Giant cell tumours in fingers among the Inuit population in Greenland.

OBJECTIVE: Giant cell tumours (GCTs) of the tendon sheets in fingers are rare. We therefore find it of interest to report on 5 cases identified in the Inuit population in Greenland within 16 months prior to this study. MATERIAL AND METHODS: The Inuit account for 56,000 people of the total population in Greenland. From November 2010 to 16 months prior to this study, we diagnosed 5 cases (0.6% of all orthopaedic operations) with a GCT of the flexor tendon sheet of a finger. The patients were aged between 10 and 54 years, and 4 were women. All of them had noticed slow-growing tumours over 3 or more years and were referred for a suspected ganglion. RESULTS: In two cases, the tumour was located at the distal interphalangeal (DIP) joint in the thumb and in one case at the third finger. Two other patients had tumours at the metacarpophalangeal (MCP) joint of the third finger and the thumb, respectively; one of these two had a communicating tumour to the DIP joint. The last patient had two tumours on the same finger, one at the MCP joint and the other at the DIP joint. In one case, the tumour had also eroded the cortex of the first phalanx of the thumb, and the largest tumour measured 5 cm. CONCLUSION: GCTs of the flexor tendon sheets in fingers are rare. It could be a coincidence that we have seen 5 cases within a short period of time. It is not possible to identify past cases through a register. A tumour in a finger is not the most common location for a ganglion, especially not at the DIP level. Therefore, a large tumour at this location is more likely to be a GCT.

[Giant xanthomas of all four extremities as a result of hyperlipidaemia in a 24-year-old]. / Ekstreme xantomer på alle ekstremiteter som følge af hyperlipidæmi hos en 24-årig.

A young male had giant xanthomas of all four extremities. We chose surgical treatment and as a result he was able to wear shoes again. Aggressive treatment of xanthomas and the underlying heart disease is essential in treating young patients.

Effective treatment at a Danish trauma centre.

INTRODUCTION: The trauma centre at Aarhus University Hospital, Denmark was established in 1999 and has continuously tried to improve its efficiency through regular training of personnel and auditing of selected trauma cases. The purpose of the present study was to assess the efficiency of the trauma teams to perform the initial evaluation using the time spent in the emergency room after arrival and the time to the first chest X-ray as measures for effectiveness. MATERIAL AND METHODS: This was a prospective cohort study conducted from January 2000 to December 2008 and which included all trauma patients admitted to the hospital. RESULTS: The results are based on 4,493 admissions, of which 1,102 patients (24%) had an injury severity score > 15. The median time spent in the trauma room was 50 minutes in 2000, which was steadily reduced throughout the period reaching a median time of 27 minutes in 2008 (p < 0.0001, Kruskal-Wallis test). The median time to the first chest X-ray was reduced from seven minutes in 2001 to five minutes in 2008 (p < 0.024, Kruskal-Wallis test). CONCLUSION: Utilisation of a standardised protocol for initial evaluation and treatment of trauma patients and continuous training of trauma teams may considered some of the main factors responsible for these findings. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Geriatric intervention in elderly patients with hip fracture in an orthopedic ward.

BACKGROUND: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic collaboration (orthogeriatrics) has been organized in different ways. The aim of this study is to evaluate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome. METHODS: A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was compared to a historical cohort group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the GP. RESULTS: Median length of stay was reduced from 15 to 13 days. More patients began treatment with calcium/vitamin-D and bisphosphonate (p=sig). There was no difference in hemoglobin variation between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant. CONCLUSIONS: Our study indicates that co-management of hip fracture patients by orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. The concept should be further developed particularly among the frail elderly.

[Interdisciplinary geriatric intervention among nursing home residents with hip fracture reduces mortality]. / Tvaerfaglig geriatrisk postoperativ intervention hos aeldre i plejebolig med hoftenaer fraktur reducerer mortalitet.

