Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty--the Danish Prolonged Prophylaxis (DaPP) Study.

The aim of this study was to compare the efficacy and safety of prolonged (35 days) thromboprophylaxis with a standard length (7 days) regimen of a low molecular weight heparin in patients undergoing total hip arthroplasty. The study was multicentre, randomised, double-blind, and prospective with two groups. Following seven days on a standard length regimen of dalteparin (5000 antifactor Xa units subcutaneously once daily starting 12 h before surgery), patients were randomized to continue the prophylaxis with either subcutaneous injections of dalteparin or placebo injections for a further 28 days. Efficacy was evaluated at the end of the study (day 35) in all patients with bilateral ascending phlebography to detect deep vein thrombosis. Bleeding complications and other adverse events were registered throughout the study period. Three hundred consecutive patients agreed to participate before the operation: 281 were finally randomised and 215 completed the study; two patients died before randomisation; 17 developed deep vein thrombosis; none developed pulmonary embolism; and five of 113 patients (4.4%, 95% CI 1-10%) developed deep vein thrombosis in the dalteparin group, compared with 12 of 102 (11.8%; 95% CI 6-20%) in the placebo group (p=0.039). Deep vein thrombosis in the proximal veins was diagnosed in one patient (0.9%; 95% CI 0-5%) in the dalteparin group, and in five (5.0%; 95% CI 2-11%) in the placebo group (p=0.076). Major bleeding was observed in one patient in the placebo group; minor bleeding complications and adverse events were equally distributed between the groups. We concluded that prolonged (35 days) thrombo prophylaxis with dalteparin is more effective than a standard length (7 days) regimen without increased risk of bleeding complications or other adverse events.

Coxarthrosis following traumatic posterior dislocation of the hip.

One hundred and twenty-seven hips in 125 adults were treated for traumatic posterior dislocation during a period of two decades. Ninety-eight patients (100 hips) were available for follow-up examination at a minimum of five years (average, fourteen years) after injury. By both clinical and radiographic criteria eighty hips (80 per cent) had an excellent or good result. Forty-two per cent of the hips that were reduced more than six hours after the dislocation had an excellent or good result and 88 per cent of those that were reduced within six hours after dislocation had an excellent or good result. Thirty-one per cent of the hips with a Grade-III dislocation had an excellent or good result, as compared with 90 per cent of those with a Grade-I dislocation. Twenty-two per cent of the hips with an excellent or good result had avascular necrosis of the femoral head. We found the time-interval between injury and reduction, the severity of the initial injury, and the development of avascular necrosis of the femoral head to be the most important factors with regard to the long-term prognosis. Avascular necrosis occurred most frequently in hips that underwent reduction after a delay of more than six hours.

Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both.

To determine the prognosis and best treatment for patients who have a posterior dislocation of the hip associated with a fracture of the femoral head or neck (Grade IV, according to the classification of Stewart and Milford), we surveyed the records of 201 patients who had been treated for 203 posterior dislocations from 1958 to 1985 and selected the cases of 19 patients (19 posterior fracture-dislocations of the hip) for further review. Each of the injuries had resulted from a motor-vehicle accident. Thirteen patients had had a posterior dislocation with an associated fracture of the femoral head located either caudad or cephalad to the fovea centralis (Pipkin Type-I or Type-II injury), one had had a posterior dislocation with associated fractures of the femoral head and neck (Pipkin Type III), two had had a posterior dislocation with associated fractures of the femoral head and the acetabular rim (Pipkin Type IV), and three had had a fracture-dislocation that we could not categorize according to the Pipkin classification. Twelve patients had been treated by closed reduction for a Type-I or Type-II injury; one, by open reduction after an unsuccessful closed reduction for a Type-I injury; one, by primary total hip replacement for a Type-III injury; and three, by open reduction with screw fixation of the acetabular fracture and removal of the fragment of the head for two Type-IV injuries and one unclassified injury. An additional two patients had had both a fracture of the femoral neck and a dislocation; one hip was treated primarily with a Moore prosthesis and the other was left unreduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Traumatic hip dislocation in children. Follow up of 13 cases.

Thirteen cases of traumatic anterior and posterior hip dislocations in children were treated during a period of 25 years. All of them were available for follow up from 5 to 26 years postinjury. Twelve of the patients had their dislocation reduced within six hours after the injury. None of them developed any complication, and the range of movement was the same as in the noninjured hip. One patient, who had his hip reduced 37 hours after the injury, experienced pain due to osteoarthritis 7 years after the injury at the age of 21 years.

Simple bone cysts in children treated with methylprednisolone acetate.

Eleven children with simple bone cysts in the proximal humerus metaphysis were treated with intracavity infiltration of methylprednisolone acetate. Nine patients were treated once; the remainder required second injections. Five lesions resolved completely, while six healed sufficiently to eliminate the risk of pathologic fracture, and to permit physical activities without restrictions. Simple bone cysts can be treated satisfactorily with injection of methylprednisolone acetate, thus obviating surgery.

Slipped capital femoral epiphysis: long-term results of an abandoned technique.

