Radiographic signs of acetabular retroversion using a low-dose slot-scanning radiographic system (EOS®).

INTRODUCTION: Acetabular retroversion is assessed using pelvic X-ray. Cross-over-sign (COS), posterior-wall-sign (PWS) and ischial-spine-sign (ISS) are important radiographic signs of the condition. The pelvic area is sensitive to radiation and thus, possibilities to reduce dose should be considered. The purpose was to compare radiographic signs of acetabular retroversion on conventional pelvic anteroposterior (AP) X-rays with a low-dose slot-scanning system (EOS) in a sample of patients with retroversion of the acetabulum and to compare the radiation doses. METHODS: 34 participants with radiographic signs of acetabular retroversion in one or both hips on conventional pelvic X-ray were consecutively recruited. Pelvic EOS-images were acquired in each patient and COS, PWS, ISS, COS-ratio and PWS-ratio was assessed. Radiation dose comparison of X-ray vs. EOS was performed using Dose-Area Products. RESULTS: Retroversion was present in 57 out of 68 hips. The absolute agreement was 91%, 84% and 76% for COS, PWS and ISS, respectively. No statistically significant differences were present between COS-ratio and PWS-ratio in either modality and Bland-Altman limits of agreement were narrow. The mean radiation dose was 1053 mGy*cm2 in X-ray and 593 mGy*cm2 in EOS (p = 0.003). CONCLUSION: The results indicate that pelvic EOS provides diagnostic qualities similar to conventional X-ray using 44% less radiation when radiographic signs of acetabular retroversion are assessed.

Early micromovement of the Articular Surface Replacement (ASR) femoral component: two-year radiostereometry results.

Radiostereometric analysis (RSA) can detect early micromovement in unstable implant designs which are likely subsequently to have a high failure rate. In 2010, the Articular Surface Replacement (ASR) was withdrawn because of a high failure rate. In 19 ASR femoral components, the mean micromovement over the first two years after implantation was 0.107 mm (SD 0.513) laterally, 0.055 mm (SD 0.204) distally and 0.150 mm (SD 0.413) anteriorly. The mean backward tilt around the x-axis was -0.08° (SD 1.088), mean internal rotation was 0.165° (SD 0.924) and mean varus tilt 0.238° (SD 0.420). The baseline to two-year varus tilt was statistically significant from zero movement, but there was no significant movement from one year onwards. We conclude that the ASR femoral component achieves initial stability and that early migration is not the mode of failure for this resurfacing arthroplasty.

Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement: two-year results from a randomised study.

It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into two groups to receive either a resurfacing or a THR and were followed for two years. One patient's resurfacing subsequently failed, leaving 19 patients in each group. Resurfaced replacements maintained proximal femoral BMD and, compared with THR, had an increased bone mineral density in Gruen zones 2, 3, 6, and particularly zone 7, with a gain of 7.5% (95% confidence interval (CI) 2.6 to 12.5) compared with a loss of 14.6% (95% CI 7.6 to 21.6). Resurfacing replacements maintained the BMD of the medial femoral neck and increased that in the lateral zones between 12.8% (95% CI 4.3 to 21.4) and 25.9% (95% CI 7.1 to 44.6). On the acetabular side, BMD was similar in every zone at each point in time. The mean BMD of all acetabular regions in the resurfaced group was reduced to 96.2% (95% CI 93.7 to 98.6) and for the total hip replacement group to 97.6% (95% CI 93.7 to 101.5) (p = 0.4863). A mean total loss of 3.7% (95% CI 1.0 to 6.5) and 4.9% (95% CI 0.8 to 9.0) of BMD was found above the acetabular component in W1 and 10.2% (95% CI 0.9 to 19.4) and 9.1% (95% CI 3.8 to 14.4) medial to the implant in W2 for resurfaced replacements and THRs respectively. Resurfacing resulted in a mean loss of BMD of 6.7% (95% CI 0.7 to 12.7) in W3 but the BMD inferior to the acetabular component was maintained in both groups. These results suggest that the ability of a resurfacing hip replacement to preserve BMD only applies to the femoral side.

Constrained liners for recurrent dislocations in total hip arthroplasty.

This study reports the results and complications from treating recurrent hip dislocations with a constrained liner (CL) after total hip arthroplasty (THA). Forty patients who had a CL inserted as a secondary prophylactic treatment were retrospectively reviewed after a median observation period of 27 months (range 7-77 months). During the observation period five patients had to be revised: one for deep infection and four on account of re-dislocations. Our results indicate that patients with recurrent THA dislocations can be treated with a CL and has a satisfactory low complication rate and a relatively low risk of re-dislocation.

Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study.

