Correction to: Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial).

An amendment to this paper has been published and can be accessed via the original article.

Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial).

BACKGROUND: Syndesmotic injuries are common and their incidence is rising. In case of surgical fixation of the syndesmosis a metal syndesmotic screw is used most often. It is however unclear whether this screw needs to be removed routinely after the syndesmosis has healed. Traditionally the screw is removed after six to 12 weeks as it is thought to hamper ankle functional and to be a source of pain. Some studies however suggest this is only the case in a minority of patients. We therefore aim to investigate the effect of retaining the syndesmotic screw on functional outcome. DESIGN: This is a pragmatic international multicentre randomised controlled trial in patients with an acute syndesmotic injury for which a metallic syndesmotic screw was placed. Patients will be randomised to either routine removal of the syndesmotic screw or removal on demand. Primary outcome is functional recovery at 12 months measured with the Olerud-Molander Score. Secondary outcomes are quality of life, pain and costs. In total 194 patients will be needed to demonstrate non-inferiority between the two interventions at 80% power and a significance level of 0.025 including 15% loss to follow-up. DISCUSSION: If removal on demand of the syndesmotic screw is non-inferior to routine removal in terms of functional outcome, this will offer a strong argument to adopt this as standard practice of care. This means that patients will not have to undergo a secondary procedure, leading to less complications and subsequent lower costs. TRIAL REGISTRATION: This study was registered at the Netherlands Trial Register (NTR5965), Clinicaltrials.gov ( NCT02896998 ) on July 15th 2016.

The usefulness of MRI and arthroscopy in the diagnosis and treatment of soft-tissue injuries associated with split-depression fractures of the lateral tibial condyle.

The role of arthroscopy in the treatment of soft-tissue injuries associated with proximal tibial fractures remains debatable. Our hypothesis was that MRI over-diagnoses clinically relevant associated soft-tissue injuries. This prospective study involved 50 consecutive patients who underwent surgical treatment for a split-depression fracture of the lateral tibial condyle (AO/OTA type B3.1). The mean age of patients was 50 years (23 to 86) and 27 (54%) were female. All patients had MRI and arthroscopy. Arthroscopy identified 12 tears of the lateral meniscus, including eight bucket-handle tears that were sutured and four that were resected, as well as six tears of the medial meniscus, of which five were resected. Lateral meniscal injuries were diagnosed on MRI in four of 12 patients, yielding an overall sensitivity of 33% (95% confidence interval (CI) 11 to 65). Specificity was 76% (95% CI 59 to 88), with nine tears diagnosed among 38 menisci that did not contain a tear. MRI identified medial meniscal injuries in four of six patients, yielding an overall sensitivity of 67% (95% CI 24 to 94). Specificity was 66% (95% CI 50 to 79), with 15 tears diagnosed in 44 menisci that did not contain tears. MRI appears to offer only a marginal benefit as the specificity and sensitivity for diagnosing meniscal injuries are poor in patients with a fracture. There were fewer arthroscopically-confirmed associated lesions than reported previously in MRI studies.

Factors predicting the development of early osteoarthritis following lateral tibial plateau fractures: mid-term clinical and radiographic outcomes of 73 operatively treated patients.

BACKGROUND AND AIMS: The indications for operative treatment of lateral tibial plateau fractures are still controversial. The objective of this study was to determine whether residual articular surface depression and valgus malalignment of plated lateral tibial plateau fractures at medium-term follow-up affect the clinical and radiographic outcomes. MATERIAL AND METHODS: A chart review of patients with operatively treated (AO type B3.1) tibial plateau fractures that were admitted to our level I trauma center between 2002 and 2008 was performed. Out of 123 patients, 73 were available to participate in a clinical and radiographic follow-up examination. The mean follow-up time was 54 months. Patients were clinically assessed and completed the Lysholm knee score and Western Ontario and McMaster Universities Osteoarthritis Index. Maximal articular surface depression, radiological mechanical axis, and degree of posttraumatic osteoarthritis were evaluated from standing radiographs. RESULTS: Patients with valgus malalignment of 5° or greater at follow-up developed more advanced osteoarthritis (Kellgren-Lawrence grade 3-4) than patients with a normal mechanical axis (p = 0.006). Similarly, patients with articular depression greater than 2 mm at follow-up also developed more advanced osteoarthritis compared to patients with a depression of 2 mm or less (p = 0.001). The degree of valgus malalignment or articular depression had no effect on the Western Ontario and McMaster Universities Osteoarthritis Index or Lysholm scores. CONCLUSIONS: The postoperative articular congruity and normal mechanical axis of the lower leg after plate fixation in lateral tibial plateau fractures seem to have a role in prevention of posttraumatic osteoarthritis but does not appear to predict clinical outcome at medium-term follow-up. The role of initial dislocation and associated cartilage damage in the development of osteoarthritis following these fractures is still unknown.