INTRODUCTION: Nursing home residents represent the majority of hip fracture hospitalisation cases. Quick discharge to nursing homes after surgery is common practice. A previous study indicates an increased risk of death immediately after discharge. MATERIAL AND METHODS: A total of 211 residents, hospitalised from nursing homes for hip fracture surgery, were selected for a retrospective follow-up study. The orthopaedic ward's geriatric team (GO-team) visited the residents no later than one day after discharge. The number of visits depended on the need for treatment and rehabilitation. Intervention was, among others, focussed on: nutrition, fluid therapy and blood transfusion. RESULTS: Intensive geriatric intervention reduced the 30-day mortality (odds ratio (OR) = 0.08; 95% confidence interval (CI): 0.01; 0.52) and reduced 3-month mortality (OR = 0.03; 95% CI: 0.003; 0.25). Fluid therapy and nutritional support were associated with reduced probability of death (OR = 0.12; 95% CI: 0.02; 0.67)/(OR = 0.23; 95% CI: 0.07; 0.79). Non-elective readmissions were reduced (OR = 0.20; 95% CI: 0.04; 0.91). Post-surgical blood transfusion was associated with improved functional ability (beta = 8.22; 95% CI: 1.44; 15.0). CONCLUSION: Geriatric interdisciplinary intervention among residents in nursing homes has a positive effect and improves survival and reduces non-elective readmission within three months. Still, there is uncertainty about the effect of fluid therapy and blood transfusions and further investigations are needed.

[Oram's sign for hip or pelvic disorder]. / Orams tegn på hofte- eller baekkenlidelse.

INTRODUCTION: The so-called Oram's sign states that the penis points to the side of the disorder on standard antero-posterior (AP) x-rays of the pelvis. The present study is a scientific evaluation of the sign in a relevant clinical context. MATERIAL AND METHODS: This is a retrospective study based on a blinded reading by four males and one female doctor of AP x-rays of the pelvis from 51 male patients with hip and pelvic disorders and 11 x-rays without pathology from an additional nine males and two females. The sensitivity and specificity and the positive and negative likelihood ratios were calculated together with the Kappa values for intra- and interobserver agreement. RESULTS: The sensitivity of Oram's sign for the individual reader varied between 40.3% and 25.8%. The overall sensitivity and specificity for all readers were 55% and 14%, respectively. The test performance did not show any significant variation between the male readers and the female reader. The sensitivity of Oram's sign in relation to the various pathologic findings varied between 32.1% for femoral neck fractures, 66.6% for osteoarthritis of the hip and 88.8% for pelvic fracture. Oram's sign could not be defined in 16.3% of the cases. The intra- and interobserver agreement was poor with relatively low Kappa values. CONCLUSION: Oram's sign was not useful in this study on the diagnosis of hip fractures mainly due to a low sensitivity and too low observer agreement.

Drug and alcohol use among patients admitted to a Danish trauma centre: a prospective study from a regional trauma centre in Scandinavia.

OBJECTIVES: The incidence of drug and alcohol use is unknown among Danish trauma patients, and has not been thoroughly investigated in Europe. METHODS: Patients admitted to the regional trauma centre in Aarhus, Denmark, were prospectively screened by blood and urine tests for the presence of alcohol, and legal and illicit drugs. The correlation with the Injury Severity Score, hospitalization time, and mortality after drug or alcohol intake was investigated. RESULTS: A quarter of all patients admitted in 1999 and 2000 had an alcohol level exceeding the national legal driving limit of 50 mg/dl, and one or more drugs were found in one in five patients. The presence of any drug or alcohol correlated positively with the Injury Severity Score, whereas alcohol level, hospitalization time, and mortality did not correlate. CONCLUSION: The rate of trauma patients with a blood serum level of alcohol greater than 100 mg/dl was similar to a previous European study and to US studies. The prevalence of drugs was less, and benzodiazepines were the most used group of drugs in our study. The routine screening of Danish trauma patients in order to implement preventative measures may be beneficial.