patients were weight bearing fully after 270 days. Mean time to weight bearing was 225 days. Time to full weight bearing was shorter in patients where nails were used to stabilize the construct: median 115 (range 0-268) compared to plates: median 244 (range 219-271).Two cases are not fully consolidation at present. Three cases needed grafting, one was misaligned. There were no amputations, no persistent infections, and no implant failures
Conclusions: The induced membrane technique is a relevant alternative to traditional bone substitution in select cases, yet somewhat unpredictable in its course and prolonged immobilisation is often required. Nailing seems to improve the outcome by reducing treatment time and volume of bone graft needed and should be considered when feasible.

191. Analysis of drain fluid particle content after implantation of an antibiotic eluting bone graft substitute close to a partial pelvic replacement
Hettwer Werner
Orthopaedic Department, Rigshospitalet

Background: Endoprosthetic reconstruction for pathologic acetabular fractures is associated with a high risk of periprosthetic joint infection. In this setting, bone defect reconstruction utilising co-delivery of a synthetic bone substitute with an antibiotic, is an attractive treatment option from a prophylactic perspective.
Purpose / Aim of Study: We wished to investigate the possible presence of potentially wear inducing HA particles in the periprosthetic haematoma.
Materials and Methods: We analysed a drain fluid sample from an endoprosthetic reconstruction of a pathologic acetabular fracture with implantation of a gentamicin eluting, biphasic bone graft substitute, consisting of 40% hydroxyapatite (HA) and 60% calcium sulphate (CERAMENTTMG), into the residual peri-acetabular bone defect. This sample was divided into two 1.5ml subsamples, to one of which 100mg HA particles were added as control before burning off all organic substance at very high temperature. These heat treated samples were then examined with scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDAX) and compared to a reference sample consisting of HA particles only.
Findings / Results: On SEM, hydroxyapatite particles were readily recognisable in the control and reference samples, whereas only very few particles over 2ìm were apparent in the ”pure” drain sample. EDAX revealed that very large amounts of salts were present in both drainage samples. The pure drainage sample contained markedly lower amounts of calcium and phosphate compared to reference and control samples. No HA particles as such, were seen in the pure sample.
Conclusions: We could not find clear evidence that the drain fluid really contained HA particles. More thorough investigations are needed and future analyses with prior removal of the high salt content would likely yield more conclusive results.

192. Utility of the Ganz Trochanteric Flip Osteotomy and Surgical Dislocation of the Hip for Benign Tumors of the Hip.
Hettwer Werner
Orthopaedic Department, Rigshospitalet

Background: Adequate access is critical for complete and thorough intralesional removal of benign bone lesions in order to ensure a low local recurrence rate. This can be a challenge for some tumors located in the femoral neck or the hip joint.
Purpose / Aim of Study: The surgical technique for operative dislocation of the hip described by Ganz affords excellent exposure of the femoral head, neck and acetabulum. We present 2 cases to illustrate the utility of this approach in the musculoskeletal oncology setting.
Materials and Methods: The technique consists of a posterior approach with a ‘trochanteric flip’ osteotomy, followed by a z-shaped capsulotomy, designed to preserve the blood supply to the femoral head, which allows surgical dislocation in an anterior direction. To illustrate the utility of each of the steps of this approach, two different case examples are described: Firstly, defect reconstruction of a large enchondroma of the proximal femur through a trochanteric flip osteotomy and secondly, complete removal of extensive synovial chondromatosis through a formal surgical dislocation
Findings / Results: In both cases, generous access could be achieved comfortably, allowing controlled removal of the lesion under direct vision, while affording ample space for throrough and safe application of adjuvants such as burring, and/or surgical reconsruction of the defect, if required. Wound closure including transosseous refixation of the trochanter fragment, as well as immediate post operative course were straight forward and without complication. Both patients maintain complete restoration of function at 1-year follow up.
Conclusions: This approach can be useful to the musculoskeletal tumor surgeon in portions or its entirety, to approach various benign intra-articular, as well as intra-osseous bone and soft tissue tumors of the hip and the proximal femur.

