Does the use of surgical face masks reduce postoperative infections in traumatic wounds sutured outside hospital? A randomized study at a Norwegian casualty center.

OBJECTIVE: To investigate if wearing surgical face mask by doctors and nurses during suturing of traumatic wounds has any impact on postoperative infection rate. DESIGN: Randomized controlled study with masked or unmasked health personnel groups. SETTING: A Norwegian Minor Injury Department. SUBJECTS: Adult patients with traumatic wounds sutured at the clinic between 7 October 2019 and 28 May 2020. MAIN OUTCOME MEASURES: Postoperative infections of sutured wounds. RESULTS: One hundred and sixty-five patients with 176 wounds were included in the study. Nine out of 88 wounds (10.2%) in the masked group and 11 out of 88 wounds in the unmasked group (12.5%) had a wound infection. CONCLUSIONS: Despite a higher percentage of postoperative infections in the unmasked than in the masked group (12.5% versus 10.2%), the difference was not statistically significant (p = .6). This might imply that the use of facemasks during suture of traumatic wounds in an outpatient setting does not significantly reduce the number of infections. However, due to the covid pandemic, the study had to be prematurely stopped before the planned number of participants had been recruited (n = 594). This increases the risk of type II error.

Few studies from hospital setting have found significant difference in postoperative wound infections if surgical face masks were worn or not during surgery.High quality studies about face masks and wound infections from primary care are lacking.This randomized study at a minor injury department outside hospital found no significant difference in frequency of postoperative wound infection if health personnel had worn surgical face masks or not while suturing traumatic wounds.

Acute management of fractures in primary care - a cost minimisation analysis.

BACKGROUND: In Norway, primary healthcare has first-line responsibility for all medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care in hospitals. However, the cooperating municipalities of Bykle and Valle have X-ray facilities and handle minor fractures locally. The aim of this study was to estimate the costs of X-ray diagnosis and initial treatment of fractures at the local primary care centre compared with initial transport and treatment in hospital. METHODS: We conducted a cost minimisation analysis by comparing expected costs of initial examination with X-ray and treatment of patients with fractures or suspected fractures at two possible sites, in the local municipality or at the hospital. A cost minimisation analysis is an economic evaluation based on the assumption that the outcomes of the two treatment procedure regimens are equal. Costs were estimated in Euros (EUR) using 2021 mean exchange rates. RESULTS: In 2019, we identified a total of 403 patients with suspected fractures in the two municipalities. Among these, 12 patients bypassed the primary care system as they needed urgent hospital care. A total of 391 injured patients were assessed with X-ray at the primary health care centres, 382 received their initial treatment there, and nine were referred to hospital. In an alternative hospital model, without X-ray and treatment possibilities in the municipality, the 382 patients would have been sent directly to hospital for radiological imaging and treatment. The total cost was estimated at EUR 367,756 in the hospital model and at EUR 69,835 in the primary care model, a cost saving of EUR 297,921. CONCLUSION: Based on cost minimisation analysis, this study found that radiological diagnosis of suspected fractures and initial treatment of uncomplicated fractures in primary care cost substantially less than transport to and treatment in hospital.

Incidence, pattern and mechanisms of injuries and fractures in children under two years of age.

BACKGROUND: Fractures in children under 2 years of age are rare, and little has been published on their mechanisms. We aimed at examining the incidence, mechanisms, pattern and fracture characteristics in a large, population-based cohort of otherwise healthy children. METHODS: This retrospective, cross-sectional study includes all children aged 0-2 years, attending the Accident and Emergency department in Bergen between 2010 and 2015, due to an injury warranting radiography. Clinical data was categorized from the medical notes, and all radiographs were reviewed by an experienced paediatric radiologist. RESULTS: In total 408 children (212 male), 3-23 months of age (mean 17.7 months), were included. 149 (77 male) children had a total of 162 fractures, yielding an annual incidence of 5.4 per 1000, varying from 0.7 per 1000 for those under 12 months of age, increasing tenfold to 7.3 per 1000 for children aged 12-24 months of age. More than half of the fractures (53.1%) were seen in children aged 18-23 months, while none was found in those under 7 months of age. The youngest age group had mostly femur and tibia fractures, the oldest mostly forearm fractures (n = 55, 33.9%), followed by tibia fractures (21.6%) and fractures to the clavicle (14.8%). The reported mechanisms for the 162 fractures were fall from a chair/bed/table (41.4%), fall from own height (18.5%) or crush injury (15.4%). In 8 of 162 (4.9%) fractures, the history was clearly inconsistent and suspicious of non-accidental injury (NAI). CONCLUSION: Injuries and fractures in young children in general, and non-ambulant children in particular, are rare and should be thoroughly assessed for NAI. LEVEL OF EVIDENCE: Retrospective, population based cross-sectional study. Level 3.

