Complications associated with anterior plate fixation of distal radial fractures: a retrospective study of 599 patients.

We evaluated the incidence of postoperative complications following anterior locking plate fixation of distal radial fractures. We investigated whether there is an association with the patient's age, severity of the fracture or surgeon's experience. The medical records of all patients treated with anterior locking plate for a distal radial fracture between 2016 and 2018 were retrospectively reviewed. Radiographs were evaluated regarding Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification, Soong grade and dorsal screw prominence. Six-hundred and three distal radial fractures treated with anterior locking plate fixation in 599 patients were included. The overall postoperative complication incidence was 11%. Secondary surgery was performed in 9%. No statistical significance in the incidence of complications was found regarding age, AO/OTA type or surgeon experience.Level of evidence: IV.

Fibular nailing for bi-malleolar and tri-malleolar ankle fractures yields good functional outcomes - a retrospective single-centre study.

INTRODUCTION: The surgical treatment of elderly patients with unstable ankle fractures is challenging. Open reduction and internal fixation with conventional plating technique often yields a poor outcome. However, fracture management with isolated fibular nailing represents an alternative method. METHODS: We performed a retrospective study of patients treated with isolated fibular nailing at the North Zealand Hospital, Denmark, between 1 January 2012 and 31 December 2016. A total of 58 patients were included. The primary outcome was post-operative function (dependency of a walking aid). Secondary outcomes were pain, radiographic union and complications (infection, fracture displacement and screw migration). RESULTS: At the last follow-up (mean follow-up of 10.3 months), 84.2% of the patients had returned to their baseline level of function. 18% had persistent pain. The last post-operative radiographic follow-up showed union in 93.7% of fractures of the lateral malleolus and 50% of the medial malleolus. The complication rate was 13.7%. CONCLUSIONS: Isolated fibular nailing with immediate full weight bearing in plaster yields an acceptable functional outcome in elderly patients with unstable fractures of the malleoli. FUNDING: none. TRIAL REGISTRATION: not relevant.

Dipeptidyl Peptidase-4 Inhibitor Induced Angioedema - An Overlooked Adverse Drug Reaction?

INTRODUCTION: Angioedema is a potentially fatal adverse drug reaction of some medications, as swellings of the upper airways can cause death by asphyxiation. Angiotensin converting enzymeinhibitors are widely known to cause angioedema but less is known about the association between dipeptidyl peptidase-4 inhibitors (gliptins) and angioedema. Dipeptidyl peptidase-4 inhibitors are antidiabetic drugs used to improve glycaemic control. They, as a class effect, inadvertently affect the degradation of the vasoactive kinins bradykinin and substance P, both of which can cause angioedema due to vasodilatation and increase in vascular permeability in the capillaries. OBJECTIVE: To assess the risk and pathomechanism of angioedema due to inhibition of dipeptidyl peptidase- 4 inhibitors when used as monotherapy and in combination with angiotensin converting enzymeinhibitors. METHOD: PubMed, Embase, the Cochrane Library, PubMed Central, Web of Science, Google Scholar and clinicaltrials.gov were searched using different combinations of keywords "angioedema", "dipeptidyl peptidase 4", "dipeptidyl peptidase 4 inhibitors", "gliptins", "bradykinin", "substance P" and "angiotensin converting enzyme-inhibitors". Original research papers were preferably used as references and their bibliographies were used to further the search for original research results. RESULTS: Both angiotensin converting enzyme and dipeptidyl peptidase-4 are major enzymes in the degradation pathway of bradykinin and substance P, and when inhibited pharmacologically - especially at the same time - the theoretical risk of angioedema is increased due to accumulation of vasoactive kinins. CONCLUSION: Treatment with dipeptidyl peptidase-4 inhibitors must be carefully considered and monitored especially during concurrent treatment with angiotensin converting enzyme-inhibitors or when treating patients with a known predisposition to angioedema.

Long-term results using LigaSure™ 5 mm instrument for treatment of Zenker's diverticulum.

The purpose of the present study was to evaluate the long-term results and patient's satisfaction of a new approach using the LigaSure™ 5 mm instrument for treatment of Zenker's diverticulum (ZD) and to compare with other long-term results using traditional treatment modalities. Between December 2011 and August 2013, a total of 23 patients with ZD underwent endoscopic surgery using the LigaSure™ technique in our department. A retrospective evaluation of the surgery was based on medical records and additionally a long-term follow-up was performed using a standardized questionnaire that was send to all patients. The questions dealt with complaints according to a visual analog scale (VAS) and were sent a minimum of one year after the surgery (mean time 22 months, range 12-32 month). The overall response rate was 91%. The mean age of the patients was 69 years (range 37-89 years). The patients reported nine for overall satisfaction on the VAS (range 0-10: 10 being very content and 0 very uncontent, 25 and 75% quartiles: 7 and 10) regarding the final outcome of their surgery, although several of the patients had continuous symptoms within the first postoperative year. Eight patients (38%) reported no symptoms at all. Our results suggest that endoscopic management of ZD with the LigaSure™ 5 mm instrument is a minimally invasive, fast and safe method with solid long-term outcome with relief of symptoms and patient satisfaction. This new operative instrument was not found inferior to traditional endoscopic techniques and is now the standard treatment method for ZD in our departments.

