High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.

The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.

Postoperative computed tomography three months after lumbar disc surgery. A prospective single-blind study.

In a prospective single-blind study, 60 patients surgically treated for lumbar disc herniation underwent clinical examination and computed tomography preoperatively and 3 months after surgery. At follow-up (58 patients; median, 31 months; range, 21-37 months), 29 patients had an excellent outcome (51%), 20 improved (33%), and 9 were unchanged or worse (16%). Dural or radicular scar tissue was present by computed tomography in 88% of the patients, but the findings could not be correlated with the clinical outcome. Recurrent or persistent disc herniation was found in 9% of the patients. The clinical outcome of patients with abnormal computed tomography did not differ significantly from patients without this finding. A relation between facet joint degeneration and less successful clinical outcome was demonstrated. Computed tomography (without contrast) 3 months after surgery gave little information which could be correlated with the clinical outcome. Patients with an excellent outcome had all degrees of intraspinal scar tissue.

First-time operation for lumbar disc herniation with or without free fat transplantation. Prospective triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation.

STUDY DESIGN: This prospective triple-blind randomized study of 99 patients concerned the use of free fat transplantation for operation for lumbar disc herniation. OBJECTIVE: To subsequently examine the patients after median 376 days who were subjected to enhanced computed tomographic scan. SUMMARY OF BACKGROUND DATA: In studies on experiments with animals, the degree of intraspinal scar tissue has shown to be reduced in connection with free fat transplantation. Scar tissue is seen frequently after operation for lumbar disc herniation, but it is uncertain whether the scar tissue can lead to symptoms. METHODS: The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced computed tomographic scan was assessed regarding the degree of scar tissue and survival of fat transplant. RESULTS: There was no different in the clinical outcome between the two groups. Significantly fewer patients had dural scarring in the group who had a fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on computed tomographic scan at the follow-up examination in 66% of the patients who had a fat transplantation. CONCLUSIONS: Free fat transplantation can reduced the degree of dural scar tissue after operation for lumbar disc herniation but does not result in a clinically better outcome.

Retroperitoneal fibrosis after long-term daily use of ergotamine.

A case of retroperitoneal fibrosis is presented. Because of migraine the patient had taken ergotamine daily for 15 years. Ergotamine is discussed as an etiological factor. The current surgical treatments are reviewed.

Isolated compression of the motor branch of the median nerve by a ganglion. Case report.

A 25-year-old hairdresser presented with a fluctuant lump in the palm of her right hand that was intermittently painful and made control of her right thumb difficult. She had no sensory loss. At operation a cystic swelling was found 8 mm in diameter distal to the carpal ligament and compressing the median nerve. The cyst ruptured during dissection, and it was not possible to localise the pedicle. Histological examination showed that it was a ganglion, and nine weeks after the operation the patient had regained normal use of her hand and resumed her work.

Perioperative analgesia by 3-in-one block in total hip arthroplasty. Prospective randomized blind study.

In a prospective randomized blind study of 182 patients undergoing total hip arthroplasty, the patients per- and postoperative need for analgesics was assessed in two groups, one receiving general anesthesia and a 3-in-one block, the other group only general anesthesia. Although we found a significant reduction in analgesics per- and postoperatively in the 3-in-one block group, the difference in analgesics was small and has no clinical relevance in the patient with a healthy cardiovascular status. We conclude that 3-in-one block in combination with light general anesthesia is not the anesthetic of choice in total hip arthroplasty using the posterior approach.

[The value of 1-year follow-up after total cemented hip alloplasty. Clinical and economic consequences of a routine check-up]. / Vaerdien af "et års kontrol" efter cementeret total hoftealloplastik. Kliniske og økonomiske konsekvenser af en rutinekontrol.

The need for, expenses of and consequences of one year follow-up after total cemented hip replacements with posterior access are reviewed. A total of 150 patients were registered prospectively and consecutively with Charnley scores preoperatively, three months and one year after operation. The Charnley scores increased significantly from the preoperative values till the follow-up at three months and from the follow-up at three months till follow-up at one year (p less than 0.001). In five patients, (3%) follow-up examination after one year was of significance. Anisomelia was corrected in all three by means of adjustment of footwear. The cost of follow-up examination after one year is estimated to be 630 Danish crowns (approximately 53 pounds) per patient. It is concluded that follow-up examination after total cemented hip replacement is not necessary. Alteration of follow-up examination after one year to follow-up examination after five years for patients who were under 60 years at the time of operation in order to reveal aseptic loosening would imply that only 10% of the patients in this material should be followed-up.

[Lumbar disk prolapse surgery with or without free fat transplantation. A prospective triple-blind randomized study]. / Lumbal diskusprolaps-operation med eller uden fri fedt-transplantation. Prospektivt tripelblindt randomiseret studie.

The aim of this prospective triple-blind randomized study was to determine if a free fat transplant used in operation in lumbar disc herniation could reduce the degree of intraspinal scar tissue and to evaluate whether the scar tissue could lead to symptoms. Ninety-nine patients were subsequently examined after median 376 days. The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced CT-scanning was assessed regarding the degree of scar tissue and survival of the fat transplant. There was no difference in the clinical outcome between the two groups. Significantly fewer had dural scarring in the group who had a free fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on CT-scan at the follow-up examination in 66% of the patients who had a fat transplantation. Free fat transplantation can reduce the degree of dural scar tissue after operation for lumbal disc herniation, but does not result in a clinically better outcome.

Rhesus immunization after bone allografting. A case report.

Only a few cases of Rhesus blood-type immunization after bone allografting have been reported (Hill et al. 1974, Johnson et al. 1985). Rhesus immunization in girls or fertile women may have severe consequences. We report a case of Rhesus-antibody production after bone allografting for an aneurysmal bone cyst.

Femoral shaft fracture in 265 children. Log-normal correlation with age of speed of healing.

After exclusion of delayed unions and pseudoarthroses in teenagers, the time required for union of 275 consecutive fractures of the femoral diaphysis in children followed a log-normal pattern with a constant 10 percent coefficient of variation and a geometric mean increasing uniformly by 0.7 weeks per year. Multiple injuries increased, and operative treatment reduced the geometric mean time for fracture healing.