Prevalence of metaphyseal injury and its mimickers in otherwise healthy children under two years of age.

BACKGROUND: Metaphyseal lesions in infants and toddlers are believed to have a high specificity for inflicted injury. OBJECTIVES: To examine the prevalence of metaphyseal injury and its mimickers in otherwise healthy children younger than 2 years of age. MATERIALS AND METHODS: During 2010-2015, all children 2 years old and younger seen at the Accident and Emergency (A&E) Department due to an injury who had radiographs taken were included. Information on mechanism and clinical findings were drawn from the medical notes. All radiographs were reviewed by two of five researchers together with an experienced paediatric radiologist, registering fracture site and type, and metaphyseal appearances. RESULTS: Four hundred and eight children (212 boys) (mean age: 17.7 months, range: 3-24 months) were included, of whom 149 (77 boys) had a total of 162 fractures (incidence of 5.4 per 1,000 children). Only one metaphyseal lesion, without a history of trauma, was seen. Of the 860 metaphyses analysed, 140 (16.3%) were defined as either irregular (74/860, 8.6%) or as having a metaphyseal collar (66/860, 7.7%). Sixty-four of the 66 collars (97.0%) and 54/104 irregularities (60.8%) were located around the wrist and the ankle, while 25/74 irregularities (33.8%) were found around the knee joint. CONCLUSION: Metaphyseal lesions with a history of trauma did not occur in otherwise healthy neonates and infants younger than 2 years of age, indicating that this type of fracture has a particular trauma mechanism. Metaphyseal irregularities/collars are frequently seen and should not be mistaken for a classic metaphyseal lesion.

Fractures diagnosed in primary care - a five-year retrospective observational study from a Norwegian rural municipality with a ski resort.

Objective: The aim of this study was to characterize fractures recorded at a Norwegian primary care centre near a ski resort.Design: A retrospective five-year observational study in the period 2010-2014.Setting: A primary care centre equipped with an x-ray machine and located near a ski resort in a small rural municipality of 931 inhabitants in Norway. The X-ray images are digitalized and instantly transferred for assessment of a radiologist and/or an orthopedic surgeon both before and after treatment.Subjects: All patients with radiologically confirmed fractures.Results: A total of 1154 X-ray examinations were done, out of which 480 (41.6%) were fractures verified by a radiologist. The most frequent fractures were in the wrist (30%), collarbone (15%), shin (11%), humerus (9%) and ankle (8%). 316 (66%) of the fractures were in males and of these 225 were in age group 10-19 years. Males dominated among fractures in collarbone (92% males), finger (80% males), and foot (85% males). Women with fractures of the wrist, ankle, humerus and metacarpal bones, had a higher median age than men with similar fractures. Nonsurgical treatment with cast or braces was initially offered in 371 (77%) of the fracture-cases at the primary care level.Conclusion: Young men acquired most of the fractures, predominantly in the wrist, and mostly during the winter sport season. Nearly eight of ten fractures were treated locally in primary care centre.Key pointsA large seasonal variation was found in number of patients with fractures.More than 60% had fractures in the wrist, collarbone, shin or ankle.More than half of the patients with a fracture were males and below 20 years old.Most fractures were ski-related.

Postoperative treatment after partial nail ablation of ingrown toenails - does it matter what we recommend? A blinded randomised study.

Trial design: In this blinded randomized study we analyzed patient reported outcome of three different treatments after nail surgery. We compared daily footbath with either alkaline or acidic soap or just a simple bandage of gauze dressing. Method: After partial nail ablation surgery, patients were randomized into three postoperative treatment modalities. Outcome in terms of reduction in pain, improvement of function, reduction of signs of infection and postoperative soothing effect were reported after one and two weeks. A generalized linear mixed model was used to analyze possible statistical differences between the groups. Results: 97 patients, 57% women, mean age 31 years, were included. Men reported significantly less pain and better function than women. Despite a registered lower growth of invasive pathogenic microbes following the use of acidic soaps, this did not lead to less infections than in the groups using either alkaline soap baths or bandaging. On the contrary, patients keeping the bandage on had significantly lower signs of infection after one week. Two patients using soap baths had growth of MRSA. Two weeks postoperatively, all three treatment alternatives had similar patient reported outcome in all parameters, and nobody needed antibiotics. Conclusions: This prospective randomized study was unable to prove that footbath with either acidic or alkaline soap should be preferred to just leave the postoperative bandage on for a week after partial nail ablation. We recommend that postoperative advice should be given on an individual basis, especially since our study did not involve patients with high risk of infections.

