Complications and functional outcome after fixation of distal tibia fractures with locking plate - A multicentre study.

INTRODUCTION: The aim of this study was to evaluate the proportion of complications and the functional outcome following ORIF with low-profile locking plates in patients with distal tibia fractures. METHOD: Retrospective data was retrieved using county databases, operation books, health record and X-ray images for 6 hospitals (1 level 1, 5 level 2) in the Region of Southern Denmark. Between January 2007 and April 2011 70 consecutive patients with 71 distal tibia fractures were treated with low-profile locking plate were included. The proportion of post-operative complications, classified as minor and major complications, was retrieved from electronic health records and patient interviews. Long-term functional outcome assessed by EuroQol EQ-5D-5L questionnaire, AOFAS Ankle-Hindfoot scale, and return to pre-injury job function through patient interview and examination. RESULTS: There were 32 43A, 5 43B and 34 43C-fractures, 12 open and 10 high-energy fractures. Forty-nine cases (69%) experienced complications during the follow-up time, of which 34 were minor complications and 15 were major complications. Median EQ-5D-5L index value was 0.76, median EQ VAS-score was 80, and median AOFAS score was 73. Thirty-three percent of working patients had not returned to work as a result of the fracture. CONCLUSIONS: Our study suggest that treatment of distal tibia fractures with low-profile locking plates might have a higher proportion of complications and worse functional outcome than previously reported. LEVEL OF EVIDENCE: Therapeutic level IV Case Serie.

Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity - A prospective comparative study.

BACKGROUND: Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. METHODS: Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal open wedge osteotomy and fixation with plate (Hemax), group 1, or operation with proximal crescentic osteotomy and fixation with a 3mm cannulated screw, group 2. The mean age was 52 years (19-71). Forty-one females and four males were included. Clinical and radiological follow-ups were performed 4 and 12 months after the operation. RESULTS: In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively, 11.6̊ after 4 months and 12.6̊ after 12 months. In group 2 the mean intermetatarsal angle was 18.9̊ preoperatively, 12.0̊ after 4 months and 12.6̊ after 12 months. The AOFAS score improved from 59.3 to 81.5 in group 1 and from 61.8 to 84.8 in group 2 respectively measured 12 months postoperatively. The relative length of the 1 metatarsal compared to 2 metatarsal bone was 0.88 and 0.87 preoperatively and 0.88 and 0.86 for group 1 and 2 respectively measured after 12 months. CONCLUSION: Crescentic osteotomy and open wedge osteotomy improve AOFAS score and VAS scores on patients operated with severe hallux valgus. No significant difference was found in the two groups looking at the postoperative improvement of HVA and IMA measured 4 and 12 months postoperatively. The postoperative VAS score and AOFAS score were comparable for the two groups with no significant difference. An expected tendency to gain better length of the first metatarsal using the open wedge osteotomy compared to the crescentic osteotomy was not found. Even though the IMA and HVA reduction was only suboptimal the improvement in AOFAS score was comparable to other similar clinical trials.

Acute exercise does not induce an acute phase response (APR) in Standardbred trotters.

The purpose of the study was to investigate whether acute strenuous exercise (1600- to 2500-m race) would elicit an acute phase response (APR) in Standardbred trotters. Blood levels of several inflammatory markers [serum amyloid A (SAA), haptoglobin, fibrinogen, white blood cell count (WBC), and iron], muscle enzymes [creatinine kinase (CK) and aspartate transaminase (AST)], and hemoglobin were assessed in 58 Standardbred trotters before and after racing. Hemoglobin levels increased and iron levels decreased 12 to 14 h after racing and haptoglobin concentrations, white blood cell counts, and iron levels were decreased 2 and/or 7 d after racing. Concentrations of CK, AST, SAA, and fibrinogen were unaltered in response to racing. Acute strenuous exercise did not elicit an acute phase reaction. The observed acute increase in hemoglobin levels and decreases in haptoglobin and iron levels may have been caused by exercise-induced hemolysis, which indicates that horses might experience a condition similar to athlete's anemia in humans. The pathogenesis and clinical implications of the hematological and blood-biochemical changes elicited by acute exercise in Standardbred trotters in the present study warrant further investigation.

L'objectif de la présente étude est d'investiguer l'effet de l'exercice intensif (1600­2500 m) sur l'apparition d'une phase inflammatoire aigué chez des trotteurs. Les taux sanguins de différents marqueurs inflammatoires [serum amyloid A (SAA), haptoglobine, fibrinogène, globules blanc (WBC) et fer], d'enzymes musculaires [creatinine kinase (CK) et aspartate transaminase (AST)] et d'hémoglobine ont été évalué dans 58 trotteurs avant et après la course. Respectivement une augmentation et diminution des taux d'hémoglobine et de fer furent présente 12­14 heures suivant la course. Une réduction des taux d'haptoglobine, de globules blanc et de fer était présente 2 et/ou 7 jours après la course. Aucun changement dans les concentrations de CK, AST, SAA et fibrinogène n'a pu être démontre en relation avec la course.L'exercice intense réalise lors de cette étude n'a pu induire de phase inflammatoire aigué. L'augmentation d'hémoglobine et la diminution d'haptoglobine et de fer peuvent être causées par une hémolyse induite par l'exercice, indiquant qu'une condition similaire à l'anémie de l'athlète chez l'homme existe chez le cheval. La pathogénèse et l'implication clinique des modifications hématologiques et biochimiques lié à un exercice intense chez les trotteurs dans la présente étude justifié de plus amples investigations.(Traduit par Docteur Denis Verwilghen).

Pulmonary tuberculosis in two employees at a skilled nursing facility: screening and treatment protocols.

In 2004, two employees in a skilled nursing facility developed active pulmonary tuberculosis (TB). Both employees were purified protein derivative (PPD) test positive for more than 10 years before developing the disease. Four employees converted to positive PPD status during the exposure investigation--two at baseline and two at the 12-week follow up. No additional cases of active TB were found. Several changes and additions have been made to the TB screening protocol after these two index cases were discovered.