Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study.

INTRODUCTION: Hip fracture patients represent a frail group of elderly with increased morbidity and mortality. The aim of this study was to evaluate the occurrence and distribution of a second hip fracture in the time interval between the first and the second hip fracture. METHODS: All incident hip fractures in residents of Funen County, Denmark, from 1994 through 2004 were recorded. Verified fractures were sequenced within each patient using the unique Danish identification numbers. RESULTS: In total, 9990 incident hip fractures occurred: 9122 first hip fractures and 868 (8.7%) second fractures. Within the first year after the first hip fracture, the incidence rate of the second fracture in men decreased from 73 per 1000 person-years (py) during the first 3 months to 8 per 1000 py at 12 months; in women, it decreased from 116 per 1000 py during the first 3 months to 15 per 1000 py at 12 months. Of all the second fractures, 50% occurred within 12 months in men and within 19 months in women. CONCLUSIONS: Few hip fracture patients experience a second hip fracture and when they do, it is within a short time-frame from the first. The risk of sustaining a second hip fracture is high during the first 12 months following the first hip fracture, decreasing to a level equal to or below the incidence of the first hip fracture after this 12-month period. Preventive strategies at the time of the first hip fracture should therefore aim at immediate effects, as interventions with effects after 12 months (men) and 19 months (women) bypass at least 50% of the fractures.

The trochanteric gamma nail versus the dynamic hip screw: a prospective randomised study. One-year follow-up of 146 intertrochanteric fractures.

In a prospective, randomized trial we compared the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in the treatment of 146 intertrochanteric fractures. Follow-up was after four and 12 months. The operation time was significantly shorter in the DHS group. At discharge the need for walking aids was less in the DHS group. There were no differences in intraoperative blood loss, medical complications, mortality or length of hospital stay. Major fracture complications occurred twiceas often in the TGN group compared with the DHS group, however they were not statistically significant. Any potential for the TGN leading to a less invasive procedure and a more rapid postoperative mobilisation could not be demonstrated. Compared with the TGN we prefer the DHS for most intertrochanteric fractures in a setting where the majority of these fractures are treated by younger doctors and not by highly specialized hip/trauma surgeons. The TGN may have advantages in selected intertrochanteric fractures.;

[Admission, initial examination and care of severely injured in Denmark]. / Modtagelse, initial undersøgelse og behandling af svaert tilskadekomne i Danmark.

INTRODUCTION: The aim of this study was to describe the initial care and management of trauma patients in Denmark. MATERIAL AND METHODS: A questionnaire was sent to all 64 hospitals in Denmark in July 1999. All responded. The questionnaire covered 81 questions. RESULTS: The number of severely injured patients received by the hospitals was evenly distributed. Nine hospitals received more than 50 severely injured patients/year. Protocols for trauma care were available in 46 hospitals. Monitoring with ECG and pulse oximetry in the emergency room was possible in most hospitals. Most hospitals were also equipped to perform endotracheal intubation, chest tube drainage, surgical airway, and peritoneal lavage. Radiological and clinical laboratory services were available round the clock in most hospitals. Ultrasonography could be performed in 41 and CT in 36 hospitals. Three hospitals did not transfer patients to other facilities. An estimated quarter of the severely traumatised patients are transferred to a hospital with a higher level of trauma treatment. CONCLUSION: Many Danish hospitals receive trauma patients. However, a number of hospitals do not have the necessary organisation, clinical capabilities, or resources for trauma care. There is a need for regional and national guidelines for trauma care with recommendations ensuring early recognition of patients who may be sufficiently cared for in the local hospital, and those who require transfer to trauma centres for definitive care.

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.

[Is the number of injuries following deliberate violence increasing?]. / Er antallet af tilskadekomster som følge af forsaetlig vold stigende?

The purpose was to estimate the annual incidence of hospital-treated injuries related to violence in the city of Odense in the period of 1988 to 1996. The overall incidence was estimated to 0.57 (1996) per 100 persons per year, with the highest incidence among men between 15 to 25 years. The lifetime cumulative incidence proportion was estimated to 45% for men and 21% for women. During the period 1988-1996 the overall annual incidence showed a slight decrease.

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.

["Moon-cars" are dangerous]. / "Moon-cars" er ikke ufarlige.

