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The aging of our society is associated with an increasing number of insufficiency fractures of the pelvis and the current standard of care is pain control and early mobilization. The aim of this study was to explore whether parathyroid hormone (PTH) treatment can support bone healing in these patients.We conducted a systematic review searching the databases PubMed, Embase and Cochrane. Our primary outcome was fracture healing, secondary outcome measures comprised pain, mobility and patient-reported outcome measures (PROMs).Eight articles were included in the qualitative synthesis, of which two were included in a meta-analysis. However, only three studies were comparative including one randomized controlled trial. Fracture healing and reported pain were assessed after eight weeks, and were significantly improved in the group being treated with PTH (p < 0.01) in the meta-analysis. All articles described a positive effect for PTH on fracture healing and pain.Our systematic review indicates that there is a positive effect of PTH treatment on healing and pain in patients with insufficiency fracture in the pelvic ring, but further research is necessary. Cite this article: EFORT Open Rev 2021;6:9-14. DOI: 10.1302/2058-5241.6.200029.
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INTRODUCTION The aim of this study was to describe the diversity in the incidence, diagnosis and prognosis of patients met by the trigger teams for trauma, STEMI, stroke and medical emergency patients (MEP). METHODS This was a single-centre, retrospective cohort study of all patients admitted to Odense University Hospital (OUH) from November 2012 to September 2015 with trauma, STEMI, stroke or MEP trigger team activation on arrival. OUH is a tertiary referral centre for patients with severe trauma, STEMI (directly referred to the catheterisation laboratory), stroke and MEP. RESULTS A total of 8,075 trigger team activations were recorded, a median of eight calls per day (range: 1-18), covering 16.7% trauma calls, 28.3% STEMI calls, 19.7% stroke calls and 35.3% MEP calls. This corresponds to 160/100,000 person years (py) trauma calls, 65/100,000 py STEMI calls, 73/100,000 py stroke calls and 339/100,000 py MEP calls. Seven-day mortality was 10% (95% confidence interval (CI): 9-12%) for patients with trauma calls, 6% (95% CI: 5-7%) for STEMI calls, 3% (95% CI: 3-4%) for stroke calls and 16% (95% CI: 15-17%) for MEP calls. Patients from trauma, STEMI and stroke calls were discharged with a diagnosis within 3-5 International Classification of Diseases (version 10) main coding areas, whereas patients from MEP calls had discharge diagnoses within 13 main coding areas. CONCLUSION Patients with MEP calls are more frequent, have a more diverse aetiology and a higher mortality than patients in the other trigger teams. A need exists for further guidelines and research regarding MEP with a view to reducing the high mortality rate among MEP in the future. FUNDING Annmarie Lassen was funded by an unrestricted grant from the philanthropic fund the Tryg Foundation given to the University of Southern Denmark. TRIAL REGISTRATION The study was approved by the Danish Health Authority (Record no. 3-3013-1385/1) and the Danish Data Protection Agency (Record no. 2013-41-2435).
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Infarto del Miocardio con Elevación del ST , Servicio de Urgencia en Hospital , Mortalidad Hospitalaria , Hospitales Universitarios , Humanos , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) is, to date, the most widely used scale for evaluating foot and ankle disorders. We translated it into Danish and evaluated the reliability, validity and responsiveness of the Danish version of the AOFAS-AHS (AOFAS-DK) in patients aged >18 years with isolated ankle-related fractures. Forward-backward translation, cross-cultural adaption, and validation study were performed. In total, 125 patients completed the AOFAS-DK and the Self-reported Foot and Ankle Score (SEFAS) at 3 time points after the date of fracture. The evaluation was performed according to the Consensus-based Standards for the selection of health Measurement Instruments guidelines. The intra-class correlation coefficient level of the AOFAS-DK total score was 0.87 (95% confidence interval: 0.80-0.91). Cronbach's alpha (CA) for the AOFAS-DK function subscale was 0.62, whereas the floor and ceiling effect of the function subscale was 32% (T1) and 19% (T2), respectively. Construct validity was correlated with the SEFAS, and >75% of the predefined hypotheses could be confirmed. Responsiveness was analyzed using longitudinal data, and showed that the AOFAS-DK can detect changes in scores. The Danish version of the self-administered section of the AOFAS-AHS showed overall good reliability, validity, and responsiveness. The low CA values and the presence of the floor effect might be due to the low number of items and response options available in the scale. The AOFAS-DK can be used to evaluate physical function in patients with ankle-related fractures.