A comparison of pain assessment by physicians, parents and children in an outpatient setting.

INTRODUCTION: Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief. PATIENTS AND METHODS: This cross-sectional study involved 243 children aged 3-15 years treated at Bergen Accident and Emergency Department (ED) in 2011. The child patient's pain intensity was measured using age-adapted scales while parents and physicians did independent numeric rating scale (NRS) assessments. RESULTS: Physicians assessed the child's mean pain to be NRS=3.2 (SD 2.0), parents: NRS=4.8 (SD 2.2) and children: NRS=5.5 (SD 2.4). The overall child-parent agreement was moderate (Cohen's weighted κ=0.55), but low between child-physician (κ=0.12) and parent-physician (κ=0.17). Physicians significantly underestimated pain in all paediatric patients ≥3 years old and in all categories of medical conditions. However, the difference in pain assessment between child and physician was significantly lower for fractures (NRS=1.2; 95% CI 0.5 to 2.0) compared to wounds (NRS=3.4; CI 2.2 to 4.5; p=0.001), infections (NRS=3.1; CI 2.2 to 4.0; p=0.002) and soft tissue injuries (NRS=2.4; CI 1.9 to 2.9; p=0.007). The physicians' pain assessment improved with increasing levels of pain, but only 42.1% of children with severe pain (NRS≥7) received pain relief. CONCLUSIONS: Paediatric pain was significantly underestimated by ED physicians. In the absence of a self-report from the child, parents' evaluation should be listened to. Despite improved pain assessments in children with fractures and when pain was perceived to be severe, it is worrying that barely half of the children with severe pain received analgesics in the ED.

Physicians' use of pain scale and treatment procedures among children and youth in emergency primary care - a cross sectional study.

BACKGROUND: Pain is a common symptom in children and youth attending casualty centres and emergency departments. The aim of this study was to acquire more knowledge about how pain in children is measured and handled by emergency primary care physicians. METHODS: A structured questionnaire study was performed among 75 emergency primary care physicians in a Norwegian accident and emergency department (AED). We used descriptive statistics to analyse the use of a pain scale, the use of weight and age when dosing pain medication, the need for more knowledge and the need for pain management procedures in children. The Pearson chi-square test was used to analyse differences between groups. RESULTS: A pain scale with a visual analogue scale (VAS) had been used by 59 % of physicians in young patients aged 9 to 19 years, by 23 % in children aged 3 to 8 years, and by 3 % in children below 3 years. A total of 63 % of physicians reported that they used the child's weight instead of the age interval when estimating the needed dose of painkillers. They relied on parents' weight estimation and seldom measured the child's weight at attendance. Most emergency medical care physicians reported a need for more knowledge and better procedures related to both pain evaluation and pain treatment in children and youth. The physicians included in the study were demographically representative of AED physicians in Norway (average age 37 years old, 55 % men, 76 % had studied medicine in Norway and 49 % had fewer than 5 years of medical experience). CONCLUSIONS: Emergency primary care physicians report a need for pain assessment procedures in children and youth. They sometimes use a pain scale when measuring and managing pain in patients aged 9 to 19 years, but seldom in younger patients.

Costs analysis and comparison of usefulness of acute MRI and 2 weeks of cast immobilization for clinically suspected scaphoid fractures.