INTRODUCTION: Hip fracture patients represent a frail group of elderly with increased morbidity and mortality. The aim of this study was to evaluate the occurrence and distribution of a second hip fracture in the time interval between the first and the second hip fracture. METHODS: All incident hip fractures in residents of Funen County, Denmark, from 1994 through 2004 were recorded. Verified fractures were sequenced within each patient using the unique Danish identification numbers. RESULTS: In total, 9990 incident hip fractures occurred: 9122 first hip fractures and 868 (8.7%) second fractures. Within the first year after the first hip fracture, the incidence rate of the second fracture in men decreased from 73 per 1000 person-years (py) during the first 3 months to 8 per 1000 py at 12 months; in women, it decreased from 116 per 1000 py during the first 3 months to 15 per 1000 py at 12 months. Of all the second fractures, 50% occurred within 12 months in men and within 19 months in women. CONCLUSIONS: Few hip fracture patients experience a second hip fracture and when they do, it is within a short time-frame from the first. The risk of sustaining a second hip fracture is high during the first 12 months following the first hip fracture, decreasing to a level equal to or below the incidence of the first hip fracture after this 12-month period. Preventive strategies at the time of the first hip fracture should therefore aim at immediate effects, as interventions with effects after 12 months (men) and 19 months (women) bypass at least 50% of the fractures.

The trochanteric gamma nail versus the dynamic hip screw: a prospective randomised study. One-year follow-up of 146 intertrochanteric fractures.

In a prospective, randomized trial we compared the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in the treatment of 146 intertrochanteric fractures. Follow-up was after four and 12 months. The operation time was significantly shorter in the DHS group. At discharge the need for walking aids was less in the DHS group. There were no differences in intraoperative blood loss, medical complications, mortality or length of hospital stay. Major fracture complications occurred twiceas often in the TGN group compared with the DHS group, however they were not statistically significant. Any potential for the TGN leading to a less invasive procedure and a more rapid postoperative mobilisation could not be demonstrated. Compared with the TGN we prefer the DHS for most intertrochanteric fractures in a setting where the majority of these fractures are treated by younger doctors and not by highly specialized hip/trauma surgeons. The TGN may have advantages in selected intertrochanteric fractures.;

Bone bank service in Odense, Denmark. Audit of the first ten years with bone banking at the Department of Orthopaedics, Odense University Hospital.

There has been an increase in the demand for allograft bone in recent years. The Odense University Hospital bone bank has been in function since 1990, and this paper outlines our results during the 10 year period 1990-1999. Potential donors were screened by contemporary banking techniques which include a social history, donor serum tests for HIV, hepatitis B and C, and graft microbiology. The bones were stored at -80 degrees C. No type of secondary sterilisation was made. 423 femoral heads were approved and donated to 300 patients,1-6 heads/operation. The allografts have been used mainly to reconstruct defects at revision hip arthroplasty (34%), and for fracture surgery (24%). 7 % of all transplanted patients were reoperated because of infection. In the hip revision group the infection rate was 4 %. There were no cases of disease transmission. During the 10 year period there was a change in the clinical use of the allografts. In the first years the allografts were mainly used for spinal fusion surgery, but today the majority are used in hip revision and fracture surgery. The clinical results correspond to those reported in larger international series.

Microvascular free flaps in the treatment of defects of the lower legs.

Thirty-four microvascular free flaps were used to treat defects in the lower extremities after injuries. Twenty patients (74%) had severe open fractures (Gustilo type III B & C). Latissimus dorsi (n = 16) and iliac osteocutaneous (n = 7) flaps were most commonly used for coverage, and the overall failure rate was 9% (3/34). At follow up 29 of the patients (94%) had a reduced range of movement of the ankle, nine (29%) had some swelling and oedema, and 13 (42%) had occasional pain in the leg. Sixteen (52%) of the patients were limping, but 26 (84%) could walk one kilometre or more with no problems. No legs were amputated. The unemployment rate increased from 1/34 (3%) to 6/31 (19%) at follow up. Twenty-seven (87%) of our patients were satisfied with the results, despite the considerable and persistent limitation of function, and the increase in the unemployment rate.

Percutaneous osteosynthesis with two screws in treating femoral neck fractures.

In a consecutive, retrospective study, 182 patients were followed 1 year after surgical treatment of a fractured femoral neck. The patients were admitted on alternate days to the neighboring departments of orthopedic surgery O and phi, respectively. In Department O, the patients were submitted to sliding screw-plate (SSP) osteosynthesis, while patients in Department phi were treated with two percutaneously introduced screws. Our results showed that double-screw osteosynthesis can be performed significantly quicker and with less blood loss than application of SSP. Healing of the fractures in the two groups did not differ significantly, nor did the cumulative rate of failure or the frequency of secondary surgical procedures. We find that, judged from these parameters, percutaneously introduced double-screw osteosynthesis is at least as effective as SSP osteosynthesis.

[Burn injuries due to fireworks during New Year holiday. A 10-year case load]. / Fyrvaerkeribetingede brandsår omkring nytår. En 10 års opgørelse.