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Tobillo , Lenguaje , Dinamarca , Humanos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Estados UnidosRESUMEN
OBJECTIVES: Intramedullary nails are used increasingly in the surgical treatment of intertrochanteric femur fractures (IFFs). However, controversy has developed regarding the length of the nail itself. The purpose of this study is to investigate differences in reoperation rate, as well as operating time, length of hospital stay and 1-year mortality between short and long intramedullary nails in IFF-type AO 31-A1 and AO 31-A2. DATA SOURCES: A search was conducted using PUBMED, Embase and Cochrane Central (January 1, 2000-August 1, 2018). Articles written in English, German or Scandinavian language were included. STUDY SELECTION: Studies with patients > 18 years having an IFF comparing short nail with long nail and a least one of the clinical outcomes on interest (reoperation rate, operating time, length of hospital stay, 1-year mortality) were included. DATA EXTRACTION: A total of 2680 studies were identified and screened according to PRISMA guidelines. Cochrane risk of bias tool for RCTs and non-randomized studies was used to assess the risk of bias. DATA SYNTHESIS: Odds ratio and 95% confidence interval were calculated. CONCLUSIONS: No difference in complication rate leading to reoperation was found in the individual studies or in the meta-analysis [OR 0.89 (0.49; 1.16)]. There is no difference in the length of hospital stay between the two nail cohorts; a shorter operating time inserting a short nail compared to inserting a long nail was found (p < 0.0001). In the meta-analysis, we found no difference in 1-year mortality [OR 1.20 (0.80; 1.79)].
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Clavos Ortopédicos , Fracturas del Cuello Femoral/cirugía , Fijación Intramedular de Fracturas/instrumentación , Clavos Ortopédicos/efectos adversos , Fracturas del Cuello Femoral/mortalidad , Humanos , Tiempo de Internación , Tempo Operativo , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricosRESUMEN
BACKGROUND: There are no standardized therapy guidelines for rehabilitation of calcaneus fractures. While there is consensus on non or partial weight-bearing, the use of supporting devices such as specific foot ankle orthosis is still a matter of debate. Recently, a heel-unloading orthosis ("Settner shoe") was introduced for aftercare of these fractures, allowing walking by shifting the load to the middle-foot and forefoot. This orthosis enables early mobilization of patients suffering from either one-sided or two-sided fractures. The Settner shoe can be applied in non-operative therapy and after surgery. Specifically in calcaneus fractures, early regain of physical activity has been highlighted as one of the key factors for quality of life and the ability to return to work. Thus, we hypothesize that mobilization with the Settner shoe results in improved quality of life and greater physical activity within the first 3 months. METHODS: This is going to be analyzed by a randomized controlled study comparing treatment with and without this specific orthosis. The secondary outcome measure is the time point of return to work in patients aged between 18 and 60 years, with calcaneus fracture. Furthermore, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 3-dimensional gait analysis, and the Euroqol-5 dimension-3 level (EQ-5D-3 L) questionnaire for quality of life are assessed. DISCUSSION: This is the first trial applying a standardized rehabilitation protocol in patients with calcaneus fractures, aiming to improve the non-operative part of treatment by use of an orthosis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03572816 . Registered on 27 July 2018.
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Calcáneo/lesiones , Traumatismos de los Pies/rehabilitación , Ortesis del Pié , Fracturas Óseas/rehabilitación , Calidad de Vida , Reinserción al Trabajo , Soporte de Peso , Adolescente , Adulto , Anciano , Calcáneo/diagnóstico por imagen , Calcáneo/fisiopatología , Dinamarca , Diseño de Equipo , Femenino , Traumatismos de los Pies/diagnóstico por imagen , Traumatismos de los Pies/fisiopatología , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Marcha , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Exsanguination due to coagulopathy and vascular injury is a common cause of death among trauma patients. Arterial injury can be treated either by angiography and embolization or by explorative laparotomy and surgical packing. The purpose of this study was to compare 30-day mortality and blood product consumption in trauma patients with active arterial haemorrhage in the abdominal and/or pelvic region treated with either angiography and embolization or explorative laparotomy and surgical packing. MATERIAL AND METHODS: From January 1(st) 2006 to December 31(st) 2011 2,173 patients with an ISS of >9 were admitted to the Trauma Centre of Copenhagen University Hospital, Rigshospitalet, Denmark. Of these, 66 patients met the inclusion criteria: age above 15 years and active arterial haemorrhage from the abdominal and/or pelvic region verified by a CT scan at admission. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, mechanism of injury, ISS, Probability of Survival, treatment modality, 30-day mortality and number and type of blood products applied were retrieved from the TARN database, patient records and the Danish Civil Registration System. RESULTS: Thirty-one patients received angiography and embolization, and 35 patients underwent exploratory laparotomy and surgical packing. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, ISS and Probability of Survival were comparable in the two groups. CONCLUSION: A significant increased risk of 30-day mortality (P = 0.04) was found in patients with active bleeding treated with explorative laparotomy and surgical packing compared to angiography and embolization when data was adjusted for age and ISS. No statistical significant difference (P > 0.05) was found in number of transfused blood products applied in the two groups of patients.