How Not to Be Misled by Disorders Mimicking Angioedema: A Review of Pseudoangioedema.

BACKGROUND: Angioedema is a vascular reaction involving the lower dermis, subcutis and/or submucosal tissue and causing a temporary localized swelling in any part of the body. For many health care professionals, the diagnosis presents an ongoing challenge; several disorders may manifest with subcutaneous or submucosal swelling and falsely be assumed to be angioedema. The clinicians at the emergency department and in the immunology/allergy clinics must be skilled at recognizing the features of angioedema and its differential diagnosis. METHODS: The review is based on a literature search with specific indexing terms in PubMed, a review of bibliographies and the authors' clinical experience. RESULTS: The most essential diseases that mimic angioedema, the so-called pseudoangioedemas, will each be discussed and illustrated by clinical photos, pointing out key features that help clarify the diagnoses and differentiate these from classic angioedema. CONCLUSIONS: A variety of dermatologic conditions can cause swelling that resembles angioedema, some with a potentially fatal outcome if misdiagnosed. Knowledge of pseudoangioedema is fundamental in the emergency setting when handling patients with edema and should be kept in mind when assessing an atypical angioedema case.

Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture.

INTRODUCTION: Acute displaced femoral neck fractures are often treated with cemented hemiarthroplasty (HA). There is increasing evidence that total hip arthroplasty (THA) may be a better alternative, but the degree to which the fixation of the femoral stem used affects the outcome is not fully known. The aim of this study is to compare rates of operative complications and implant survival following THA treatment of displaced femoral neck fractures with either a cemented or an uncemented femoral stem. METHODS: The study consists of two groups of patients (N = 334), who were treated for a displaced femoral neck fracture with THA at the Regional Hospital of Viborg during 2007-2012. The first group (50.9%) had uncemented (Corail (®) ) stem while the second group (49.1%) had cemented (Exeter (®) ) stem implanted. Nearly all patients had uncemented dual mobility cup (Saturne (®) ) as acetabular component and were followed up to three months postoperatively. Data regarding rates of implant survival and operative complications were obtained by retrospective review of medical records. RESULTS: We found a statistically significant difference regarding rates of postoperative reoperation with 1.2% (95% CI 0.005-0.03) for cemented and 5.9% (95% CI 0.02-0.09) for uncemented stem (p = 0.02). The main causes for reoperation were peri-prosthetic fractures and deep infections. There was no difference regarding dislocation or peroperative complications. Rates of dislocation were 4.3% (95% CI 0.012-0.07) for cemented and 3.5% (95% CI 0.008-0.06) for uncemented stem (p = 0.72). Rates of peroperative complications were 6.1% (95% CI 0.024-0.1) for cemented and 8.2% (95% CI 0.04-0.12) for uncemented stem (p = 0.1). DISCUSSION: Our results indicate that cemented femoral stem is superior to cementless when rates of reoperation are compared.

Idiopathic Thrombocytopenic Purpura Misdiagnosed as Hereditary Angioedema.

Hereditary angioedema is a rare, but potentially life-threatening genetic disorder that results from an autosomal dominant trait. It is characterized by acute, recurrent attacks of severe local edema, most commonly affecting the skin and mucosa. Swelling in hereditary angioedema patients does however not always have to be caused by angioedema but can relate to other concomitant disorders. In this report we are focusing on misdiagnosis in a patient with known hereditary angioedema, whose bleeding episode caused by idiopathic thrombocytopenic purpura was mistaken for an acute attack of hereditary angioedema. The case illustrates how clinicians can have difficulties in handling patients with rare diseases, especially in the emergency care setting.

[Lumbar Morel-Lavallée lesion caused by a minor trauma].

The Morel-Lavallée lesion (MLL) is a closed internal degloving lesion caused by a significant soft-tissue injury, which separates the skin and subcutaneous tissue from the underlying fascia. The separation creates a potential blood-filled cavity, which can become a source of chronic pain. Although the diagnosis of MLL in the greater trochanter and proximal thigh is well established, its occurrence in the lumbar area is unusual. This case report presents a 19-year-old very adipose woman with lower back pain due to a long-standing MLL, and our purpose is to increase the awareness of MLL in the lumbar area.