Editor's Choice - The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events.

OBJECTIVE/BACKGROUND: The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery. METHODS: This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated. RESULTS: Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p = .008). The combined 30 day mortality and stroke rate was 3.8%. CONCLUSION: This national study with almost complete inclusion and follow-up shows that the delays occur mainly at patient level and in hospital. The delay is associated with new neurological events. Dual antiplatelet therapy is associated with reduced risk of having a new neurological event before surgery.

Do we underestimate the predictive value of the ulnar styloid affection in Colles fractures?

Various radiographic factors have been suggested as predictively important when dealing with an unstable distal radius fracture. Accordingly, many classification systems have been established in order to give an accurate description of a fracture and to grade the seriousness of the injury. In this paper, we use the classification of Colles fractures introduced by Frykman to investigate the predictive value of a concomitant fracture of the ulnar styloid. We found styloid affection to be a better predictor of a poor outcome than intra-articularity, but the combination carries the worst prognosis. We therefore suggest that a fracture of the distal radius associated with those two types of injuries should be considered for surgical treatment.

Physiotherapy: an overestimated factor in after-treatment of fractures in the distal radius?

Supervision by physiotherapists, starting 4-6 weeks after cast removal, was compared with self-training in 110 patients treated for Colles' fracture. The patients guided by physiotherapists were all satisfied with the treatment, but no functional advantages could be discerned when compared with self-training.