Changes in clavicle length in acute fractures within 3 weeks: a prospective ultrasonographic study of 59 patients.

BACKGROUND: Within traumatology a common indication for acute surgery of fractured clavicles is bone shortening over 2 cm. This indication is among but a few indications; which are recommended to be treated operatively within the very first weeks after a fracture. Theoretically clavicle fractures could become less shortened over time due to decreasing muscle pull. If this reduced shortening does indeed happen, some patients with initial bone shortening over 2 cm could perhaps be treated conservatively? However, it is unknown what happens to the length of the clavicle within the first weeks after a fracture. The aim of this study was to investigate if the length of the fresh fractured clavicles changes within the first three weeks. METHODS: Rested length measurements using navigation ultrasound were done on 59 patients with a fractured clavicle. Measurements were performed within the first three weeks after a lateral or mid-clavicular fracture. The inclusion period was from March 2014 to February 2016. Median age was 40 years and age range was 18-81 years. The data was analyzed using mixed linear models. RESULTS: The clavicle length showed no change within the first three weeks after fracture (p = 0.24). CONCLUSION: Fractured clavicles retain their length for the first three weeks.

Pesticide-induced surface migration by lumbricid earthworms in grassland: life-stage and species differences.

Pesticide-induced changes in surface migration by earthworms in grassland were investigated using trapping and the fungicide benomyl. Traps were tended daily for 15 days after spraying, resulting in 2152 earthworms, five species, and juvenile predominance which reflected species/life-stage composition in the soil. Significant increases in migration (all worms) occurred already by day 2 due to spraying, final treatment level being 2.8 x control. Life-stage composition indicated an increased juvenile proportion from 55% to 75% due to treatment. Spraying caused surfacing juveniles to increase significantly by day 2, reaching a final level 3.8 x control, whereas for mature worms a significant increase did not occur until day 4. Species rank-order was Aporrectodea longa>A. rosea>Lumbricus terrestris>A. caliginosa in control areas, but A. longa>L. terrestris>A. rosea>A. caliginosa in sprayed areas; spraying altered the rank-order such that the anecic A. longa and L. terrestris dominated, jointly increasing from 59% to 78%. At species level, L. terrestris and A. longa exhibited significant increases of 4.6 x and 3.6 x in final migration levels in treated areas, the endogeic A. rosea and A. caliginosa having trends for increase. Species-specific differences for reaction time occurred, with significantly elevated migration already by day 1 for L. terrestris, and day 2 for A. longa and A. caliginosa. For each species, juveniles consistently showed greater increases than mature worms due to spraying, significantly so for juvenile L. terrestris, A. longa, and A. caliginosa, the two anecics reaching as high as 5.3 x and 4.7 x. The response of mature worms differed: A. longa and A. rosea increased surfacing due to treatment, L. terrestris showed a delayed reaction, whereas A. caliginosa exhibited suppressed migration. Results are discussed relative to behavior, ecological category, and risk of toxic exposure.

Occupational therapy and Colles' fractures.

In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups at any time. It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary.

Plaster cast compared with bridging external fixation for distal radius fractures of the Colles' type.

We compared two different treatments for displaced distal radius Colles' type fractures (Older type 3 and 4), at two hospitals. We found bridging external fixation superior to reduction and fixation in a dorsal plaster cast regarding both the end-anatomic results at 3 months and the functional scores at 3 and 9 months (modified Gartland and Werley).

Diagnosis of scaphoid fracture and dedicated extremity MRI.

We evaluated the value of dedicated extremity magnetic resonance imaging (E-MRI) in patients with clinical suspicion of a scaphoid fracture and normal initial radiographs. 52 patients underwent E-MRI within a mean of 4 (2-10) days after trauma. Follow-up radiographs were performed at average 11 (8-14) weeks after trauma, and these images were used as the "gold standard". A T1-weighted turbo gradient echo 3D and a tau short inversion recovery STIR were performed, both in coronal planes. The imaging time was less than 10 min. The images were evaluated independently by two radiologists. E-MRI detected occult fractures of the scaphoid in 9 patients, and of the distal radius in a further 6 patients. All these fractures were confirmed at follow-up radiographs. Furthermore, E-MRI revealed a fracture of the capitate bone in 1 patient, and of the triquetrum in 2 patients, and in 8 patients, bone bruise in 1 or more of the carpal bones. However, these fractures and bone lesions could not be confirmed by the follow-up radiographs. The agreement between the two examiners was high (kappa = 0.8) for E-MRI detection of fractures. E-MRI seems to be better than radiographs in the early diagnosis of occult fractures of the scaphoid bone and the wrist.

Are hard-copy prints from peroperative fluoroscopy images useful as documentation?

We have examined the applicability of peroperative image documentation, in promoting early mobilization after osteosynthesis and saving the standard X-ray examination. One hundred and twenty-three patients with proximal femoral fractures were included in the investigation. Hard-copy reprints were recorded from peroperative fluoroscopy images by Fuji Film Thermal Imaging System FTI 200. These reprints were compared with the standard X-rays to assess the quality of the osteosynthesis and possible restriction in mobilization. The specificity of finding an unstable osteosynthesis was 0.40, whereas the sensitivity of finding a stable osteosynthesis was 0.96. In all, four unstable osteosyntheses were overlooked on the hard copy reprints. The specificity of finding patients in need of restricted mobilization was 0.44 and the sensitivity of finding patients allowed free mobilization was 0.93. Eight patients needing restricted mobilization were overlooked on the reprints. Hard-copy images do not safely reveal unstable osteosynthesis and cannot replace the standard X-rays taken postoperatively.

