Brynjolfur Mogensen

Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK Study.

In this prospective nested case-control study we analyzed the circumferential differences in estimated cortical thickness (Est CTh) of the mid femoral neck as a risk factor for osteoporotic hip fractures in elderly women and men. Segmental QCT analysis of the mid femoral neck was applied to assess cortical thickness in anatomical quadrants. The superior region of the femoral neck was a stronger predictor for hip fracture than the inferior region, particularly in men. There were significant gender differences in Est CTh measurements in the control group but not in the case group. In multivariable analysis for risk of femoral neck (FN) fracture, Est CTh in the supero-anterior (SA) quadrant was significant in both women and men, and remained a significant predictor after adjustment for FN areal BMD (aBMD, dimensions g/cm², DXA-like), (p=0.05 and p<0.0001, respectively). In conclusion, Est CTh in the SA quadrant best discriminated cases (n=143) from controls (n=298), especially in men. Cortical thinning superiorly in the hip might be of importance in determining resistance to fracture.

Bacterial contamination of the wound during primary total hip and knee replacement. Median 13 years of follow-up of 90 replacements.

Background and purpose — Previous work has shown that despite preventive measures, intraoperative contamination of joint replacements is still common, although most of these patients seem to do well in follow-up of up to 5 years. We analyzed the prevalence and bacteriology of intraoperative contamination of primary joint replacement and assessed whether its presence is related to periprosthetic joint infection (PJI) on long-term follow-up. Patients and methods — 49 primary total hip replacements (THRs) and 41 total knee replacements (TKRs) performed between 1990 and 1991 were included in the study. 4 bacterial swabs were collected intraoperatively during each procedure. Patients were followed up for joint-related complications until March 2011. Results — 19 of 49 THRs and 22 of 41 TKRs had at least 1 positive culture. Coagulase-negative staphylococci and Staphylococcus aureus were the most common organisms, contaminating 28 and 9 operations respectively. Where information was available, bacteria from 27 of 29 contaminated operations were susceptible to the prophylactic antibiotic administered. 13% of samples gathered before 130 min of surgery were contaminated, as compared to 35% collected after that time. 2 infections were diagnosed, both in TKRs. 1 of them may have been related to intraoperative contamination. Interpretation — Intraoperative contamination was common but few infections occurred, possibly due to the effect of prophylactic antibiotics. The rate of contamination was higher with longer duration of surgery. It appears that positive results from intraoperative swabs do not predict the occurrence of PJI.

Epidemiology of childhood injuries in Reykjavík 1974-1991

OBJECTIVE To determine and analyse the incidence of childhood injuries in Reykjavík 1974-1991. DESIGN Descriptive, retrospective study. SETTING Reykjavík City district with a mean number of 88700 inhabitants, of which 23.4% were children under 15 years of age. SUBJECTS All children 0-14 years old who came to the emergency department at Reykjavík City Hospital because of an injury. MAIN OUTCOME MEASURES Number of injured children per 1000 children per year. RESULTS 111726 cases were studied. The total incidence of injuries increased from 275 per 1000 children per year in 1974-76 to 327 in 1980-82, but it then decreased to 275 in 1989-91. The injury incidence for 0-4 years old decreased from 353 in 1980-82 to 259 in 1989-91. The injury incidence for children 5-9 years old was 249 in 1989-91. The injury incidence for children 10-14 years old increased from 235 in 1974-76 to 336 in 1980-82, and in 1989-91 it was 321. The incidence of hospital admissions was 7.6 per 1000 children per year, or 2.6%. The child accident mortality rate in Reykjavík from 1987-1991 was 6.5 per 100000 children per year. CONCLUSION Childhood injuries in Reykjavík are far too many, and a major effort is needed to reduce their number.

Socket wall addition for dislocating total hip: Report of two cases

Two cases of socket wall addition in patients with a recurrent dislocation of a revised total hip prosthesis are described. Both patients have a good result seven and thirteen months after the operation.

Emergency thoracotomy as a rescue treatment for trauma patients in Iceland.

