[Aftercare of malleolar fractures in Denmark. A questionnaire study]. / Efterbehandling af malleolfrakturer i Danmark. En enqueteundersøgelse.

A questionnaire was sent out to 59 orthopaedic departments. Seventy-eight percent returned the questionnaire. Four thousand two hundred ankle fractures are treated annually. Fifty percent are operated on (range 12.5-83%). Large departments are on average more surgically active than smaller ones. The noticeable difference, however, in surgical frequency is not connected to size, function or location of orthopaedic department. All fractures are usually immobilized with a circular plaster bandage. Thirty percent use dynamic bandages for some stable ankle fractures. Eighty-five percent bandage for six weeks, 15% for up to eight weeks. Very few allow early mobilization of surgically treated fractures (6%). The rest do not allow mobilization until at least three weeks after surgery. Stable fractures are more frequently permitted immediate mobilization. Several randomized studies recommend that all ankle fractures should be mobilized immediately, surgically treated in a circular plaster bandage, stable fractures in dynamic bandages.

Successful immediate weight-bearing of internal fixated ankle fractures in a general population.

Several studies on operated ankle fractures have shown that immediate weight-bearing is recommendable. Consequently, we changed our postoperative standard regimen, from 3 weeks of non-weight-bearing followed by 3 weeks of weight-bearing, to full immediate weight-bearing in all 6 weeks. A below-knee walking cast was applied immediately after surgery. Between December 1995 and September 1996, we studied 62 patients (median age, 55 years; range 21-92 years; M/F, 24/38), with ankle fractures who attended our emergency department and were subsequently admitted for open reduction and internal fixation. We excluded patients with distal tibia fracture and patients under 18 years of age. Overall, our elderly population did not have complication rates higher than those reported in similar studies on younger patients. In 1 patient, we observed radiographic widening of the ankle joint, of about 3 mm, 6 weeks postoperatively. No patients required reoperation. Our study indicates that full immediate weight-bearing after open reduction and internal fixation is recommendable, even in an elderly population.

Prognosis of fracture of the talus in children. 21 (7-34)-year follow-up of 14 cases.

14 children suffering from a fracture of the talar neck or body were examined after 21 (7-34) years. The talar neck was fractured in 10 children and the talar body in 4.3 fractures were displaced and primarily treated with reduction and immobilization. Nondisplaced fractures were treated conservatively. All fractures healed. All patients with displaced fractures had exercise-induced pain at follow-up. Of 11 patients with nondisplaced fractures only 1 had minor complaints. CT and conventional radiographs showed arthrosis in the talocrural joint and normal subtalar joints in those with displaced fractures. The radiographic findings were normal after nondisplaced fractures.

Osteochondral lesions of the talar dome in children. A 24 (7-36) year follow-up of 13 cases.

13 patients who in childhood had had osteochondral lesions (OCL) of the talar dome participated in a long-term follow-up including physical examination, computed tomography (CT) and conventional radiographs. Most of the cases were caused by trauma. Conventional radiographs showed abnormal findings in 4 cases and CT in a further one. In 3 cases the primary lesion could still be seen as an osteochondral defect, and 2 had a loose body in the joint. 3 of these 5 patients had mild symptoms. We conclude that arthrosis following OCL in childhood is infrequent and recommend conservative treatment initially. In those with persisting symptoms, additional imaging evaluation with CT and MRI is recommended.

The anterior interosseous nerve syndrome.

A follow-up examination of 21 cases of anterior interosseous nerve syndrome in 20 patients is presented. In 15 patients the anterior interosseous nerve was explored, with objective signs of compression in nine. 11 of these patients showed satisfactory function and three had a tendon transfer. Five cases were not operated on. Two recovered and three had continuous paralysis after more than four years. One patient had a primary tendon transfer. We conclude that exploration of the anterior interosseous nerve is the treatment of choice, and that expectant treatment can be reserved for patients with slight disability or poor general health. As recovery may take over a year, tendon transfer should be postponed until after this period in patients who do not show satisfactory recovery.

CT scan compared to tomography in suspected hip fracture.

In a prospective study the diagnostic value of CT scanning and tomography were compared in the cases of eight consecutive patients in whom initial radiographs showed a suspected hip fracture. CT scan did not contribute more to diagnosis than tomography.

Ultrasonographic detection of foreign bodies in soft tissue. A human cadaver study.

The usefulness of ultrasound in the detection of foreign bodies was examined in a blind study in human cadavers using glass, plastic and wood as foreign bodies. Of 65 foreign bodies placed in 102 cicatrices, 58 were found using a 5 MHz transducer. The sensitivity was 89% and the specificity 93% making ultrasound a useful clinical tool for this purpose.

Spondyloepiphyseal dysplasia tarda. Report of a family with autosomal dominant transmission.