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BACKGROUND AND PURPOSE: Historically, the treatment of periprosthetic femoral fractures (PFFs) has been associated with a high frequency of complications and reoperations. The preferred treatment is internal fixation, a revision of the femoral stem, or a combination of both. An improved understanding of plate use during internal fixation, and the introduction of locking-plate osteosynthesis may lead to improved outcome. We evaluated the outcome of Vancouver type B1 and C PFFs treated by locking-plate osteosynthesis, by assessing rates of fracture union and reoperations and by analyzing failure cases. PATIENTS AND METHODS: From 2002 through 2011, 58 consecutive patients (60 fractures) with low-energy PFF around or below a stable femoral stem, i.e. Vancouver type B1 and C fractures, underwent osteosynthesis with a locking plate. All patients had a total hip replacement (THR). They were followed up clinically and radiographically, with 6 weeks between visits, until fracture union or until death. Fracture union was evaluated 6 months postoperatively. RESULTS: At a median follow-up time of 23 (0-121) months after PFF, 8 patients (8 fractures) had been reoperated due either to infection (n = 4), failure of fixation (n = 3), or loosening of the femoral stem (n = 1). All the patients who had been followed up for at least 6 months-and who did not undergo reoperation or die-went on to fracture union (n = 43). INTERPRETATION: Locking-plate osteosynthesis of periprosthetic Vancouver type B1 and C fractures gives good results regarding fracture union. It appears that spanning of the prosthesis to avoid stress-rising areas is important for successful treatment. Infection is the major cause of failure.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Placas Óseas , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/instrumentación , Fracturas Periprotésicas/cirugía , Rango del Movimiento Articular/fisiología , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Cohortes , Intervalos de Confianza , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/etiología , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/diagnóstico por imagen , Radiografía , Recuperación de la Función , Reoperación/métodos , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose was to compare radiographic parameters with a sex-matched and age-matched control group at the onset of disease and at skeletal maturity. The study comprised 143 patients with Legg-Calvé-Perthes disease, treated using a Thomas splint. Wiberg's centre-edge angle and the acetabular index angle were applied. The age at diagnosis was 6.6 years with no difference between boys and girls. At the time of diagnosis, the centre-edge angle was decreased from 18° in the control group to 10° in the affected hip. The age at follow-up was 16 (SD 2) years for the boys and 15 (SD 3) years for the girls. At the time of skeletal maturity, the centre-edge angle was decreased and the acetabular index angle increased in the affected hip and the nonaffected hip in Stulberg class III/IV/V hips compared with the control group. Initially radiographic changes only occur on the affected hip. At skeletal maturity both hips show radiographic changes.
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Articulación de la Cadera/diagnóstico por imagen , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Acetábulo/crecimiento & desarrollo , Acetábulo/patología , Acetábulo/cirugía , Desarrollo Óseo/fisiología , Niño , Femenino , Articulación de la Cadera/patología , Articulación de la Cadera/cirugía , Humanos , Enfermedad de Legg-Calve-Perthes/patología , Enfermedad de Legg-Calve-Perthes/cirugía , Masculino , Radiografía , Férulas (Fijadores)RESUMEN
The purpose of this study was to evaluate prognostic risk factors related to a poor radiological outcome. The study consisted of 74 patients with Legg-Calvé-Perthes disease treated using a Thomas splint. The modified Herring lateral pillar classification and the reviewed Stulberg classification system were applied. A significant correlation between the Herring group and Stulberg was found (P=0.03). There was a significant correlation between age at onset of the disease and Stulberg outcome (P=0.05). The Herring classification correlated to the Stulberg outcome. An age of 7 years or more at onset was considered as a risk factor for a poor Stulberg outcome.