BACKGROUND AND PURPOSE: Fractures of the scaphoid are often not detected on initial plain radiographs. Conventional management of clinically suspected scaphoid fractures is cast immobilization for 2 weeks and then reassessment. Early MRI is a diagnostic alternative. We compared the cost and usefulness of the early MRI diagnostic strategy with that of conventional management. PATIENTS AND METHODS: This prospective pseudo-randomized study included patients between 18 and 49 years of age who attended Bergen Accident and Emergency Department, Bergen, Norway during 1 year in 2009-2010, after sustaining an acute wrist trauma in the previous week and with a clinically suspected scaphoid fracture. 61 patients were investigated with acute MRI, while 63 patients received standard treatment as a control group. We used cost-minimization analysis to estimate the cost of the 2 patient groups. RESULTS: Concerning cost, there were no statistically significant differences in the total direct medical costs or in indirect costs between the groups. Concerning usefulness, patients in the MRI group without a fracture (n = 35) used a cast for fewer days (mean 1 day) than patients in the control group with no fractures (n = 52) (mean 14 days; p < 0.001). They had less than half the number of days on sick leave than patients in the control group (mean 7 days vs. 15 days; p = 0.002). INTERPRETATION: In a Norwegian setting, an early MRI was of value in patients with clinically suspected scaphoid fracture and normal plain radiographs.

Infections in traumatic wounds sutured at a Norwegian Accident and Emergency Department.

BACKGROUND: Different countries have different wound treatment traditions. We have studied the incidence and different factors related to infections in wound injuries sutured at a Norwegian A&E department. METHOD: In this prospective study, clinical data were collected on 102 patients with traumatic wound injuries treated with sutures at Bergen Accident and Emergency Department between 30 February 2011 and 30 June 2011. Any wound infections in 97 of these patients at the time of suture removal were assessed and classified according to severity on a scale of grade 0 to grade 4. RESULTS: There were no serious infections, but mild clinical wound infections occurred in 15% of patients: 11% grade 1 and 4% grade 2 infections. Patients less than 65 years old had often cut themselves with knives (n = 33, 37%), and on their hands (n = 60, 67%), Men were most frequently injured at work (n = 38, 54%) and women most often at home (n = 18, 56%). No statistically significant correlation was found between the incidence of wound infections and the length of the wound, the time elapsed before suturing, the wound's location on the body, contamination or underlying chronic diseases. Two of the three self-inflictors in our study had clinical wound infections. Half of the bacteriological samples from ten of 15 wounds with clinical infection had plentiful growth of Staphylococcus aureus. One patient received oral antibiotic treatment for wound infection, and two had local antibiotic treatment. INTERPRETATION: Mild clinical infections were found in almost one of six wounds sutured at a Norwegian A&E department. More studies are necessary to provide basic data to enable targeted improvements in wound treatment in the primary healthcare service.

Clinical scaphoid score (CSS) to identify scaphoid fracture with MRI in patients with normal x-ray after a wrist trauma.

INTRODUCTION: The aim of this study was to compare a combination of three commonly used tests to identify scaphoid fractures with MRI in patients with normal x-ray after a wrist trauma. PATIENTS AND METHODS: This prospective MRI study included patients between 18 years and 49 years, who attended the Emergency Department, 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 after the trauma. The study period lasted 1 year. The patients were examined with three commonly used clinical scaphoid tests; tenderness in the anatomical snuffbox with the wrist in ulnar deviation (3 points), tenderness over the scaphoid tubercle (2 points) and pain upon longitudinal compression of the thumb (1 point). The clinical scaphoid score (CSS) is a sum of these points, which was compared with MRI verified fracture of the scaphoid. RESULTS: We included 154 patients with wrist sprain and normal x-rays; 13 had occult scaphoid fracture. A CSS of 4 or more was the only statistically significant 'cut-off' value to identify occult scaphoid fractures (p<0.05). Diagnostic sensitivity increased with more experienced Emergency Department doctors. CONCLUSIONS: If a patient with wrist pain after injury and normal x-ray has a CSS≥4 (pain in the anatomical snuffbox in addition to pain at scaphoid tubercle or longitudinal compression or both) we recommend MRI. A CSS <4 has a negative predictive value of 96%, which makes scaphoid fracture unlikely.

[Cardiovascular risk assessment for the use of ADHD drugs in children]. / Kardiovaskulær risikovurdering ved bruk av AD/HD-medikamenter hos barn.