Sweating response to moderate thermal stress in atopic dermatitis.

The local sweating response to thermal stress (mean ambient temperature 33 degrees C) was assessed under resting conditions on the non-eczematous back skin of 26 young men with atopic dermatitis (AD) and in 22 non-atopic controls with other dermatoses. The baseline (transepidermal) water loss was separately determined at room temperature (mean 23.6 degrees C) to calculate the pure sweat loss. A gravimetric collecting method was used for the measurements at 40, 60 and 80 min. In the heated room the sweat loss in AD patients was significantly lower at all time intervals. The cumulative sweat loss was 50-60% lower in AD patients than in the controls (P less than 0.02). Subjects with dry AD skin had a lower sweat loss than subjects with normal-looking skin. Compared with controls the sweat loss in AD patients was lowest at 40 min, suggesting a retarded sweating response. Half of the patients with AD and half of the controls had active participation in sports, and showed a greater sweat loss compared to the non-sporting subjects in the same group.

Local cholinergic sweat stimulation in atopic dermatitis. An evaporimetric study.

In atopic dermatitis the nature of potential sweating disturbances is still obscure. Using an evaporimeter, local sweating response to a supra-threshold concentration of methacholine and baseline water loss were measured from non-eczematous back skin of 167 young males in five main groups (pure atopic dermatitis, atopic dermatitis with rhinitis/asthma, rhinitis/asthma, non-atopic dermatosis, and non-atopic healthy). Subjects with atopic dermatitis were further divided into two subgroups: dry-looking and normal-looking back skin. Compared with non-atopic healthy individuals, the sweat loss was significantly depressed (p less than 0.01) and the baseline water loss significantly increased (p less than 0.001) in the main groups with atopic dermatitis. Both these trends were most distinct in atopic dry-looking skin, whereas in normal-looking atopic skin only the sweat loss was depressed (p less than 0.05). Respiratory atopy had no effect on the sweating response. No significant correlation was found between the individual baseline water loss and the sweating response.

Baseline water loss and cholinergic sweat stimulation in atopic dermatitis: a gravimetric measurement of local skin water loss.

The sweat gland function in atopic dermatitis (AD) and in respiratory atopy is a matter of controversy. We examined the baseline water loss and local sweating response in non-eczematous back skin of 146 young men: pure AD, AD with rhinitis/asthma, rhinitis/asthma alone, non-atopic dermatosis and non-atopic healthy. All AD subjects were further divided into the subgroups AD dry and AD normal skin. Following injections of saline and a high concentration of methacholine (5 x 10(4) mol/l) into separate sites the moisture losses were collected into closed pads over a period of 40 min. The baseline water loss was significantly increased (P less than 0.001) and median pure sweat loss was significantly decreased (P less than 0.01) in AD compared with nonatopic healthy individuals. These trends were accentuated in AD dry skin. Respiratory symptoms had no appreciable influence on results. A depressed sweating response occurred in 30% of AD subjects and 9% of non-AD subjects. An elevated baseline water loss value and a depressed sweat loss value coexisted in 22% of subjects with AD dry skin compared with 3% of the non-atopics.

Local sweat stimulation with the skin prick technique.

Intracutaneous injections of cholinergic agonists are usually employed for induction of local sweating. The possibility to apply a less painful skin prick technique as a sweat test was examined. Pricks were made on the forearm skin of 25 young men by puncturing the skin through drops of methacholine (MCH) and control saline solutions with lancets having a point length of 1 mm. The drops were kept on skin for 10 min and were then wiped off. Using an evaporimeter the measurements of water loss (WL) were started 5 min later and continued at 5 min intervals. Sweat loss (SL) was calculated from the difference of rates of evaporative WL recorded at the MCH and saline pricks. Ten, 1, 0.1, and 0.01% solutions of MCH elicited the following average peak evaporative sweat losses: 107.1, 77.5, 32.4 and 5.4 g m-2h-1. Both the degree and duration of the sweat responses were dependent on concentration. The prick technique is well tolerated and may serve for comparative studies of local sweating.