Minor burns due to fireworks which are treated in the Casualty Department have remained constant during the past ten years. The injured patients are boys and young men between 7-19 years. Boys are injured ten times as frequently as girls. The commonest sites of injuries are the upper limbs, the head and neck. The number of patients admitted to hospital on account of serious burns has increased. These are most frequently caused by clothes catching fire from fireworks which have been hidden under outer clothes or in trouser pockets. In order to avoid the serious burns caused by burning clothes, it is recommended that fireworks should not be concealed under clothes but carried away from the body possibly in a container made of non-inflammable material.

[Skateboard accidents. 168 skateboard accidents treated at the Odense Hospital Emergency Department during the period 1 January 1980 to 12 December 1988]. / Skateboardulykker. 168 skateboardulykker behandlet på skadestuen ved Odense Sygehus i perioden 1.1.1980 till 31.12.1988.

During recent years, an increasing number of skateboard accidents have been registered in Odense Hospital. Typically, boys aged 10-14 years are involved and these had fallen on outstretched arms. No injuries endangering life were registered but 36% had fractures and half of these were localized to the wrist. Approximately 8% of the injuries resulted in hospitalization. Despite prohibition in the traffic legislation, 65% of the injuries occurred in trafficated regions and only 15% occurred in specially made skateboard rinks. The real risk involved in board skating are unknown but, in this selected group of board skaters, no significant connection could be demonstrated between routine experience in board skating, employment of protective equipment and frequency of fractures. Employment of protective equipment was commonest among persons who were members of a club and among those injured on skateboard ramps. The frequency of fractures was significantly higher among persons injured on ramps than among the remainder. Possible prophylactic measures are discussed and simple rules are recommended.

Foot spas as a cause of burns.

Within 2 weeks the authors saw two patients with deep burns of their feet caused by foot spas. Both devices had been used according to the manufacturers' instructions and had been approved by The Danish Electric Material Control. Examination however showed that the bottom plate of these devices reached unacceptably high temperatures that far exceeded the stipulation for approval. As a consequence of this report, the rules for approval of foot spas in Denmark have been changed, as well as a warning to persons at risk that should be included in the directions for use in the future.

Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment.

The mechanism of trauma and late results of treatment were analyzed in 17 pediatric and 16 adult Monteggia lesions. Pediatric Monteggia lesions were almost entirely found to be the result of low energy trauma leading to a closed, noncomminuted fracture in an otherwise noninjured child. In the adult cases, however, these lesions were most often found to be the result of high energy trauma leading to open and comminuted fractures. Furthermore, 62% of the adults had other, and often more serious, injuries. Results at follow up (average 7 years) were excellent in the pediatric cases, whereas all adults had sequelae, especially regarding range of motion. The results of this study clearly suggest that a Monteggia lesion represents a more severe injury in the adult.

[Roller skating accidents. 393 roller skating accidents treated at the casualty department of Odense Hospital during the period 1 January 1980 to 30 September 1988]. / Rulleskøjteulykker. 393 rulleskøjteulykker behandlet på skadestuen ved Odense Sygehus i perioden 1.1.1980 til 30.9.1988.

During recent years, the import of roller skates has increased markedly and, during the period 1.1.1980-30.9.1988, an increase has been observed in the number of roller skate accidents treated in the Casualty Department of Odense Hospital. These accidents are particularly frequent in early spring and involve children under the age of 15 years, in particular, with slight preponderance of girls. The typical mechanism of injury is a fall which the victim tries to mitigate with the hands and arms. Nearly 90% of all injuries were localized to the locomotor system and just under half of the patients sustained fractures, typically of the wrist. Over 8% of the injuries necessitated hospitalization. The great majority of accidents occurred in unorganized groups and not in clubs, in ordinary traffic and without the use of protective equipment. In a selected group of roller skaters, as in this investigation, no connection could be found between the type of roller skates, employment of protective equipment and the frequency of fractures. The actual risk in roller skating is not known but possible prophylactic measures are discussed and simple safety rules are recommended.

Hip fractures in children. A long-term follow up of 17 cases.

Late results (average 18 years posttrauma) after hip fractures in 17 children are reported. The average age at the time of fractures was 8.5 years (range 2 to 15 years). The treatment was conservative for undisplaced or slightly displaced transcervical and cervicotrochanteric fractures (Delbet's Type II and III) as well as for intertrochanteric fractures (Delbet's Type IV). The overall complication rate was 25%. Avascular necrosis of the femoral head was seen in two hips, premature epiphyseal closure with leg shortening in two cases, and a coxa vara in one hip. These complications only had resulted in few symptoms at follow up.

Necrotizing fasciitis. A report of 3 cases.

Necrotizing fasciitis is a serious infectious disease characterized by a necrotizing cellulitis of the subcutaneous tissue. The mortality has not changed over the last 50 years, probably because the condition is not recognized early enough to permit effective treatment by debridement. We report 3 cases illustrating different clinical courses.