BACKGROUND: Drug therapy for ADHD (Attention Deficit Hyperactivity Disorder) has generally been regarded as safe. ECG screening of healthy children and adolescents before initiating this type of treatment appears to be usual in Norway, despite recommendations that ECGs should only be undertaken in individuals who are at risk. The purpose of this article is to clarify relevant guidelines for cardiovascular risk assessment for the use of ADHD drugs in children and adolescents, as well as to propose practical recommendations. METHOD: The article is based on a literature search in PubMed completed on 1 October 2013, and on the author's own clinical experience and discretionary assessments. RESULTS: The use of CNS stimulants and atomoxetine is associated with a slight rise in blood pressure and pulse rate, as well as small changes in QT interval. A small percentage of patients (5-10%) experience a clinically significant rise in blood pressure and pulse rate. Sudden death does not appear to occur more frequently in children and adolescents taking ADHD drugs in therapeutic doses than in children and adolescents who do not use such drugs. There is little knowledge available on the long-term effects of ADHD drugs on the cardiovascular system of otherwise healthy individuals, or on the risk related to the use of ADHD drugs in children and adolescents with cardiac disease. The drugs are thought to increase the risk of sudden cardiac death in some arrhythmia syndromes. INTERPRETATION: Our assessment is that caution should be exercised in the use of ADHD drugs in children with potentially dangerous cardiac arrhythmias. We recommend clinical examination and a thorough medical history review in order to identify individuals at risk before initiating drug therapy, and also suggest that it is not necessary for healthy children to be given an ECG examination before introducing ADHD drugs. In children with known cardiac disease, arrhythmia or risk factors for cardiac disease, ADHD treatment should be undertaken in consultation with a medical specialist with competence in pediatric cardiology.

Patient-reported outcomes after initial conservative fracture treatment in primary healthcare - a survey study.

BACKGROUND: Primary healthcare in Norway has first-line responsibility for medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care. However, some municipalities have X-ray facilities and handle minor fractures locally. We investigated patient-reported outcome measures after initial treatment of radiologically diagnosed fractures of the wrist, collarbone, and ankle at a primary healthcare centre in a rural municipality with a large ski resort. The patients' general satisfaction with the treatment was also investigated. METHODS: Validated questionnaires were sent to patients with fractures of the wrist or collarbone (Quick DASH-Disability of Arm, Shoulder and Hand) or the ankle (FAOS -The Foot and Ankle Outcome Score). Patients with wrist and collarbone fractures also answered the Quality-of-life questions that are a subscale of the FAOS questionnaire for ankle fractures. Patient satisfaction was measured for all fracture groups. The Quick DASH scale ranges from 0 (no disability at all) to 100 (great disability), while for FAOS a score of 100 indicates no symptoms and 0 indicates extreme disabilities. RESULTS: A total of 148 of 238 patients answered the questionnaire (62% response rate). Patients with distal radius fractures had a mean Quick DASH score of 5.1 (median 0, range 0-77), and scores were significantly lower for males (p = 0.013) and increased with age (p = 0.024). Patients with collarbone fractures had a mean Quick DASH score of 2.1 (median 0, range 0-32) with no significant age or gender differences. Patients with ankle fractures had the following mean subscale-scores: Pain, 93.8; Symptoms, 71.4; Activities of daily living, 97.4; Sport, 90.0; and Quality of life, 92.1. The scores did not differ significantly by specialization of the physician. A total of 88% of the patients were highly or very highly satisfied with the handling of their fracture. CONCLUSIONS: The patients reported low rates of functional disability and high rates of satisfaction after initial radiological diagnosis and treatment of their fracture at the primary healthcare centre. Specialisation of the treating physician was not associated with the outcome in any of the fracture types.

[Burn injuries in children]. / Brannskader hos barn i Bergen.

BACKGROUND: Burn injuries in children may cause permanent harm. This study reports data on incidence, injury mechanisms and products that cause burn injuries (in the period 01.01.07-31.12.07) and compares findings with those from previous studies (in 1989 and 1998). MATERIAL AND METHODS: Semi-structured questionnaires were filled in by patients or next-of-kin and health workers at Bergen Accident and Emergency Department, casualty centres in three municipalities in western Norway (Fana, Åsane and Loddefjord) and at the National Burns Centre, Haukeland University Hospital. Missing data were retrieved retrospectively from medical records. RESULTS: We recorded 142 children with burn injuries; 35% were boys under two years of age. The annual incidence was the same as earlier; 6.6 per 1,000 under five years and 3.1 per 1,000 children under 15 years living in the community of Bergen. Contact injuries and scalds were most common and were caused by contact with ovens, stoves and hot food or liquids. Most children (93%) had less severe burns; 6% (9) were hospitalized (four of them had a non-western background). Almost 95% were given first aid by cooling. INTERPRETATION: Children under two years, especially boys, are most at risk of burn injuries. Ovens were the cause more often now than before. The incidence has been the same the last 20 years and is the same as that in Trondheim ten years ago. The fact that the small city, Harstad, (northern Norway) attained substantially less injuries after the introduction of preventive actions indicates that such actions are needed to reduce the number of burn injuries among children.

