Reproducibility of the stability-based classification for ankle fractures.

BACKGROUND: Classification of ankle fracture is important when deciding for operative or conservative treatment. This study rates the reproducibility of ankle stability assessment and compares it with the classification by Lauge-Hansen and Arbeitsgemeinschaft für Osteosyntesefragen (AO) in adult patients with primary ankle fractures. METHODS: A total of 496 consecutive ankle fractures were included, and the X-ray images were reviewed 2 times by 2 medical students, 2 residents, and 1 consultant in orthopedic traumatology. The raters were blinded to each other and to their own results. Unweighted Kappa statistics were used to assess reproducibility. RESULTS: Overall mean (95% CI) interrater Kappa results were 0.65 (0.64; 0.68) for Lauge-Hansen, 0.62 (0.60; 0.63) for AO and 0.61 (0.57; 0.62) for the stability assessment. The intrarater results ranged from a mean Kappa of 0.64-0.80 for the medical students, 0.65-0.81 for the residents and 0.82-0.84 for the consultant. CONCLUSION: The stability assessment has substantial to almost-perfect agreement which is comparable to the Lauge-Hansen and AO classifications.

[Slipped capital femoral epiphysis is diagnosed too late].

Slipped capital femoral epiphysis (SCFE) is a serious orthopaedic hip disease in the adolescent population. It has a prevalence of 10.8 per 100.000 children and usually occurs in children 9-16 years of age. Despite focus on delay of the diagnosis, no improvements have been made. An adolescent complaining of stress-related pain in the hip, groin, thigh or knee should be suspected of having SCFE, until an X-ray has excluded this diagnosis. Delayed diagnosis may have serious consequences in terms of further displacement of the femoral head and risk of increased avascular necrosis.

[Bone tumour as differential diagnosis of pain in the extremities in a newborn baby].

Infants are a challenging group of patients: their symptoms can be subtle, and it is difficult to differentiate between pain and normal reaction to their needs. It is important to investigate symptoms by a thorough examination of the physical condition and the history of symptoms and to contact a specialist at an early stage. An X-ray should also be performed early. Infants can also suffer from serious conditions such as bone tumours which need fast and proper treatment, and this case report describes an infant boy with suspected bone tumour, which turned out to be a fracture from the prenatal period or during labour.

[Traumatic cervical disc prolapse with severe neurological impact].

A 51-year-old male drove into a ditch on his scooter. Immediately after the trauma the patient complained of neck pain and decreased ability to feel and move his extremities. An initial trauma computed tomography (CT) of the columna showed normal conditions. Because the patient had neurological deficiencies, magnetic resonance imaging of the columna was performed 12 days later, and a disc prolapse at the C3/C4 level with spinal cord compression was visible. Despite decompression the patient did not recover. Traumatic cervical disc prolapse is a rare and positionally dangerous condition, which can be present despite a CT showing normal conditions.

High rate of complications following volar plating of distal radius fractures.

INTRODUCTION: Fracture of the distal radius (DRF) is one of the most common fractures treated by orthopaedic surgeons. The most common operative treatments of these fractures are open reduction and internal fixation. The incidents and types of complications associated with the use of these operations have not been studied in detail. MATERIAL AND METHODS: We performed a retrospective study documenting types of complications and their occurrence in a group of patients who received open reduction and internal fixation. Our definition of a complication was a case in which the patient had one or more complications which required an operation, or suffered from complex regional pain syndrome, or skin healing problems lasting more than four weeks from the operation. RESULTS: A total of 165 patients were included. In all, 39 complications in 30 wrists were registered: i.e. 18% had a minimum of one complication. CONCLUSION: Our finding that 18% suffer from a serious complication when treated using a volar locking plate must be taken into consideration when surgeons choose between conservative or operative treatment for DRF treatment. A few other studies have looked at the incidents of complications and have reported similar results. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Snapping pes syndrome with a loose bone fragment is a rare cause for medial knee pains]. / Snapping pes-syndrom med løs knoglefragment er en sjælden årsag til mediale knæsmerter.

A case of a patient with snapping pes syndrome following a blunt trauma to the knee is presented. Snapping pes syndrome is a painful catching experienced at the posteromedial corner of the knee from pes anserinus when moving from flexion to extension. Since the accident ten years ago the patient experienced a painful snapping phenomenon on the inner side of the knee. MRI and arthroscopies found no explanation. Ultrasound revealed that the semitendinosus snapped over a bony fragment during extension of the knee. Removal of the fragment resulted in remission.

Validation of the Ottawa ankle rules in a Danish emergency department.

INTRODUCTION: The Ottawa ankle rules (OAR) is a tool physicians may use to determine whether or not to perform an x-ray after an ankle or midfoot distortion or blunt trauma to these structures. The rationale of using the OAR is to exclude a fracture by means of clinical examination without resort to x-rays, and thereby limiting the use of x-rays, time, costs, etc. The principle of the OAR is that an ankle x-ray is only required when there is bone tenderness along the distal six centimetres of the posterior part of the medial or lateral malleolus, or when the patient is unable to bear weight immediately after the accident and in the emergency department (ED). Similarly, an x-ray of the midfoot is required only when there is bone tenderness at the base of the 5th metatarsal or the navicular bone, or when the patient is unable to bear weight immediately after the accident and also in the ED. Our hypothesis was that by introducing the OAR, we would reduce the use of x-rays without increasing the number of missed fractures. MATERIAL AND METHODS: The study was designed as an intervention study with 882 patients in the control group and 1,014 patients in the intervention group. The intervention consisted of several OAR implementation measures. RESULTS: Before use of the OAR, 62% had an x-ray taken. This proportion was reduced to 57% with the introduction of the OAR. We registered a significant reduction (p < 0.001) in x-ray without increasing the number of missed fractures. CONCLUSION: The OAR may reduce the number of x-rays and possibly also save costs and time if implemented in Denmark.

[Münchhausen's syndrome--a diagnosis to remember]. / Münchhausens syndrom--en diagnose vi ikke må glemme.

We hereby report a case of self mutilation against the right upper extremity in a 26-year-old male. The condition started after a minor trauma. After a few days the diagnosis compartment syndrome was suspected and a fasciectomy of the forearm was performed. The patient subsequently claimed that he had experienced further symptoms. Despite countless investigations, it was not possible to identify the course of the patient's symptoms. It has become clear that the patient suffers from >>Münchhausen's syndrome<<.

[Surgical treatment of tennis elbow]. / Operativ behandling af tennisalbue.

INTRODUCTION: Surgical treatment of lateral epicondylitits (LE) has not been investigated sufficiently to allow general guidelines, nor has non-invasive treatment produced sufficiently good results. We present the results of 31 mini-tenotomies performed to treat lateral epicondylitis. MATERIALS AND METHODS: We performed a retrospective follow-up study of 31 elbows treated with mini-tenotomy for LE. The average period with symptoms was 125 weeks, the average follow-up 73 weeks. The mini-tenotomies were performed under local anaesthesia and the extensor aponeurosis was cut close to the epicondyl. RESULTS: A total of 27 of 31 patients reported that their LE had become much better or that all the pain had gone. The Quick DASH score decreased from 66 preoperatively to 13 at the follow-up (p < 0.001). Surgery achieved its maximal effect on average four weeks after surgery. Two patients experienced that the pain came back. CONCLUSION: A prospective randomised investigation is warranted; yet, the present results indicate that mini-tenotomy could be a promising treatment for a selected group with isolated LE.