Length of immobilisation after fractures of the distal radius.

Thirty-three patients with undisplaced fractures of the distal radius were included in a clinical controlled trial with the purpose of evaluating whether it was safe to reduce the time of immobilisation in a plaster splint from 5 to 3 weeks. We did not find any difference in radiological healing at 3 months or in the functional scores after 3 and 9 months.

Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb.

The results after operations for rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb are reported to be good. Few authors describe the measurements used to assess the postoperative function of the thumb. We review the results of 15 patients, who underwent surgery between 1982 and 1987. We found that the number of patients satisfied with the operation was consistent with that reported in the literature. On the other hand, we found poor agreement between the subjective complaints and the objective findings. We therefore propose and describe a scoring system to assess subjective impressions of the result and the objective findings. Surgical procedures are not discussed. However, the duration of immobilization of the thumb should, perhaps, be reconsidered. Further studies may show that a shorter period of immobilization in plaster, the use of dynamic bandaging, or early starting of physiotherapy produce better results.

Diagnostic value of ultrasound in scaphoid fractures.

Diagnostic ultrasound was used in 103 patients with a clinically suspected fracture of the scaphoid bone in order to achieve an early diagnosis. There were 48 women and 55 men aged 10-75 years (mean 31.4 years) tested with ultrasound. Of the patients, 72 were tested within 3 days after injury the remainder between 4 and 42 days. Fracture was confirmed radiologically in 27. We found that the ultrasound test, applied with a frequency of 1 MHz and intensity of 0.5 W/cm2 and 2.0 W/cm2 for 30s, had a sensitivity of 37 per cent and a specificity of 61 per cent. We thus conclude that ultrasound is not suitable for early diagnosis of scaphoid fracture.

[Possible causes of infection in hip alloplasty]. / Mulig aetiologi til inficeret hoftehemialloplastik.

In order to illustrate possible causes of infection following arthroplastic hip operations, a retrospective review was undertaken of all operations of this type carried out during the period 1 May 1985 to 1 August 1988 in the Department of Orthopaedic Surgery, Herlev Hospital. A total of 127 operations on 126 patients were undertaken. Deep infection occurred in eight patients. Suggestions are made for reduction of this high frequency of infection.

[Information to women applying for sterilization]. / Information af sterilisationssøgende kvinder.

On the basis of a questionnaire investigation among the general practitioners in the County of Frederiksborg, the authors have compared the information given to women applying for sterilization with information in the available literature about the nature of the intervention, its sequelae and the risks involved. The authors found that under half of the practitioners gave informations about disturbances of menstruation, dyspareunia and altered sexual life. In the literature, it is stated that these occur in 10-60%, 3-11% and 4-48% of the women. Less than one third of the practitioners gave information about the risk of perforation of an organ or vessels, tearing of the ovarian tubes and postoperative pain. In the literature, it is stated that these occur in 0.1-2.5%, 0.28-9% and 24% of the women depending on the operative method used. The authors recommend revision of our knowledge on these subjects and alterations in the written information provided.

[Unwanted pregnancy after removal of the IUD]. / Uønsket graviditet ved spiralfjernelse.

Four cases of unwanted pregnancy occurring in the same cycle as removal of an IUD are presented. The duration of ovum transport from the Fallopian tube into the uterine cavity, survival of spermatozoa in the female genital tract and timing of ovulation, which may be delayed in women with IUDs are variables which influence the probability of pregnancy and should be taken into consideration when removing an IUD. Unless pregnancy is desired, it is recommended when possible not to remove an IUD after the ninth day of the menstrual cycle unless another contraceptive method has been initiated.

[Women applying for abortion and their knowledge about abortion]. / Abortsøgende kvinders viden om abortindgrebet.

PIP: There are few operations which require direct written approval from the patient; among these is the termination of pregnancy. The woman must attest that she has been informed concerning the procedure itself. It is therefore interesting to investigate the knowledge that a sample of 105 women seeking abortion have on the nature of the operation, complications, after effects and possibilities for social assistance in carrying through the pregnancy compared to the information required under the law for termination of pregnancy. Knowledge of the method of abortion and of the risk for retained tissue increased significantly with age. There was no significant difference among age groups concerning knowledge of anesthesia, bleeding, infection or social aid arrangements. 7% of the women thought that there was risk of sterility. 84% of the women did not know that there was a risk for retained tissue. About half were not clear that the procedure involved suction and that there was risk of bleeding and infection following the procedure. 40% did not know that there was any possibility for referral to social agencies for further assistance.^ieng

[Information for women applying for abortion]. / Information af abortsøgende kvinder.

PIP: A total of 202 Danish general practitioners participated in a questionnaire investigation concerning the information which women applying for termination of pregnancy receive. The replies showed great differences in the number of doctors who give patients information about referral to social services, the risk of retained fetal tissue, pain, psychological effects and hemorrhage. Significantly more of the female doctors than male doctors told their patients about the possibility of referral to social services. The authors propose that women applying for abortion should be informed both verbally and in writing and that the information cover the following points: 1) possibility of referral to community social services for assistance in carrying through the pregnancy; 2) course and duration of the procedure; 3) a description of the operation itself including anesthesia and the method of abortion; 4) after effects, bleeding and pain; 5) complications, psychological effects, lower abdominal symptoms and retained fetal tissues; and 6) follow up by her own physician and future contraception.^ieng