We investigated the number and seriousness of moon-car accidents in our region (a moon-car is a toy-vehicle, see Fig. 1). The study was retrospective combined with a telephone-interview. Forty-seven patients were seen in the emergency room after a moon-car accident in the period 1/1 1990-31/12 95. There were 12 fractures, including five fractures of the tibial shaft and one supracondylar humeral fracture which was operated. There were 17 wounds, 14 of which were sutured. Seventeen patients had distorsions/contusions, three cases of head contusions (observed for concussion) and two with teeth damages. We found that the number of moon-car accidents is increasing (13 patients the last year), and that the accidents are not only minor. New rules in day care centres should be able to especially limit the number of more serious accidents.

Sports injuries in school-aged children. A study of traumatologic and socioeconomic outcome.

In this Danish study we attempted to identify the socioeconomic consequences of sports injuries in children. A total of 1320 children, 650 boys and 670 girls, aged 6-17, completed questionnaires covering the period from the injury to recovery. The incidence rate was 74 per 1000 per year. The hospitalization rate was 4.1%. Due to the injury 37.2% of the children were absent from school for an average of 1.2 days (range 0-60 days), resulting in 1598 days' absence from school. Most of the children were injured during training (34.7%) or competition (22.6%). The other injuries occurred during recreational sporting activities (32.0%) or at school (10.7%). Fifty-four percent were absent from training or games, on average 6.0 times (range 0-99), with a total loss of 7897 training sessions. Fifteen percent of the parents were absent from work, on average for 2.2 days. Two hundred and nineteen children were absent from an after-school job, for an average of 8.6 days. The total loss was 1896 working days. The study shows that the socioeconomic consequences of sports injuries in children are a complex consisting of different parts and that the injuries had a substantial impact on the functional and social status of the children and their families.

[Roller skating injuries]. / Rulleskøjteulykker.

The aim of this study was to investigate the number and types of accidents which occur in connection with roller-skates, and also to find out in which anatomical area the most injuries occurred. During the period 01.02.1995 to 31.08.1996, 389 patients sustained injuries in connection with roller-skates. Fifty-nine percent of all accidents happened on a public road. Out of 389 injuries, 174 sustained a fracture: 68% were forearm or distal radius/ulna fractures; 89% were upper extremity fractures. Thirty-three patients were admitted: four for observation due to concussion; 15 for reduction of fractures and application of plaster; and ten for osteosynthesis. Roller-skating accidents are extremely common. Possible prophylaxis includes protective equipment and restricted rinks for roller-skate enthusiast.

The epidemiology of sports injuries in school-aged children.

In the 5-year-period 1988-1992, 6096 children aged 6-17 (54.5% boys and 45.5% girls) were treated at the Emergency Department at Esbjerg Central Hospital after having sustained a sports injury. The data were registered according to the European Home- and Leisure-Accident Surveillance System (EHLASS) protocol. We found a total incidence rate in the municipality of Esbjerg of 73.3 per 1000 per year. Boys were most often injured in soccer, skateboard, handball, gymnastics and basketball, and girls in handball, horse-riding, gymnastics, basketball and roller-skating. The types of injuries were contusions 37.1%, fractures 22.0%, sprains 24.8%, wounds 9.5%, strains 5.0% and luxations 1.4%. The hospitalization rate was 3.8%. Compared to other studies the total incidence rate was high.

[It is not always necessary to establish a "first aid station" at mass gatherings. Cutty Sark Tallships Race 1993]. / Ikke altid behov for "fremskudt skadestue" ved store arrangementer. Cutty Sark Tallships Race 1993.

Previous studies from outdoor music festivals have recommended medical service facilities at first-aid stations. The Cutty Sark Tallships Race was a large outdoor event that took place over four days in Esbjerg harbour with about 500,000 participants and spectators. A total of 68 patients were treated, 28 in the first-aid station at the harbour and 40 at the nearby located hospital. The disease and injuries presented were not severe. The orthopaedic casualties dominated (82%), wounds, contusions and fractures being the most common ones. Only seven casualties were related to alcohol abuse. No casualties were related to drug abuse. The economic expense was estimated to DKK 14,676. Thus, at outdoor mass gatherings of a nature like the Cutty Sark Tallships Race, located near a hospital, first-aid stations are not necessary.

[Bicycle accidents 1980-1992. Do the official traffic accident statistics show the true picture?]. / Cykelulykker 1980-1992. Viser den officielle foerdselsuheldsstatistik den reelle udvikling?

In Denmark, official statistics concerning road traffic accidents are based upon police recordings. In this study, these official data are compared to data from the emergency room at Odense University Hospital from the period 1980 to 1992. The purpose is to examine whether the official statistics show a reliable picture of the development in accident numbers compared to data from the emergency room. The results confirm that it is necessary to use data from the emergency room to describe the true development in numbers of bicycle accidents.

