Expected long-term outcome after a tibial shaft fracture.

OBJECTIVE: A prospective study of 207 laymen and professionals answered a questionnaire regarding the expectations of the long-term outcome 6 months after a unilateral tibial shaft fracture. The aim was (1) to disclose the expected outcome after unilateral tibial shaft fracture, and (2) to compare these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were compared with SIP scores obtained from 33 patients with a unilateral tibial fracture. RESULTS: Marked variation was observed between the groups. CONCLUSION: Physiotherapists expected the lowest degree of disability and orthopedic surgeons the highest. In the three groups of students, white collar workers and blue collar workers only minor variations were observed and their SIP scores showed better correlation with the SIP scores obtained from the patients than those of orthopedic surgeons and physiotherapists.

Residual impairment after lower extremity fracture.

In a prospective follow-up study of 158 consecutive patients 18 to 64 years old with unilateral lower extremity fracture, our aim was to disclose the impairment and disability 6 months after the injury. The patients were interviewed within 1 week after the trauma, and all patients returned to the hospital for an interview and a clinical assessment 6 months later. The disability was measured by administering the Sickness Impact Profile (SIP) to all patients by an interview process. SIP scores were calculated for pretraumatic and posttraumatic states. The pretraumatic SIP scores described the functional status before the injury. Additionally, three major aspects of impairments were measured 6 months after the fractures: range of motion, muscle strength, and pain. Most patients had a significantly higher SIP score 6 months after the fracture(s) than pretraumatically. The mean overall SIP score was 2.7 pretraumatically and 8.7 6 months posttraumatically. Major deficits in range of motion was observed, especially in the ankle joint. Additionally, loss of muscle strength was observed in the thigh and calf muscles in one fourth of the patients. Only low levels of residual pain were reported after 6 months.

[Intraoperative autotransfusion. Reinfusion of erythrocytes in total hip arthroplasty reduces the need for blood from banks]. / Intraoperativ autotransfusion. Genanvendelse af erytrocytter giver nedsat forbrug af bankblod ved total hoftealloplastik.

We have tested a cell-saver system, which collects, washes, concentrates and filtrates red blood cells before autotransfusion. The study consisted of 35 consecutive patients who had a total hip arthroplasty (THA), 18 using the cell-saver and 17 not using it. There was no significant difference in the peroperative bleeding, or in the total blood loss. The median blood loss was 1950 ml (925-6337 ml) in the cell-saver group and 2350 ml (1260-4440 ml) in the control group. The need for homologous transfusion was significantly higher in the control group compared to the cell-saver group, median 500 vs 250 ml of sag-M blood. This difference is of the same magnitude as the amount of autotransfused red blood cells suspended in saline water, median 398 ml. In the cell-saver group nine patients did not need any homologous transfusions at all, whereas in the control group only one did not need any transfusion.

Assessment of anterior cruciate laxity using the Genucom System.

One hundred subjects with normal knees and 47 patients with chronic rupture of the anterior cruciate ligament were tested in the Genucom Knee Analysis System; the 13 different laxity tests were carried out on both knees. Measurements on right and left knees in normal subjects showed that only the lateral pivot shift test, performed at 25 degrees of knee flexion, had a good side-to-side correlation, but did not differentiate the involved and uninvolved knees in the patients with anterior cruciate ligament deficiency. The sensitivity of the lateral pivot shift was 30% and specificity 91%. The corresponding figures for the anterior drawer test at 30 degrees flexion using 93 N force were 45% and 88%. Measurements showed great variation. Care should be taken in interpreting the results from the Genucom System. It should be considered as an experimental device with little value in assessing patients with anterior cruciate ligament deficiency.

[Measurement of anteroposterior knee stability with Genucom and Stryker equipments. A comparative in vivo study of a normal subject]. / Målinger af knaeets antero-posteriore løshed med anvendelse af Genucom og Stryker måleudstyr. En sammenlignende in vivo undersøgelse af et normalmateriale.