OBJECTIVE Emergency thoracotomy (ET) can be life-saving in highly selected trauma patients, especially after penetrating chest trauma. There is little information on the outcome of ET in European trauma centres. Here we report our experience in Iceland. MATERIAL AND METHODS This was a retrospective analysis of all patients who underwent ET in Iceland between 2005 and 2010. Patient demographics, mechanism, and location of major injury (LOMI) were registered, together with signs of life (SOL), the need for cardiopulmonary resuscitation (CPR), and transfusions. Based on physiological status from injury at admission, the severity score (ISS), revised trauma score (RTS), and probability of survival (PS) were calculated. RESULTS Of nine ET patients (all males, median age 36years, range 20-76) there were five long-term survivors. All but one made a good recovery. There were five blunt traumas (3 survivors) and four penetrating injuries (2 survivors). The most frequent LOMI was isolated thoracic injury (n=6), but three patients had multiple trauma. Thoracotomy was performed in five patients, sternotomy in two, and two underwent both procedures. One patient was operated in the ambulance and the others were operated after arrival. Median ISS and NISS were 29 (range 16-54) and 50 (range 25-75), respectively. Median RTS was 7 (range 0-8) with estimated PS of 85% (range 1-96%). Median blood loss was 10L (range 0.9-55). A median of 23 units of packed red blood cells were transfused (range 0-112). For four patients, CPR was required prior to transport; two others required CPR in the emergency room. Three patients never had SOL and all of them died. CONCLUSION ET is used infrequently in Iceland and the number of patients was small. More than half of them survived the procedure. This is especially encouraging considering how severely injured the patients were.

Late Results of Intertrochanteric Osteotomy for Advanced Osteoarthritis of the Hip

The results are presented of 50 intertrochanteric osteotomies after a minimum observation time of 9.3 years. This method of treatment was found to be of lasting benefit in 86 per cent of the patients. The results encourage us to consider osteotomy also in younger patients with osteoarthritis.

Incidence of bicycle injuries presenting to the emergency department in Reykjavik 2005-2010

INTRODUCTION Bicycling has become increasingly popular in Iceland. Official registration of bicycle accidents is based on police reports. As minor accidents are often not reported to the police, these accidents may be underreported in police records. The aim of this study was to examine the epidemiology of bicycle related accidents in patients seeking medical assistance at the Emergency Department (ED) at Landspitali-University Hospital, Reykjavik (LUH), Iceland. MATERIALS AND METHODS This retrospective cohort study was conducted at the ED at LUH, Iceland from January 2005 to December 2010. All medical files were reviewed and sex, age, year and month of accident/injury, helmet wearing, ICD-10 diagnosis, severity of injury according to the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) recorded. The rate of hospital admission was examined with length of stay, Intensive Care Unit admission, use of medical imaging and operative treatment. RESULTS A total of 3472 patients presented to the ED with bicycle related accidents , 68.3% men and 31.7% female. The average age of patients was 22,6 years (1-95 years). Most are injured during recreational activities (72.4%) and in residence areas (45,7%). Most injuries occurred during May-September (71.4%). Data on counterparty was missing in 74.9% of cases. The cause of accident was in 44.0% a low fall or jump. The upper extremity was injured in 47.1% cases. A majority of the patients (65.6%) had a mild injury (ISS≤3points) and 29.3% had a moderate injury (4-8 points). No fatalities were found during the study period. Use of helmets was only recorded in 14.2% of cases. In total 124 patients were admitted during the period where the mean time of admission was 5 days. CONCLUSION The incidence of bicycle injuries increased during the study period but appears to have increased less than the number of bicyclists. Injuries are more frequent among males and the majority are of a young age. The accidents usually occur during the spring and summer. Most injuries are minor but 3.6% required admission. Department of Emergency Medicine, The National University Hospital of Iceland1, Icelandic Transportation Safety Board2, Faculty of Medicine, University of Iceland3 KEY WORDS: bicycle accident, emergency department, helmet, injury. Correspondence: Hjalti Mar Bjornsson, hjaltimb@landspitali.is.