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Articulación de la Cadera/patología , Enfermedad de Legg-Calve-Perthes/diagnóstico , Edad de Inicio , Niño , Preescolar , Dinamarca/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Enfermedad de Legg-Calve-Perthes/epidemiología , Enfermedad de Legg-Calve-Perthes/terapia , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Férulas (Fijadores) , Soporte de PesoRESUMEN
BACKGROUND: Legg-Calvé-Perthes disease (LCPD) was described a century ago. In previous long-term reports of patients with LCPD, nonoperative treatment varied considerably. The likelihood of hip osteoarthritis (OA) developing in patients with LCPD and possible need for THA are not well defined. QUESTIONS/PURPOSES: The purpose of the study was to determine whether nonoperatively treated patients with LCPD (1) had an increased prevalence of THA compared with gender- and age-matched control subjects, (2) if patients with Stulberg Classes III/IV/V femoral heads had an increased risk of THA compared with those with Classes I/II femoral heads. Given the limitation in the study, we (3) evaluated whether patients with LCPD were at risk for having radiographic hip OA more commonly than control subjects and (4) whether hips with Classes III/IV/V femoral heads had an increased prevalence of OA compared with hips with Classes I/II femoral heads. PATIENTS AND METHODS: The study population consisted of 167 patients with LCPD treated with a Thomas splint. The control population consisted of gender- and age-matched control subjects who were participants in the Copenhagen City Heart Study: the Osteoarthritis Substudy. Radiographs at skeletal maturity were classified according to the classification system of Stulberg et al. Data from the Danish Hip Arthroplasty Register and the Registries of the National Board of Health were collected to obtain the number of patients with LCPD having THA. At a mean followup of 47 years later (range, 37-58 years), weightbearing pelvic radiographs were obtained. Radiographic OA was defined as a joint space width of 2.0 mm or less. RESULTS: Thirteen percent of patients with LCPD had THAs compared with none in the control group. Seven percent of the patients with LCPD had OA compared with 1% in the control group. The prevalence of THA and OA was increased in hips with Classes III/IV/V femoral heads compared with hips with Classes I/II femoral heads. CONCLUSIONS: Patients with LCPD have an increased risk of having THA compared with a gender- and age-matched control group. Our data suggest that patients with LCPD have a greater risk of having radiographic OA develop than a gender- and age-matched control group. It seems that patients with Classes III/IV/V femoral heads have an increased risk of THA and OA compared with patients with Classes I/II femoral heads. LEVEL OF EVIDENCE: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Artroplastia de Reemplazo de Cadera , Enfermedad de Legg-Calve-Perthes/terapia , Osteoartritis de la Cadera/cirugía , Férulas (Fijadores) , Estudios de Casos y Controles , Niño , Preescolar , Dinamarca , Progresión de la Enfermedad , Femenino , Humanos , Enfermedad de Legg-Calve-Perthes/complicaciones , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/etiología , Radiografía , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 63-year-old man was admitted to hospital. He had a history of splenectomy secondary to trauma, previous alcohol abuse, cirrhosis and oesophagus varices. The patient had been bitten by a dog three days before admittance. He rapidly developed disseminated intravascular coagulation and multiple organ dysfunction. Six days after the bite, the patient died despite antibiotic treatment. The gram-negative rod Capnocytophaga canimorsus was found in the blood culture. This case emphasizes the importance of early diagnosis and prompt treatment of infections in post-splenectomy patients as they carry a greater-than-normal risk of serious complications.
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Mordeduras y Picaduras/microbiología , Capnocytophaga , Infecciones por Bacterias Gramnegativas/microbiología , Sepsis/microbiología , Animales , Capnocytophaga/aislamiento & purificación , Perros , Resultado Fatal , Traumatismos del Antebrazo/microbiología , Traumatismos del Antebrazo/patología , Humanos , Masculino , Persona de Mediana Edad , EsplenectomíaRESUMEN
Osteonecrosis is an adverse effect of corticosteroid therapy. We describe a 64-year-old woman with progressive bilateral knee pain and advanced osteonecrosis. Her symptoms developed after treatment with high-dose corticosteroids seven years earlier. The patient was ultimately treated with bilateral total knee arthroplasties.