Correction to: Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial).

An amendment to this paper has been published and can be accessed via the original article.

Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial).

BACKGROUND: Syndesmotic injuries are common and their incidence is rising. In case of surgical fixation of the syndesmosis a metal syndesmotic screw is used most often. It is however unclear whether this screw needs to be removed routinely after the syndesmosis has healed. Traditionally the screw is removed after six to 12 weeks as it is thought to hamper ankle functional and to be a source of pain. Some studies however suggest this is only the case in a minority of patients. We therefore aim to investigate the effect of retaining the syndesmotic screw on functional outcome. DESIGN: This is a pragmatic international multicentre randomised controlled trial in patients with an acute syndesmotic injury for which a metallic syndesmotic screw was placed. Patients will be randomised to either routine removal of the syndesmotic screw or removal on demand. Primary outcome is functional recovery at 12 months measured with the Olerud-Molander Score. Secondary outcomes are quality of life, pain and costs. In total 194 patients will be needed to demonstrate non-inferiority between the two interventions at 80% power and a significance level of 0.025 including 15% loss to follow-up. DISCUSSION: If removal on demand of the syndesmotic screw is non-inferior to routine removal in terms of functional outcome, this will offer a strong argument to adopt this as standard practice of care. This means that patients will not have to undergo a secondary procedure, leading to less complications and subsequent lower costs. TRIAL REGISTRATION: This study was registered at the Netherlands Trial Register (NTR5965), Clinicaltrials.gov ( NCT02896998 ) on July 15th 2016.

Complications after hip fracture surgery: are they preventable?

PURPOSE: Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention. METHODS: Prospective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality. RESULTS: The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97-2.35) and delay in surgery (OR 3.16; 95% CI 1.43-6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality. CONCLUSION: The overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.

Spinal epidural abscess presenting with abdominal pain.

We report a case of spinal epidural abscess presenting as abdominal pain. An 7-year-old boy presented with abdominal pain. He was operated on under suspicion of appendicitis. During operation, no abnormalities were found. Postoperatively, the abdominal pain did not subside. Subsequently, the boy developed neurological abnormalities. MRI showed a spinal epidural abscess. A laminectomy was performed and the boy was treated with antibiotics; he recovered well. This case showed that it is important to consider a spinal epidural abscess as a cause of abdominal pain with fever in children.

[Thyroid papillary hyperplasia mistaken for papillary carcinoma in fine needle aspiration cytology and frozen section examination]. / Papillaire hyperplasie van de schildklier bij cytologische punctie en vriescoupediagnostiek aangezien voor papillair schildkliercarcinoom.

In a 40-year-old woman with a swelling in the left lobe of the thyroid gland, fine needle aspiration cytology led to the suspicion of papillary thyroid carcinoma. Hemithyroidectomy with a frozen section examination followed. The frozen section was also suggestive of papillary carcinoma and total thyroidectomy with cervicocentral lymph node dissection was performed. However, the final histological examination revealed papillary hyperplasia and not a malignancy. Thyroid papillary hyperplasia presenting as a single thyroid nodule is rare. Nevertheless, the possibility of thyroid papillary hyperplasia should be considered when the features of fine needle aspiration cytology are suggestive, but not fully evident for papillary carcinoma. In these cases it is important to wait for the final histology and abandon frozen section examination.

Return of the milk curd syndrome.

Five extremely low birth weight (ELBW) infants were treated in our institution for the milk curd syndrome, a milk bolus intestinal obstruction. The medical records of the five patients, who all underwent surgery, were retrospectively reviewed. History and examination are usually sufficient to diagnose the milk curd syndrome in ELBW infants. Confirmation with an abdominal X-ray may be possible but the X-ray findings may be mistaken for localised necrotising enterocolitis (NEC). Contrast enemas in an attempt to shift the bolus obstruction may be dangerous, and have a low success rate. Enterotomy and removal of the bolus is a safe and effective treatment if the diagnosis is early, otherwise resection with or without diverting ileostomy may be necessary. It appears that after years of disappearance, the milk curd syndrome has again become a clinical entity. It is probably due to a combination of high calcium and fat intake in an ever increasing population of ELBW infants.

Development of postural adjustments during reaching in preterm infants.

Preterm infants often show postural abnormalities, such as hyperextension of neck and trunk, which can interfere with motor and cognitive development. Little is, however, known on the pathophysiology of postural development in preterm infants. Therefore, we longitudinally studied the development of postural adjustments during reaching movements in 12 preterm infants between the (corrected) ages of 4 and 18 mo. Five infants showed minor neurological dysfunctions at 18 mo, such as a mild diffuse hypotonia, a mild hypertonia of the legs, or a mild asymmetry in posture and motility, and seven infants were neurologically normal. Each assessment consisted of a simultaneous recording of video-data and surface electromyograms of arm, neck, trunk, and leg muscles during reaching in various lying and sitting positions. Comparable data on postural development in ten full-term infants were available. The preterm infants showed an excessive amount of postural activity during reaching movements at all ages studied. Moreover, the postural adjustments were temporally disorganized and could not be modulated with respect to the velocity of the arm movement and the initial sitting position. We hypothesized that the preterms' disability to modulate their postural adjustments might be due to a reduced capacity to learn from prior experience. In our small group the postural dysfunctions were not related to the presence of hyperextension at early ages, to the neurological outcome at 18 mo, or to the lesions found on the neonatal brain ultrasound scans.