[Unpowered scooter injuries]. / Skader ved bruk av sparkesykkel.

BACKGROUND: Injuries caused by the use of unpowered kick scooters in Bergen were registered after their introduction on the Norwegian market in 2000. MATERIAL AND METHODS: In a prospective one-year registration we found 62 patients with 82 injuries in Bergen accident and emergency department. RESULTS: Boys and girls were injured to the same extent; the age span was from 6 to 53 years, mean age 11. Most injuries occurred in September. Two thirds injured their arms/hands, one-sixth their head and one-sixth their legs/feet. Wounds accounted for 37 injuries, often in the face (n = 11) or knees (n = 12). Fractures occurred in 34 % (n = 28); one third needed reduction. Lower arm fractures were most numerous (n = 17), the Smith type with volar angulation occurring in almost half of these. Few had used safety equipment (n = 5). INTERPRETATION: Kick scooters cause fewer injuries than rollerblades and skateboards, but the use of wrist protection and helmet is still recommended. Kick scooters should not be used in traffic.

Osteoporosis as a risk factor for distal radial fractures: a case-control study.

BACKGROUND: Distal radial fractures occur earlier in life than hip and spinal fractures and may be the first sign of osteoporosis. The aims of this case-control study were to compare the prevalence of osteopenia and osteoporosis between female and male patients with low-energy distal radial fractures and matched controls and to investigate whether observed differences in bone mineral density between patients and controls could be explained by potential confounders. METHODS: Six hundred and sixty-four female and eighty-five male patients who sustained a distal radial fracture, and 554 female and fifty-four male controls, were included in the study. All distal radial fractures were radiographically confirmed. Bone mineral density was assessed with use of dual x-ray absorptiometry at the femoral neck, total hip (femoral neck, trochanter, and intertrochanteric area), and lumbar spine (L2-L4). A self-administered questionnaire provided information on health and lifestyle factors. RESULTS: The prevalence of osteoporosis was 34% in female patients and 10% in female controls. The corresponding values were 17% in male patients and 13% in male controls. In the age group of fifty to fifty-nine years, 18% of female patients and 5% of female controls had osteoporosis. In the age group of sixty to sixty-nine years, the corresponding values were 25% and 7%, respectively. In adjusted conditional logistic regression analyses, osteopenia and osteoporosis were significantly associated with distal radial fractures in women. Osteoporosis was significantly associated with distal radial fractures in men. CONCLUSIONS: The prevalence of osteoporosis in patients with distal radial fractures is high compared with that in control subjects, and osteoporosis is a risk factor for distal radial fractures in both women and men. Thus, patients of both sexes with an age of fifty years or older who have a distal radial fracture should be evaluated with bone densitometry for the possible treatment of osteoporosis.

Vitamin D inadequacy is associated with low-energy distal radius fractures: a case-control study.

INTRODUCTION: Vitamin D inadequacy is associated with hip fractures, but the relationship has not been explored for distal radius fractures. AIMS: To compare serum 25-hydroxyvitamin D (s-25(OH)D) status in low-energy distal radius fracture patients and a group of matched controls, and examine whether observed differences in s-25(OH)D between patients and controls would remain after adjusting for bone mineral density (BMD), body mass index (BMI), and smoking history. METHODS: A total of 575 female and 72 male low-energy distal radius fracture patients (50-90 years) and 534 female and 52 male matched controls were included. The primary measure was levels of vitamin D. Secondary measures were BMD assessed by dual energy X-ray absorptiometry, BMI and smoking history. RESULTS: Mean s-25(OH)D was 66.5nmol/L in female patients and 78.7nmol/L in controls (p<0.001). The corresponding figures in men were 64.5 and 77.0nmol/L (p=0.017). In adjusted conditional logistic regression analyzes, s-25(OH)D <50nmol/L (OR=2.32, 95% CI: 1.47-3.64, p<0.001), and 50-75 (OR=1.70, 95% CI: 1.17-2.47, p=0.005) were associated with distal radius fractures in women. s-25(OH)D <50nmol/L (OR=6.27, 95% CI: 1.17-33.66, p=0.032) was associated with distal radius fractures in men. CONCLUSIONS: Vitamin D inadequacy is associated with low-energy distal radius fractures in both women and men. Differences in vitamin D levels are independent of BMD, BMI or smoking history.