One hundred normal individuals were examined with both Stryker and Genucom equipment. The median antero-posterior instabilities were 9.0 mm in the right knee and 8.3 mm in the left knee measured with the Genucom apparatus. The Stryker laxity tester revealed median antero-posterior instabilities of 5.2 and 5.1 mm for the right and left knees, respectively. The variation between the right and left knee was considerable as measured by the Genucom knee-analysis method (p = 0.008) while no significant difference was observed between the right and left knees employing the Stryker laxity tester (p = 0.53). No differences in antero-posterior instability were found between men and women. Correlations were observed between measurements made on the individual participants between the two methods of measurement but direct comparisons can only be undertaken employing a correlation factor.

[Genucom knee analysis after introduction of Dacron prostheses in knees with isolated rupture of the anterior cruciate ligament. 44 consecutive cases]. / Genucom knae-analyse efter indsaettelse af Dacron-protese i knae med isoleret ruptur af forreste korsbånd. 44 konsekutive patienter.

During the period 1. December 1984 to 30. November 1986, reconstructive operations were performed on 44 patients with isolated unilateral rupture of the anterior cruciate ligament. The patients suffered from chronic insufficiency of the knee with episodes of dislocation. The anterior cruciate ligament was reconstructed with a synthetic Dacron prosthesis and the postoperative stability of the knee was registered by means of a Genucom knee analysis system and manual tests for stability. Reconstruction involved an increase in the average Lysholm score from 63 preoperatively to 91 postoperatively. The activity of the patients, as measured by Tegner scoring, improved in 30 cases but only 14 patients stated that they had achieved the same level of activity as before rupture of the cruciate ligament. Sixteen out of the 44 patient patients, according to the Genucom analysis, obtained an antero-posterior stability which corresponded to that in the healthy knee. No correlation was found between possible objective stability measured by Genucom and the patients Lysholm scoring. 20% (9/44) of the patients sustained rupture of the Dacron prosthesis after an average of 11 months. The present authors consider that the quality of the prosthetic material should, therefore, be improved.

Polyethylene failure of metal-backed patellar components. 111 AGC total knees followed for 7-22 months.

In a series of 111 AGC total knee arthroplasties, eight failures of the polyethylene part of the metal-backed patellar component were seen after a period of 7-22 months. All of these patients experienced a characteristic grating sound as the knee was bent, and skyline radiographs revealed direct metal-on-metal contact. At revision, fracture and separation of the polyethylene part were found together with an extensive, black, thickened synovium and abrasive wear of the naked metal backing of the patellar component. The cemented metal backings were all solidly anchored in the patella. Based on this high failure rate, we have abandoned the metal-backed patellar component in favor of an all-polyethylene component.

Garden's classification of femoral neck fractures. An assessment of inter-observer variation.

Radiographs of 100 randomly chosen femoral neck fractures were assessed by eight observers using Garden's classification. The radiographs were classified identically by all eight in only 22 cases. Another 45 cases were classified by some observers as undisplaced fractures (Stages 1 and 2) and by others as displaced fractures (Stages 3 and 4). Between the different observers the number of displaced fractures varied from 63 to 89. These results show that observers had a relatively poor ability to delineate the various stages of Garden's classification.

Conservative treatment of fingertip injuries.

In a prospective investigation of 81 consecutive patients with fingertip injuries conservative treatment was evaluated. Fingertip injuries were defined as lesions greater than or equal to 1 cm2 in the terminal phalanx without injury to the tendons or joints. All fingertip injuries were cleaned and covered by Vaseline gauze and left to heal. If less than 2 mm of soft tissue covered the bone a few millimetres of bone were nibbled away to allow good cover with soft tissue. The majority of injuries (64 per cent) occurred at work. The average healing time was 25 days. The main later complaints were intolerance of cold (36 per cent), numbness (36 per cent) and tenderness (26 per cent). None of the patients had stiff joints. On average, the two-point discrimination had increased by 1 mm in the injured fingertip. Conservative treatment is recommended as a safe and simple treatment of fingertip injuries, even when bone is exposed in the wound.

Osteosynthesis of femoral neck fracture. The sliding-screw-plate with or without compression.