Sixty-two (11 women and 51 men) of 76 consecutive patients treated between January 1960 and December 1979 with percutaneous pinning, traction, and ambulation in Thomas splints for slipped capital femoral epiphyses (physiolysis colli femoris; PCF) were re-examined radiologically and clinically to evaluate long-term results of an abandoned technique. Median follow-up time was 21 years (range: 8 to 28). The average age at symptom start was 14 years (range: 9 to 17). Fourteen patients were operated bilaterally, while 15 were operated on the right side only and 33 on the left side only. No additional hip surgery for coxarthrosis as adults had been performed. At the clinical examination the mean hip-movement-sum was 220 degrees (range: 30 degrees to 300 degrees). Pain occurred in 31 hips. A limp was found in 23 patients, and 56 had no impairment of working ability. At radiologic examination, 30 patients showed sequelae of PCF, and 30 (48%) had bilateral signs of PCF at follow up.

[Complications after osteosynthesis using Partridge's method in femoral fracture near the prosthesis]. / Komplikationer efter osteosyntese a.m. Partridge af protesenaere femurfrakturer.

The object of the investigation is to illustrate the results and complications following Partridge's osteosynthesis of proximal fractures in the neighbourhood of the prosthesis. During a period of 40 months, eight consecutive patients (two men and six women) with proximal fractures of the femur in the neighbourhood of a hip prosthesis were subjected to osteosynthesis by Partridge's method. All of the fractures resulted from low energy trauma. The average age was 72 years (51-84) and the average duration of observation was 2.3 years. Weight-bearing was permitted after an average of 14.5 weeks and the radiographically assessed healing time was 16 weeks on an average. In all of the patients, cortical erosion developed under the Partridge bands 10-16 weeks postoperatively. In five patients, the initial erosions were of limited extent and were stationary during the period of observation. In three patients, the osteolysis was progressive and reoperation with introduction of a long-shafted femur prosthesis proved necessary. In addition, homologous boney transplants were necessary in two of these patients. Stability and healing of the fracture are obtained by osteosynthesis by Partridge's method but, on account of the osteolysis which is frequently pronounced and progressive, the patients should be followed-up meticulously in view of the possibility of removal of the Partridge material and possible replacement by a long-shafted femur prosthesis before the bone is completely eroded.

Effect of a nociceptive trigeminal inhibitory splint on electromyographic activity in jaw closing muscles during sleep.

The nociceptive trigeminal inhibitory (NTI) splint has been claimed to decrease the electromyographic (EMG) activity of jaw-closing muscles and relieve symptoms of various types of temporomandibular disorders (TMD) and bruxism. The present study was designed to address the question about EMG-changes during sleep. Ten patients (age: 23-39 years) with a self-report of tooth-grinding during sleep were recruited. Patients were examined at baseline and after each treatment period with the use of the Research Diagnostic Criteria for TMD. A portable EMG-device was used to record EMG-activity from the masseter muscle during sleep. The patients received two 2-week splint treatments in a randomized cross-over fashion; an NTI splint and a standard flat occlusal splint (OS). EMG data were analysed according to published criteria. Using a 10% of maximum clenching EMG-activity cut-off threshold to determine the number of EMG-events h(-1) of sleep, the NTI splint was associated with a significant reduction (9.2 +/- 3.2 events h(-1)) compared with baseline EMG (19.3 +/- 4.0; anova: P = 0.004, Tukey post hoc: P = 0.006), whereas there were no differences between the OS (16.2 +/- 4.7) and baseline EMG (19.2 +/- 4.1; P = 0.716). There were no effects of either NTI or OS on clinical outcome measures (anovas: P > 0.194). This short-term study indicated a strong inhibitory effect on EMG-activity in jaw closing muscles during sleep of the NTI, but not the OS. However, the EMG-activity was not directly related to clinical outcome. Further studies will be needed to determine long-term effects and possible side effects of the NTI splint.

Processus supracondyloidea humeri with concomitant compression of the median nerve and the ulnar nerve.

Compression of the median nerve and the nerve due to the anatomical anomaly processus supracondyloidea humeri is a rare condition. A case of combined median and ulnar nerve compression is described. Diagnostics and treatment are discussed in the light of the present case history and those described in the literature. The conclusion is that the treatment should be superiosteal resection of the process together with the origin of the pronator teres muscle.

Compression neuritis of the ulnar nerve treated with simple decompression.

The purpose of this investigation was to test the hypothesis submitted by Osborne (1957), which proposed that the symptoms of compression ulnar neuritis, in most cases, result from compression on the ulnar nerve at the proximal border of the aponeurosis of the flexor carpi ulnaris muscle. Thirty-two simple decompression operations were performed on 31 patients, diagnosed as suffering from compression neuritis of the ulnar nerve. They were subsequently examined over a period of 5 years. Relief from symptoms was achieved in 28 cases, whilst four patients derived no improvement from the operation. Three of the four unsuccessful cases were judged to have been incorrectly diagnosed and were not suffering from compression of the ulnar nerve in the elbow. A second operation was required in two patients, in one a second decompression and in the other anteposition. No surgical or post-surgical complications occurred.

Traumatic posterior dislocation of the hip--prognostic factors influencing the incidence of avascular necrosis of the femoral head.

To elucidate the factors important for development of avascular necrosis of the femoral head following traumatic posterior dislocation of the hip, 98 adult patients with 100 hip dislocations were reviewed after a minimum follow-up of 5 years. Avascular necrosis of the femoral head was found in only 4.8% of the hips reduced within 6 h, but in 52.9% of the hips reduced more than 6 h after the injury. Dislocations were classified according to Stewart and Milford [11]; a significantly higher incidence of avascular necrosis was found in grade-III and -IV dislocations than in grade-I and -II dislocations. We could not demonstrate any benefit from skeletal traction or non-weight bearing. The age of the patients was of no importance.