Erratum to: Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989–2008

Incorrect data were given under the heading “Secular trends” in the Resultssection of this article. Thecorrected text is given here. Secular trends for the period 1989–2008 in the over-70 age group, shown in Fig. 2, reveal the time trend for incidence of MOS—the first hip, clinical vertebral, distal forearm, and upper arm fractures. The hip fracture rate increased for women in the period 1989–2000. After that, the rate decreased, resulting in 20 % lower rate in the period 2005–2008, compared to 1997– 2000 (p=0.056), and 7 % lower rate than in 1989–1992. In contrast, the rate for men increased (p=0.076) until 2001 when it leveled off. The rate from 2005 to 2008 was 40 % higher than the rate in 1989–1992, ending in 501 events per 100,000 person years. The women/men ratio changed from 2.6 to 1.7 during the 20-year period. The incidence of other MOS fractures increased until 2001 for both men and women and declined similarly for both sexes during the last decade, except for upper arm fractures in men. There was 38 % decline (IRR=0.62, P=0.11) for men and31% decline (IRR=0.69,P=0.019) for women in clinical vertebral fracture incidence during the period 1989–2008. For distal forearm fractures, the average incidence among women almost doubled from the first period (1989–1992) until the mid-period (1997–2000) (IRR=1.62, P<0.001) when a peak in the incidence was seen with a reduction of 17 % (IRR= 0.83, P=0.11) until the last period (2005–2008). Men followed a similar pattern albeit with a much lower number of fractures. We did a separate analysis for the time trend of cervical and trochanteric fractures which were very similar.

Suicide attempts and self-harm during a dramatic national economic transition: a population-based study in Iceland

Background Macroeconomic downturns have been associated with increased suicide rates. This study examined potential changes in suicide attempts and self-harm in Iceland during a period of major economic transition (2003-12). Methods Data were retrieved from the National University Hospital in Reykjavik (population size: 204.725), containing all ICD-10 diagnoses connected to potential suicidal behaviour. Poisson regression models were used to compare attendance rates before and after the 2008 economic collapse. Results During the study period, a total of 4537 attendances of 2816 individuals were recorded due to suicide attempts or self-harm. We noted a significant change in total attendance rates among men, characterized by an annual increase in attendance rate pre-collapse of 1.83 per 100.000 inhabitants and a decrease of 3.06 per 100.000 inhabitants post-collapse ( P = 0.0067). Such pattern was not observed among women. When restricting to first attendances only, we found a reduced incidence post-crisis among both men (RR: 0.85; 0.76-0.96) and women (RR: 0.86; 0.79-0.92). We further found 1% increase in unemployment rate and balance of trade to be associated with reduced attendance rates among men (RR: 0.84; 0.76-0.93 and RR: 0.81; 0.75-0.88, respectively) but not among women. Conclusion These data suggest no overall increase in attendance rates due to suicide attempts or self-harm following the 2008 Icelandic economic collapse. In fact, a high-point in self-harm and suicide attempts was observed among men at the height of the economic boom and a decrease in new attendances among both men and women after the economic collapse.

Accidental injuries among older adults: An incidence study.

BACKGROUND To date, the majority of studies assessing accidental injuries among the elderly have focused on fall injuries, while studies of other mechanisms of injuries have been lacking. Therefore, the main objective of this study was to investigate all injury-related visits among older adults to an emergency department and risk factors for injuries. METHODS Data were collected on all registered visits of adults, ≥67 years old, living in the capital of Iceland, to the emergency department of Landspitali, the National University Hospital, in 2011 and 2012. RESULTS The yearly incidence rate for injuries was 106 per 1000 adults, ≥67 years old. Of all injuries (n = 4,469), falls were the most common mechanism of injury (78 per 1000), followed by being struck or hit (12 per 1000) and being crushed, cut or pierced (8 per 1000). Other mechanisms of injury, such as acute overexertion, foreign body in natural orifice, injuries caused by thermal and chemical effect and other and unspecified mechanism were less common (8 per 1000). Fractures were the most common consequences of injuries (36 per 1000). The most frequent place of injury was in or around homes (77 per 1000), with men being more likely than women to be injured outside of the home (60 per 1000 vs. 36 per 1000). CONCLUSION Results indicate that falls are the main cause of accidental injuries, followed by being struck and hit injuries but other causes contributed to the rest. Falls constitute a major public health problem and fall-related injuries can have a substantial impact on the lives of older adults. As life expectancy continues to increase, fall risk is expected to increase. Since falls constitute a major impact on the lives of older adults and can lead to not only declines in physical activity and functional status, but to considerable health care costs, the health care system needs to intervene.