In a prospective study of 220 displaced femoral neck fractures treated with a sliding-screw-plate, the cases were allocated to osteosynthesis with or without compression. In surviving patients followed for at least 1 year, union occurred in 57/85 with compression and 58/71 without compression. At 2 years, necrosis was radiographically evident in 9/37 and 7/36 united fractures. Thus, compression cannot be recommended when displaced femoral neck fractures are treated with a sliding-screw-plate.

Holding power of different screws in the femoral head. A study in human cadaver hips.

The holding power of four different bone screws was measured by a pull-out test in 40 cadaver hips from 10 females and 10 males over 70 years of age. Each femoral head was used to test a 6.5 mm cancellous bone screw and a 12.7 mm hip compression screw. The holding power was higher in screws with a long or wide thread. Generally, the holding power in bones from females was about 70 per cent of that in bones from males.

Hip fractures in the county of Funen, Denmark. Implications of demographic aging and changes in incidence rates.

In patients 40 years and above a total of 3096 hip fractures (783 in males and 2313 in females) occurred in the entire county of Funen, Denmark from 1 July 1973 to 30 June 1979. The incidence of hip fractures increased exponentially with age in both sexes. During the survey the number of hip fractures in females showed a marked increase above what could be explained by demographic aging alone, whereas this tendency was not so pronounced in males. Provided the observed increase in incidence rates prevails, aging of the population in combination with this increase will lead to a threefold increase in the number of hip fractures over a 20-year period. This is substantially more than other Scandinavian authors have reported.

Axial compression in femoral neck osteotomies. A biomechanic study in human cadaver hips.

The risk of applying compression to a sliding-screw-plate osteosynthesis in the treatment of femoral neck fractures was evaluated in an experimental study of 40 femoral neck osteotomies. Ten pairs of bones from autopsied women between 70 years and 79 years of age were compared to 10 pairs of bones from autopsied women of more than 80 years of age. The compression was applied intermittently but measured continuously. The results showed a diphasic curve. When the maximum axial compression force was reached, any attempt to apply further compression resulted in a rapid fall in pressure at the site of the osteotomy. The median of the maximum axial compression force was 971 N, ranging from 275 N to 1756N. The maximum axial compression forces were significantly lower in bones from women of more than 80 years of age compared to bones from women in the seventh decade. The clinical implication of the study is that compression of femoral neck fractures by a sliding-screw-plate system may be hazardous in patients with brittle bone, e.g. women over 80 years of age.

External compression arthrodesis of the shoulder joint.

Compression arthrodesis of the shoulder was carried out in 16 patients. One case of postoperative infection healed by conservative treatment, and all but one had primary fusion. With a median of 12 years follow-up, 12 patients were examined clinically and radiologically; one patient was lost to follow-up and three patients were dead. The result was rated as good by 10 patients and as improved by two patients. External compression arthrodesis was found to be a safe and easy way to achieve solid fusion of the shoulder joint. Arthroplasty and arthrodesis of the shoulder joint are complementary operations, applicable in different clinical situations.

Oblique displacement osteotomy according to Crawford adams for hallux valgus.

Correction of hallux valgus by oblique displacement osteotomy ad modum Crawford Adams was carried out in 54 cases, of which all but 3 were examined clinically and radiologically 1 year or more after the operation. The median age was 32 years. Seventy-eight per cent were satisfied with the operation, and 64 per cent were totally free of pain. A feeling of stiffness in the first metatarso-phalangeal joint and/or intermittent pain during walking was found in 22 per cent of the patients, all of whom were dissatisfied with the operation. Adams' osteotomy was found to give a satisfactory correction of the deformity of hallux valgus, but the length of the first metatarsal bone could not be maintained.

Treatment of displaced fractures of the femoral neck. Smith-Petersen osteosynthesis versus sliding-nail-plate osteosynthesis.

In a prospectively planned follow-up study 383 cases of displaced medial fractures of the femoral neck were allocated either to Smith-Petersen osteosynthesis or to sliding-nail-plate osteosynthesis. Two hundred and forty-nine cases were followed for more than 2 years. The two differently treated groups were alike. The results showed that sliding-nail-plate osteosynthesis was significantly superior to Smith-Petersen osteosynthesis. We recommend that Smith-Petersen osteosynthesis be abandoned.