In a prospective, randomized trial, 104 consecutive patients with displaced femoral neck fractures were allocated either to fixation with a sliding screw plate or 4 ASIF cancellous bone screws. The patients were reexamined at fixed intervals to determine the time of union. The 2-year-cumulated rate of union was 64 per cent in the plate group and 84 per cent in the screw group.
The value of a compression bandage applied for 4 days following ankle sprains was assessed in a comparative study. The effect of the treatment was evaluated by changes in an inflammatory score based on a combination of subjective (pain, function) and objective (swelling, limitation of movement, pain on passive movement) factors. The study included two consecutive series each of 50 patients treated with a compression bandage, and untreated. There was no significant difference in the reduction of the inflammatory score from start to the fourth day (0.5 less than p less than 0.6) or from start to the eighth day (0.1 less than p less than 0.2) between the group treated with compression bandage and the untreated group. Analysis of the individual factors included in the inflammatory score demonstrated no difference in the course of pain, function, swelling, or limitation of movement between the two groups.
On 3 December, 1999, at 15.00 pm, hurricane Adam struck Esbjerg (Denmark). Wind velocity exceeded 33 m/s, the strongest hurricane ever recorded in Denmark during the last century. This article describes and analyses the orthopaedic impact of the hurricane on a local hospital in Esbjerg.We examined retrospectively all the patients treated at the Emergency Department from 3 pm on 3 December and for the following 24 hours. For comparison, we used the records of all patients treated at the Emergency Department in the same time interval on the first three Fridays in December from 1994 to 1998.No hurricane-associated deaths were recorded, but the number of patients treated on 3 December was significantly higher than that recorded in the period 1994-1998 (159 versus 74, p < 0.001). The main diagnosis was similar to that of the previous years, but more people sought treatment at the Emergency Department. Sixty-eight percent of the recorded injuries were injuries to the upper and lower extremities and 22% to the head and neck.Hurricanes can lead to substantial morbidity and mortality. Early warning is the most effective way of reducing death and injury. People should seek cover and follow the instructions given by the news media. Educational programmes for the medical staff of the Emergency Department should be made available.
The results of 42 patients with displaced proximal humeral fractures treated by conservative methods were reviewed. Follow-up evaluation included clinical and radiographic examination median two years after the trauma. The results were assessed using Neer's protocol. The patients were asked to assess the results. The patients assessed the results better than the Neer score (p < 0.001). The patients' response to non-operative treatment was satisfactory. It is concluded that the Neer classification of the results underestimates the degree of satisfaction achieved by the patients. It is concluded that displaced proximal humeral fractures can be treated satisfactorily by non-operative methods.
Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme with standard care in patients with traumatic anterior shoulder dislocations (TASD). Randomised, assessor-blinded, controlled, multicentre trial. Eighty patients with a TASD will be recruited from three orthopaedic departments in Denmark. Patients with primary or recurrent anterior shoulder dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status (primary or recurrent). Primary outcome will be change from baseline to 12 weeks in the patient-reported QoL outcome questionnaire, the Western Ontario Shoulder Instability Index (WOSI). This trial will be the first study to compare the efficacy and safety of two different nonoperative exercise treatment strategies for patients with TASD. Moreover, this is also the first study to investigate nonoperative treatment effects in patients with recurrent shoulder dislocations. Lastly, this study will add knowledge to the shared decision-making process of treatment strategies for clinical practice. ClinicalTrials.gov, identifier: NCT02371928 . Registered on 9 February 2015 at the National Institutes of Health Clinical Trials Protocol Registration System.
During six-month periods in 1981, 1986 and 1991 a prospective registration was made of all injuries caused by violence treated in the casualty ward of Esbjerg Hospital. The numbers of such contacts during these periods were 236 in 1981, 379 in 1986 and 509 in 1991. There were no differences between the three periods with respect to the following parameters: age, sex, civil status, place, types of lesions, need for further treatment and influence of alcohol. The total incidence rate rose between 1986 and 1991 from eight to nine per 1000 (not significant). The only significant increase was among females aged 15-19, where the incidence rose from 2.0 per 1000 in 1986 to 11.3 in 1991. Fourteen percent of the injured required hospitalization, occupying 1216 hospital bed days during the 1991 period.
We operated on a consecutive series of 30 closed Achilles tendon ruptures under local anesthesia and without the use of a tourniquet. We had no reruptures or major complications, and the results were comparable to other series of operatively treated achilles tendon ruptures.