We present a clinical and radiographic study of a family with the autosomal dominant form of spondyloepiphyseal dysplasia tarda, in some patients associated with hearing deficiency. Although no causal treatment is possible, correct diagnosis is important to avoid unnecessary treatment and for information about prognosis, genetic counseling, and recommendation of future occupation.

Bilateral femoral head dysplasia and osteochondritis. Multiple epiphyseal dysplasia tarda, spondylo-epiphyseal dysplasia tarda, and bilateral Legg-Perthes disease.

Multiple epiphyseal dysplasia tarda (MEDT) and spondylo-epiphyseal dysplasia tarda (SEDT) are genetically transmitted conditions affecting the hips, which may resemble bilateral Legg-Perthes disease (LPD). Misdiagnoses are not uncommon, with serious implications for treatment, prognosis and genetic counseling. An epidemiologic study of MEDT and SEDT in a well-defined population of 453,921 persons in Denmark was performed. A population prevalence of 0.7 per 100,000 inhabitants with SEDT and 4.0 per 100,000 inhabitants with MEDT was found. Distinguishing features between MEDT, SEDT and bilateral LPD based on radiologic findings in the hips, other joints, and spine were ascertained. Bilateral LPD is always asymmetric, exhibits patches of increased density in the epiphyses and often metaphyseal cyst-like changes. No spinal lesion or affection of other joints is present, and the acetabula are normal. In MEDT and SEDT the capital femoral epiphyses are symmetrically flattened, fragmented and uniformly slightly sclerotic. Generalised platyspondyly is a constant finding in SEDT.

Good prognosis after calcaneal fracture in childhood.

Fifteen children who sustained a displaced intraarticular calcaneal fracture, treated closed, were reexamined after 12 (1-29) years. All were satisfactory, although slight inconvenience was encountered as a result of the fracture. Immobilization and nonweight bearing from 4 to 6 weeks seem sufficient to treat a calcaneal fracture in children.

Calcaneus fracture in the child.

We reviewed 80 fractures of the calcaneus in 78 children through a 30-year period. The fractures were more equally distributed between the sexes than in adults. In contrast to adults, intraarticular fractures of the calcaneus in children constitute less than half, probably because a lower proportion of children sustain the fracture as a result of a fall. Associated injuries were mainly encountered by children who were traffic accident victims. It is disputable that the calcaneus in children is more resistant to fracture than in adults. The rarity of the fracture in children is more likely the result of less exposure to trauma leading to calcaneal fractures and also that the fracture is often overlooked.

Radiologic aspects of lunatomalacia.

A radiological classification of lunatomalacia, based upon the chronological radiologic manifestations in 93 patients is presented. Compression fractures were not seen as the initial event. Fifty-seven per cent of the patients had a short ulna (ulna minus variant). The presence of ulna minus variant was especially observed in the younger patients. In 16 patients suffering from a lunate fracture and in 20 patients with lunate or perilunate luxations, lunatomalacia did not develop. Immobilization as treatment of the disorder resulted in a progressive course in all patients, but one, an 8-year-old girl. The lesion of the lunate was arrested and tended to heal following radial osteotomy in all patients.

Lunatomalacia in a child.

A case of advanced lunatomalacia in an 8-year-old girl treated by immobilization is described. After 2 years of treatment, the girl had a normal wrist, and radiographically the condition had improved, albeit with some collapse of the radial part of the lunate. Our case suggests that the natural course of lunatomalacia is favorable in children as compared with adults.

Radiologic aspects of calcaneal fractures in childhood and adolescence.

One hundred and forty-three calcaneal fractures in 140 patients under the age of 19 years were reviewed. Of the total number, 75 per cent were in males. Eighty fractures were seen in females under 13 years of age and in males under 16 years of age. Fifteen (19%) of these fractures were initially not recognized. Four projections were available in the majority of the cases, and were reviewed: lateral, axial, straight dorsoplantar and oblique dorsoplantar views. The various types of fractures had different courses and localizations. The optimum demonstration of a fracture in a certain projection will therefore be dependent on the type of fracture present. It is clinically difficult to foresee a specific type of calcaneal fracture, and consequently it is recommended that all four views should be obtained routinely following trauma to the calcaneal region in patients of the pertinent age groups.

Thiemann's finger or toe disease. Follow-up of seven cases.

Thiemann's disease is a non-inflammatory disorder of unknown etiology, affecting the epiphyses of the phalanges of the fingers and the first toe in children. We have re-examined seven patients after up to 18 years. Two patients had had pain in the affected digits for several years. In four patients radiographs after closure of the growth plates showed normal phalangeal dimensions without arthrosis. We conclude that different degrees of severity of epiphyseal disturbance consistent with the type described by Thiemann may be encountered. It is possible that trauma may worsen the prognosis by deformation of a susceptible epiphysis.