[Violence-related cases in the emergency ward. A 5-year follow-up of registrations made in 1981 and 1986 at the Esbjerg emergency department]. / Voldsbetingede skadestuehenvendelser. Femårig opfølgning af undersøgelser fra 1981 og 1986 ved skadestuen i Esbjerg.

During six-month periods in 1981, 1986 and 1991 a prospective registration was made of all injuries caused by violence treated in the casualty ward of Esbjerg Hospital. The numbers of such contacts during these periods were 236 in 1981, 379 in 1986 and 509 in 1991. There were no differences between the three periods with respect to the following parameters: age, sex, civil status, place, types of lesions, need for further treatment and influence of alcohol. The total incidence rate rose between 1986 and 1991 from eight to nine per 1000 (not significant). The only significant increase was among females aged 15-19, where the incidence rose from 2.0 per 1000 in 1986 to 11.3 in 1991. Fourteen percent of the injured required hospitalization, occupying 1216 hospital bed days during the 1991 period.

[Accidents and accident mortality in Denmark--a comparison with Scandinavia and Europe]. / Ulykker og ulykkesdødsfald i Danmark--en sammenligning med Norden og EU.

As the development in mean age of the population and life expectancy has been less favourable in Denmark than in the rest of Western Europe, the Ministry of Health decided to investigate statistics for the period, 1972-1990, for the main areas where Danish life expectancy was poorer. A sharp increase in the incidence of accidental poisoning with medical drugs and alcohol during the period was found to be a factor contributing to the poorer Danish statistics during the period. In the subcategory, death after a fall, there was an increase in incidence among the elderly, but the loss of life-years remained constant. The subcategory, fatal road accidents, manifested a marked reduction in incidence, despite the increase in traffic density during the period, and there was a reduction in the loss of life-years. Thus, in the category, accidental deaths, the increase in the incidence of accidental poisonings would appear to be the only factor contributing to the poorer development in mean age and life expectancy in Denmark.

[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.

[Ethical problems of the emergency room work]. / Etiske problemer i skadestuearbejdet.

We studied the incidence of ethical problems occurring in the emergency room of a large Danish provincial hospital. During a period of two months, 3620 unselected patients were treated, and in 190 (5.2%) of these cases the attending physician identified one or more ethical problems. The three most common problems identified were a. potentially suboptimal treatment due to communication difficulties, b. potentially suboptimal treatment due to a high work-load in the emergency room, and c. questions raised by patients who presented with minimal lesions not requiring any treatment. It is suggested that a reduction of the number of ethical problems encountered in the emergency room can be obtained by allocation of more resources, education of the staff, and education of the general public explaining the role of the emergency room.

[Unsatisfactory results after repeated revision of hip alloplasties]. / Utilfredsstillende resultater efter gentagen revision af hoftealloplastik.

Sixty one cemented second revision total hip arthroplasties and 18 cemented third revision total hip arthroplasties were studied with emphasis on cause of failure, complications, risk of further revision, and clinical and radiographic outcome of surviving, not further revised patients. Aseptic loosening was the major reason for both second and third revisions followed by recurrent dislocations. Twenty one second revisions failed again. Postoperative dislocation was the major complication, entered in 10/61 second revisions and in 4/18 third revisions. Ten second revisions were reoperated on without exchange of components, but for reasons related to the implant. Clinical and radiographic outcome was favorable, but must be seen in the light of the high rate of further revisions. In 33/53 second revisions and in 5/13 third revisions left for evaluation, the overall outcome was considered unsatisfactory. Reoperations for failed arthroplasties should be the prerogative of highly experienced centers.

Unsatisfactory results after repeated revision of hip arthroplasty. 61 cases followed for 5 (1-10) years.

61 cemented second revision total hip arthroplasties and 18 cemented third revision total hip arthroplasties were studied with emphasis on causes of failure, complications, risk of further revision, and clinical and radiographic results of surviving, not further revised patients. Aseptic loosening was the major reason for both second and third revisions followed by recurrent dislocations. Of 61 second revisions, 21 failed again. Postoperative dislocation was the major complication, encountered in 10/61 after second revisions and in 4/18 third revisions. 10 second revisions were reoperated on without exchange of components, but for causes related to the implant. The clinical and radiographic outcome of surviving, not further revised patients was favorable, but must be seen in the light of the high rate of further revisions. In 33 of 53 second revisions and in 5 of 13 third revisions left for evaluation, the outcome was considered unsatisfactory. We conclude that reoperations for failed arthroplasties should be the prerogative of highly experienced centers.

[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.