[Clinical diagnosticsand treatment of multiligament injuries of the knee].

Multiligament injuries (MLI) of the knee are rare and only ca. 150 MLI reconstructions are performed per year in Denmark. This review summarises the current guidelines for work-up and treatment. Surgical treatment of MLI is centralised to five highly specialised orthopaedic departments, while all hospitals are responsible for the initial treatment and diagnostics. Injury patterns can be complex and demand thorough analysis in collaboration with a department with highly specialised function in MLI. Although a nationwide interdisciplinary approach has been implemented, patients usually do not fully return to their pre-injury activity level and have a higher risk of developing osteoarthritis.

Surgical preparation and draping prior to induction of total intravenous anaesthesia.

INTRODUCTION: Day surgery is increasing, making efforts to improve safe and effective patient turnover of importance. We hypothesised that the introduction of a simple protocol, dictating that anaesthesia should be induced only immediately prior to surgical incision (after surgical preparations) would lead to reduced duration of anaesthesia and postanaesthesia care unit (PACU) stay. METHODS: This was a retrospective, single-centre, procedure-specific, explorative feasibility study of patients undergoing anterior cruciate ligament surgery. Timestamps were collected from the electronic patient records within a three-month period before and after introduction of the protocol at the Copenhagen University Hospital, Bispebjerg and Frederiksberg. Clinical outcomes were assessed using the PACU score, based on the modified Aldrete discharge criteria. RESULTS: A total of 44 patients were included in the after-, and 74 in the before-new-protocol group. The protocol was feasible in 44/59 patients (75%). The duration of anaesthesia was significantly reduced: 113 (± 26) versus 135 (± 32), mean difference 22 (11-33) minutes, p less-than 0.001. The duration of the PACU stay was significantly reduced: 103 (± 54) versus 80 (± 35), mean difference 23 (6-40) minutes, p = 0.01. No difference was observed in clinical outcomes. CONCLUSIONS: A simple protocol by which total intravenous anaesthesia was induced immediately prior to surgical incision was feasible, reduced the duration of anaesthesia and yielded a significant reduction in the PACU stay. Further studies with a randomised design are needed to confirm these preliminary findings. FUNDING: departmental only. TRIAL REGISTRATION: not relevant.

[Younger patients with hip joint pain].

This review summarises the present knowledge of diagnosing and treating hip joint pain. The results of joint preserving surgery are good in symptomatic patients with hip dysplasia, acetabular retroversion or impingement (cam or pincer) without signs of osteoarthritis. Confirmation of intraarticular pathology as the cause of symptoms is established clinically, and the pathology can in many cases be visualised by a standing, standardised radiograph of the pelvis, which is the basis for admission to the relevant orthopaedic department. We present an algorithm for this. Dysplasia and retroversion can be treated by periacetabular osteotomy and impingement by arthroscopic procedures.

Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plaster cast: a venografic controlled study.

INTRODUCTION: The aim of this study was to investigate the incidence of deep vein thrombosis (DVT) in patients immobilized in plaster cast and the possible efficacy of prophylaxis with low molecular weight heparin (LMWH). MATERIAL AND METHODS: The study was a randomized, assessor-blinded, open multicenter (three centers) study. All patients over 18 years of age with planned plaster cast on a lower extremity of at least 3 weeks were eligible for participation. Written informed consent was obtained from 300 patients and they were randomized to either 3.500 IU anti-Xa of tinzaparin (Innohep) subcutaneously once daily or no prophylaxis. On the day the cast was removed, ascending unilateral venography was performed. Two experienced radiologists, unaware of treatment, assessed the pictures independently. The radiologist had to obtain consensus as to whether DVT was present or not. RESULTS: 300 patients were included (148 in the treatment group and 152 in the control group). Ninety-five were subsequently withdrawn. DVT was diagnosed in 10/99 patients in the treatment group and in 18/106 patients in the control group. This difference is not significant (P=.15, chi(2) test) and the odds ratio was 0.55 (95% confidence interval=0.34-1.26). CONCLUSION: DVT in legs after plaster casting is a big problem, with an incidence of almost 20%. An effective prophylactic regime is required. Once-daily dose of 3.500 IU anti-Xa of tinzaparin was not sufficient.