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.

Reduced wound leakage in arthroplasty with modified wound closure: a retrospective cohort study.

INTRODUCTION: Wound leakage has been shown to increase the risk of prosthetic joint infections (PJIs) in primary total hip (THA) and knee arthroplasty (unicondylar and total knee arthroplasty; KA). The aim of this study is to determine whether the addition of a continuous subcuticular bonding stitch to a conventional three-layer closure method reduces the incidence of prolonged wound leakage and PJIs after THA and KA. MATERIALS AND METHODS: This retrospective cohort study included all patients receiving a THA or KA. Patients in the control group with a three-layer closure method had surgery between November 1st 2015 and October 31st 2016, and were compared to the study group with a four-layer closure method that had surgery between January 1st 2017 and December 31st 2018. The primary outcome was incidence of prolonged wound leakage longer than 72 h. Differences were evaluated using logistic regression. Incidence of PJIs was the secondary outcome. RESULTS: A total of 439 THA and 339 KA in the control group and 460 THA and 350 KA in the study group were included. In the control group, 11.7% of the patients had a prolonged leaking wound compared to 1.9% in the study group (p < 0.001). The modified wound closure method showed a protective effect for obtaining prolonged wound leakage; odds ratios were 0.09 (95% CI 0.04-0.22; p < 0.001) for THA and 0.21 (95% CI 0.10-0.43; p < 0.001) for KA. PJIs decreased from 1.54 to 0.37% (p = 0.019). CONCLUSIONS: The addition of a continuous subcuticular bonding stitch reduces the incidence of prolonged wound leakage and PJIs after THA and KA compared to a conventional three-layer wound closure method. The large reduction of incidence in wound leakage and PJIs in this study, combined with relatively negligible cost and effort of the modified wound closure method, would advocate for implementing this wound closure method in arthroplasty.

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.

Design of the SALT Osteoporosis Study: a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older.

BACKGROUND: Several drugs have become available for the treatment of osteoporosis. However, screening and treatment of patients with a high fracture risk is currently not recommended in the Netherlands, because the effectiveness of bone sparing drugs has not been demonstrated in the general primary care population. Here we describe the design of the SALT Osteoporosis study, which aims to examine whether the screening and treatment of older, female patients in primary care can reduce fractures, in comparison to usual care. METHODS: A randomised pragmatic trial has been designed using a stepwise approach in general care practices in the Netherlands. Women aged ≥65 years, who are not prescribed bone sparing drugs or corticosteroids are eligible for the study. First, women with at least one clinical risk factor for fractures, as determined by questionnaires, are randomly assigned to the intervention or control group. Second, women in the intervention group having a high fracture risk according to our screening program, including an adapted fracture risk assessment (FRAX) tool, combined with dual-energy x-ray absorptiometry (DXA), and instant vertebral assessment (IVA), are offered a structured treatment program. The women in the control group receive care as usual and will undergo the same screening as the intervention group at the end of the trial. The follow-up duration will be three years and the primary outcome is time to first incident fracture and the total number of fractures. DISCUSSION: The results of the current study will be very important for underpinnings of the prevention strategy of the osteoporosis guidelines. TRIAL REGISTRATION: ID NTR2430 . Registered 26 July 2010.

Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review.

BACKGROUND: Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been published that specifically studied the complications and side effects of ESWT in treating PF. Aim of this systematic review is therefore to evaluate the complications and side effects of ESWT in order to determine whether ESWT is a safe treatment for PF. METHODS: For this systematic review the databases PubMed, MEDLINE, Cochrane and Embase were used to search for relevant literature between 1 January 2005 and 1 January 2017. PRISMA guidelines were followed. RESULTS: Thirty-nine studies were included for this review, representing 2493 patients (2697 heels) who received between 6424 and 6497 ESWT treatment sessions, with an energy flux density between 0.01 mJ/mm2 and 0.64 mJ/mm2 and a frequency of 1000-3800 SWs. Average follow-up was 14.7 months (range: 24 h - 6 years). Two complications occurred: precordial pain and a superficial skin infection after regional anaesthesia. Accordingly, 225 patients reported pain during treatment and 247 reported transient red skin after treatment. Transient pain after treatment, dysesthesia, swelling, ecchymosis and/or petechiae, severe headache, bruising and a throbbing sensation were also reported. CONCLUSION: ESWT is likely a safe treatment for PF. No complications are expected at one-year follow-up. However, according to the current literature long-term complications are unknown. Better descriptions of treatment protocols, patient characteristics and registration of complications and side effects, especially pain during treatment, are recommended.

Risk factors of hand climbing-related injuries.

This study aimed to investigate the protective mechanisms or risk factors that can be related to the occurrence of hand climbing-related injuries (CRIH ). CRIH (tendon, pulley, muscle, and joint injuries) were retrospectively screened in 528 adult climbers. The questionnaire contained anthropometric items (e.g., body mass index - BMI), as well as items regarding climbing and basic training activities (warm-up, cool-down and session durations, number of session per week, hydration, practice level, climbing surface, and duration of the cardiovascular training). Higher skilled climbers and climbers with BMI above 21 kg/m(2) were more likely to have experienced CRIH (P < 0.01). Climbers with BMI above 20 kg/m(2) were more likely to have tendon injuries while those with a BMI above 21 kg/m(2) were more likely to have pulley injuries (P < 0.01). Skilled climbers, who climb more difficult routes, may use smaller grip size and a reduced number of fingers. Higher BMI will require a higher force to climb. Both high level and elevated BMI may increase the demands to the hands and fingers leading to CRIH . These risk factors are difficult to address as we cannot recommend the climbers to climb easier routes and decrease their BMI below 20 kg/m(2) .