Biases in a randomized comparison of three types of screw fixation in displaced femoral neck fractures.

We studied fixation of displaced femoral neck fractures prospectively in a randomized multicenter study, comparing 2 Olmed screws, 2 Tronzo screws and 3 Ullevaal hip screws. The study population consisted of 482 women and 125 men, of whom 432 women and 100 men were older than 65 years of age. Their median age was 80 (54-97) years. Despite agreement on criteria, the rates of reoperations for pain and failure--salvage (prosthesis replacement) and other reoperations (removal of implant)--differed significantly between the 3 hospitals regardless of type of fixation. In total, the percentages of salvage operations were: Olmed screw 17/175, Tronzo 17/130 and Ullevaal screw 11/302 (n.s.); the percentages of other reoperations were 11, 6 and 13, respectively (n.s.). In the whole series, the 2-year rate of salvage operations was 14%. No differences between the implants were found in patients older than 65 years of age. We conclude that an agreed, common definition of a hard end-point (reoperation) does not ensure comparability of results, because of differences in clinical decision making.

Percutaneous lumbar discectomy. Technique and clinical result.

Lumbar disc herniation was treated by percutaneous discectomy using a new instrument for automatic aspiration and cutting of disc material. The inclusion criteria were limited to patients with pure disc herniation without stenosis or any other additional factors. Only contained hernias with a maximum size of 50% of the thecal sac were included. Three procedures out of 45 were technical failures. At 1-year follow-up 69% of the patients were satisfied. No complications were seen. The result was not influenced by the amount of disc material removed, age, duration of symptoms or the size of the disc hernia. Reduced size of disc hernia was found in 13 out of 14 satisfied patients followed by CT. All unsatisfied were conventionally operated on. The percutaneous treated patients had 1 day of hospitalisation and on average 11 weeks of sick-leave compared to an average of 6 days and 16 weeks following conventional discectomy.

[Head injuries with delayed intracranial hemorrhage]. / Hodetraumer med intrakraniale senblødninger.

Nine cases of delayed intracranial haematomas were found among 300 patients with head injuries during a two-year period. Six of the nine patients developed delayed traumatic intracerebral haematoma, two epidural haematoma and one subdural haematoma. Delayed intracerebral haematoma was diagnosed from 12 hours to six days after the trauma. The primary CT showed brain contusion in the majority of the patients. The outcome was poor. One patient died and two were severely disabled. The clinical course was more rapid in the two patients with epidural haematoma than in the others. Marked elevation of intracranial pressure was monitored in both cases prior to the second CT examination. In spite of successful evacuation of the haematoma, one patient died and the other developed physical and mental retardation. In one patient a subdural haematoma was diagnosed three months after the trauma. The patient did well postoperatively.

The Late Effect of Accidental Injury Questionnaire (LEAIQ).

The Late Effect of Accidental Injury Questionnaire (LEAIQ) is a self-report questionnaire constructed to assess the biological, psychological and social effects of traumatic injuries. The LEAI covers current civil and employment status (4 questions); possible negative or positive consequences of the injury (20 questions) symptoms of post-traumatic distress (24 questions); aspects of the accident situation and the emotional impact of the trauma considered to be of relevance for the development of post-traumatic stress disorder and litigation behaviour (3 questions). The last part of the LEAIQ deals with the patient's opinion about the hospital treatment and follow-up control and self-perceived current medical or social needs (4 questions). Preliminary data on reliability and validity are reported from two studies investigating a total of 640 accidentally injured adults. The data indicate that the LEAIQ is easy to fill in for the patients and provides fairly good estimates of the frequency of the long-term biological, psychological and social effects in a sample of accidentally injured adults. The data on sensitivity and negative predictive power further suggest that the LEAIQ should be suitable in clinical practice as a first-step instrument for screening late effects of trauma.

The three-year biopsychosocial outcome of 551 hospitalized accidentally injured adults.

The negative biological, psychological and social outcomes following accidental injuries were assessed after three years in 551 adults by questionnaires, medical records and information from the National Insurance Offices. Fifty-four percent reported at least one negative outcome. Some reduction of physical function was reported by 31.8% and worsened bodily health by 26.0%. In about half of these cases reduced life quality was the main problem. Of the persons 18.9% claimed worsened psychological health and 18.2% decreased capacity for work as an effect of the injury. It is concluded that accidental injuries are an important source of morbidity and reduced life quality in society and that the long-term outcomes are best conceived within a biopsychosocial frame of reference.

Head injuries during one year in a central hospital in Norway: a prospective study. Epidemiologic features.

Annual age-adjusted incidence rate of head injuries in Akershus County in 1974 was estimated to be 236/100,000, 307/100,000 for males and 164/100,000 for females. The highest incidence rate occurred in males in the age group 10-19 years (489/100,000) and the lowest among females in the age group 30-39 (68/100,000). In all age groups, the incidence rate was higher in males than females. This prospective study included 488 patients, of whom 88.9% had minor head injuries and 11.1% severe head injuries. 16 patients (3.3%) died due to their head trauma. Skull fracture was detected in 10.4% of the patients who survived the first 24 h, and 2.5% had operations. The mean hospital stay was 8.8 days, 10.2 days for the patients injured in traffic accidents and 7.0 days for the others. Besides having a higher incidence rate of head injuries, males suffered severe head injuries more often and their death rate was higher than head-injured females.

Psychopathology and accidental injuries.

One hundred and twelve adults admitted to a surgical ward due to accidental injuries were studied. Thirty-seven percent had a psychiatric disorder on admission (DSM-III axis I) and 21% had a personality disorder (axis 2). Substance abuse and dependence and antisocial personality disorders were most frequent. Eighteen percent were definitely distressed when injured. Persons with a personality disorder were distressed significantly more often and had sustained clinically more severe injuries. No support could be found for a hypothesis of accidental injuries being the result of hidden or unconscious self-destructive tendencies, and only one patient was injured in a suicide attempt. Defense Mechanism Test applied to a subgroup of 20 patients suggested that high perceptual defense may be related to injury occurrence in patients at fault for the accident.

Diagnosis and tactics in abdominal injuries.

Abdominal trauma has a high priority in the diagnosis and treatment of a patient with multiple injuries. Both blunt and penetrating injuries may be isolated or multiple and they are often combined with extraabdominal trauma. A close cooperation between surgical and other specialties is often needed. Transport from a smaller hospital to a center with full diagnostic and therapeutic facilities may be advantageous.

Life-supporting first aid self-training.

The authors studied the acquisition of life-supporting first aid knowledge and skills by 230 lay people in self-training group instruction without qualified first aid instructors and self-training at home. The self-training course consisted of audiotape-recorded instructions, flipover charts, an instruction booklet, first aid materials and a "Resusci Anne" training mannikin. The same instruction booklet and first aid materials were used for self-training at home. The two teaching systems were equally effective in providing theoretical first aid knowledge, but the course proved superior in teaching practical skills.