193. Surgical treatment of severe scoliosis in young children using magnetically controlled growing rods – initial experience in a prospective cohort
Benny Dahl, Thomas Borbjerg Andersen, Martin Gehrchen
Spine Unit, Department of Orthopaedic Surgery

Background: The surgical treatment of scoliosis in young children often requires multiple surgical procedures in general anesthesia to distract the spinal implant corresponding the growth of the spine. Recently, magnetically controlled growing rods have been introduced allowing non-invasive, outpatient distraction.
Purpose / Aim of Study: The purpose of the present study was to assess the efficacy and safety of magnetically controlled growing rods in a Danish patient population.
Materials and Methods: Eight patients have been operated; four girls and four boys. The median age at the time of surgery was 10 years (range 6 – 13). Three patients had idiopathic scoliosis and the remaining patients had neuromuscular or syndromic curves. Anchoring points were constructed caudally and cranially with pedicle screws or hooks, with intramuscular placement of the rods. Patients underwent rod distraction with 3-months intervals as outpatient procedures using a magnetic external remote controller.
Findings / Results: The median pre-operative Cobb angle was 66 degrees (range 54-95) and the immediate post-operative Cobb angle was 27 degrees (20-50)(p = 0.01). No intraoperative complications occurred. One patient underwent revision surgery 19 months after the primary procedure due to screw loosening. The average lengthening per distraction procedure was between 2.4 and 3.8 mm. All the lengthening procedures were carried out in the outpatient clinic not requiring general anesthesia or any type of analgesics.
Conclusions: The use of magnetically controlled growing rods in this cohort with severe scoliosis showed no intraoperative complications. A satisfactory correction at index operation was obtained and distraction of the rods was possible in the outpatient clinic every 3 months. The method seems promising in the growing child.

194. Early Clinical Experience with Local Bisphosphonate Delivery for Bone Defect Reconstruction in Aggressive Benign Bone Tumors
Werner Hettwer, Peter Horstmann, Michael Mørk Petersen
Orthopaedic Department, Rigshospitalet

Background: Bisphosphonates inhibit osteolysis associated with benign bone tumors mediated by osteoclasts. They also induce apoptosis of tumor cells and have shown promising reduction of local recurrence rates in small case series. We have developed a surgical method for reconstruction of cavitary bone defects with a combination of cancellous allograft and a synthetic bone graft substitute, able to deliver and elute antibiotics as well as zoledronic acid locally.
Purpose / Aim of Study: To report our early clinical experience with local delivery of zoledronic acid for bone defect reconstruction in benign, aggressively behaving bone tumors.
Materials and Methods: We prospectively followed 11 patients (9f, 2m, mean age 35 (range 18-62)) with aggressively behaving benign bone tumors (5 GCT, 4 ABC, 2 UBC) who underwent tumor resection with curettage, high speed burring and subsequent bone defect reconstruction utilising a combination of a gentamycin eluting bone graft substitute (Cerament™|G, BONESUPPORT, Lund, Sweden) and cancellous allograft with serial imaging (X-ray/CT) for a mean of 11 months (range 7-17).
Findings / Results: Radiographic evidence of local bone formation and remodeling by far exceeded rates and amounts usually observed with either single component alone. Rapid and homogeneous remodeling typically started in areas with cancellous bone contact in the periphery of the defects but was not limited to the cavities only. Substantial periosteal bone formation was also observed in areas of ungrafted surrounding cortical bone.
Conclusions: Effective local delivery and elution of zoledronic acid appears to substantially enhance and accelerate local bone formation/remodeling in our patients. Further studies to confirm this hypothesis are needed.

195. Complications following distal radius fracture osteosynthesis using two different volar locking plates.
Julie Ladeby Erichsen, Roland Knudsen, Zafar Bahadirov, Frank Damborg
Ortopædkirurgisk afd. , Kolding SLB; Ortopædkirurgisk afd., Kolding SLB

Background: Open Reduction and Internal Fixation (ORIF) of distal radius fractures using a volar locking plate, has become one of the most common operations performed. However, to date there is a limited amount of literature describing the complications following this procedure
Purpose / Aim of Study: We wanted to investigate the complications after ORIF of distal radius fractures using two different volar locking plates, and how often these complications occurred.
Materials and Methods: We included 241 patients with a distal radius fracture which had been operated on with ORIF using one of the two volar locking plates at Kolding Hospital in the period January 1. 2013 to july 1. 2014. We did a retrospective cohorte study using the patient journal and X-rays, and we registered any complications which indicated a second operative intervention.The patients were operated on using either a “Variable angle two column plate” (VA2, Synthes) or a “Distal Volar Radius plate” (DVR, Depuy).
Findings / Results: 28/241 (11,6%) patients experienced a complication which needed a second operative intervention. There were no differences in incidents of complications when operated on using either VA2 or DVR (p-value: 0.671). Patients suffering from more complex fractures (ie. AO 23-C fractures) had a tendency towards more complications than patients suffering from simple fractures when operated on using either VA2 or DVR, but this was not significant and there were no statistically significant differences between the two groups.
Conclusions: We registered 11.6% complications, which needed interventions. There was no difference in complications when using either a VA2 or DVR, although there was a tendency towards more frequent complications after more complex fractures. Other studies have shown similar results regarding the frequency of incidents of complications.