A new definition of wrist sprain necessary after findings in a prospective MRI study.

INTRODUCTION: Wrist injuries with negative X-rays are diagnosed as acute wrist sprains. The prognosis is usually good, but some patients suffer from long-lasting pain and reduced wrist function, probably due to missed diagnosis followed by inappropriate treatment. The aim of this study was to investigate acute wrist sprains with MRI to detect the pathoanatomy of the injury. PATIENTS AND METHODS: This prospective magnetic resonance imaging (MRI) study included patients between 18 and 49 years, who attended the Accident and Emergency Department (A&E) Bergen, Norway, after sustaining an acute wrist trauma within the previous week. Initial X-rays of the wrist were normal. MRI was done within a median of 1 day (range 0-31 days) after the trauma, 80% within 4 days. The study period lasted from 5 November 2009 to 4 November 2010. RESULTS: A total of 155 acute MRIs were done, out of which 30 were completely normal. Patients with positive MRI had a median of two (range 0-8) pathological findings. We found 54 fractures and 56 bone bruises, mostly located to the radius followed by the scaphoid, the triquetrum, the capitate and the lunate. There were 73 soft-tissue injuries, which included 15 injuries to the triangular fibrocartilage complex (TFCC) and five scapho-lunate (SL) ligament lesions. CONCLUSIONS: Wrist sprain is an inaccurate diagnosis. In four out of five patients with normal X-rays, MRI identified pathological findings and a large variety of injuries in different structures. We suggest that wrist sprain should be defined as "occult partial or complete soft tissue (ligament, tendon, muscle) or bony injury in relation to a trauma with negative X-ray". The MRI findings led to a more differentiated treatment in more than a third of the patients. We recommend that MRI should be considered as a part of an early investigation, especially when the wrist pain does not settle within the first couple of weeks.

Low-energy distal radius fractures in middle-aged and elderly men and women--the burden of osteoporosis and fracture risk : A study of 1794 consecutive patients.

UNLABELLED: One third of 218 men and half of 1,576 women with low-energy distal radius fractures met the bone mineral density (BMD) criteria for osteoporosis treatment. A large proportion of patients with increased fracture risk did not have osteoporosis. Thus, all distal radius fracture patients >or=50 years should be referred to bone densitometry. INTRODUCTION: Main objectives were to determine the prevalence of patients with a low-energy distal radius fracture in need of osteoporosis treatment according to existing guidelines using T-score or=50 years were included. BMD was assessed by dual energy X-ray absorptiometry (DXA) at femoral neck, total hip, and lumbar spine (L2-L4). The WHO fracture risk assessment tool (FRAX(R)) was applied to calculate the 10-year fracture risk. RESULTS: T-scores or=50 years should be referred to bone densitometry, and if indicated, offered medical treatment.

[Rollerblading and skateboarding injuries among children in Bergen, Norway]. / Rulleskøyte- og rullebrettskader blant barn i Bergen Norway.

BACKGROUND: The popularity of rollerblading and skateboarding activities in Norway is reflected in the number of injuries seen at our casualty centres and hospitals. MATERIAL AND METHODS: During 1998, we made a prospective registration of 7,041 new injuries involving children below the age of 16 treated at the Accident and Emergency Department and at Haukeland University Hospital in Bergen. RESULTS: Rollerblading and skateboarding injuries accounted for 113 cases, representing 1.6% of all injuries. Three quarters were boys, nine out of ten were 10 to 15-year-olds, and arms/hands were injured in two thirds of the cases. Almost two thirds of the injuries were fractures (n = 67), representing a higher fraction than seen in other activities. Most of them were distal radial fractures (n = 39), but scaphoid fractures, an otherwise seldom child fracture, were seen in one tenth (n = 6) of all fractures. INTERPRETATION: Scaphoid fractures can, when untreated, cause pseudarthrosis; this should be borne in mind when treating children with hand pain after fall on their rollerblades or skateboards. As fractures of the hand root and wrist accounted for 40% of all injuries, hand and wrist protection seem to be the best preventive measure in terms of number of injuries.

[Rollerblading and skateboarding injuries among children in Bergen]. / Rulleskøyte- og rullebrettskader blant barn i Bergen.

BACKGROUND: The popularity of rollerblading and skateboarding activities in Norway is reflected in the number of injuries seen at our casualty centres and hospitals. MATERIAL AND METHODS: During 1998, we made a prospective registration of 7,041 new injuries involving children below the age of 16 treated at the Accident and Emergency Department and at Haukeland University Hospital in Bergen. RESULTS: Rollerblading and skateboarding injuries accounted for 113 cases, representing 1.6% of all injuries. Three quarters were boys, nine out of ten were 10 to 15-year-olds, and arms/hands were injured in two thirds of the cases. Almost two thirds of the injuries were fractures (n = 67), representing a higher fraction than seen in other activities. Most of them were distal radial fractures (n = 39), but scaphoid fractures, an otherwise seldom child fracture, were seen in one tenth (n = 6) of all fractures. INTERPRETATION: Scaphoid fractures can, when untreated, cause pseudarthrosis; this should be borne in mind when treating children with hand pain after fall on their rollerblades or skateboards. As fractures of the hand root and wrist accounted for 40% of all injuries, hand and wrist protection seem to be the best preventive measure in terms of number of injuries.

Child injuries in Bergen, Norway.

We undertook a prospective collection of data on all children below the age of 16 presenting with a history of trauma to the Accident and Emergency Department and at Haukeland University Hospital in the city of Bergen, Norway, during 1998. Our study included 7.041 new injuries, giving an annual injury incidence of 9% for preschool children, and 13% for children aged 6 to 15. Boys were injured more often than girls, and they hurt themselves equally at all age groups. Girls, however, had the lowest incidence of injury at 4-6 years of age, and two peaks at 2 and at 10-12 years of age. In the youngest children there was a predominance of head injury (51%) while in school children upper extremity injury was the commonest (46%). Most of the younger children sustained their injuries at home, while older children were injured both at home and school. Sixty percent of all medically treated patients with injuries associated with roller blade, skateboard or snowboard activities sustained a fracture. These newer sports create a new injury pattern, but soccer and bicycle injuries still predominate. On comparing our data with previous studies performed a decade ago, we found a significant decline in bicycle injuries (p=0.019), but burns are still as common (p=0.35), which suggests a need to focus more on burns prevention.

[Fatty tissue necrosis and oil granuloma after subcutaneous injections of vitamin B12]. / Fettvevsnekrose og oljegranulom etter subkutane injeksjoner med vitamin B12.

A patient is described who developed fatty tissue necrosis and oil granuloma in her thigh after repeated subcutaneous injection of vitamin B12. The injections were taken in a badly documented attempt to prevent migraine. The preparation used was vitamin B12 combined with a mineral oil to give slow release resorption. We describe the histopathological mechanism for reaction of fatty tissue to mineral oil injections. The 40 ml cavity of fat necrosis had to be drained out several times and over a long period of time before our patient was without symptoms.