Knut Melhuus

Use of MRI for diagnosing scaphoid fracture

BACKGROUND Oslo accident and emergency clinic (Oslo skadelegevakt) treats most scaphoid fractures in Oslo. The objectives of this study were to assess the usefulness of MRI in diagnosing such fractures and to determine the number of scaphoid fractures treated at our clinic, the number of patients treated with a scaphoid cast without having a fracture, the proportion of these fractures diagnosed with conventional radiographs and that diagnosed with MRI in a given period. MATERIAL AND METHODS The article is based on a review of medical records from all patients who had taken scaphoid radiographs at Oslo accident and emergency clinic in the period 1 July 2005 - 30 June 2006. RESULTS 532 patients had their forearm immobilized in a scaphoid cast because of a clinically suspected scaphoid fracture or a diagnosed fracture. 154 of these (29 %) had a scaphoid fracture; 88 (57 %) of them were diagnosed by using conventional radiographs at the first consultation, 8 (5 %) were diagnosed at a second radiographic examination (after 1 to 2 weeks) and 58 (38 %) by use of MRI at a control visit. At the control visit 228 patients were referred to MRI; 91 (40 %) of them had a fracture (58 [25 %] had a scaphoid fracture and 33 [14 %] had other fractures). In children 10 - 14 years of age MRI was used to diagnose 22 of 26 scaphoid fractures. INTERPRETATION Three of four patients treated with a scaphoid cast due to a suspected scaphoid fracture had no fracture. Early MRI can reduce the time of immobilization for patients without fracture. Use of MRI to diagnose scaphoid fractures probably leads to treatment of some fractures that would heal without immobilization, especially in children who constituted the group most often diagnosed by MRI.

Shoulder injuries from birth to old age: A 1-year prospective study of 3031 shoulder injuries in an urban population

INTRODUCTION Shoulder injuries are commonly encountered in emergency departments. In spite of this, the epidemiology is only partly known, and soft tissue injuries in particular remain unclear. The aim of this study was to obtain an overview of shoulder injuries in a general population cohort, and to estimate the relative proportion of the main injury categories soft tissue injuries, fractures and dislocations, as well as their variation with age and gender. PATIENTS AND METHODS We registered prospectively all patients admitted with a suspected shoulder injury at a combined casualty and primary health care facility during one year. The facility serves all hospitals and all citizens of Oslo. The patient-reported questionnaires, electronic patient records and radiology reports were examined. RESULTS 3031 shoulder injuries were registered from May 2013 through April 2014. The median age was 37 years (range 14 days-102 years), 51 years in women and 31 years in men (p < 0.001), 60% were male. The male/female shoulder injury incidence rate ratio in the 20-34 years age group was 3.6 (95%CI, 3.0 to 4.3; p < 0.001). Contrary, the female/male rate ratio above 75 years was 2.1 (95%CI, 1.6-2.8; p < 0.001). Almost half of the injuries were soft tissue injuries, 35% were fractures and 17% were dislocations. The age-stratified incidence rates differed substantially in men and women. Fractures dominated in children up to 10 years and in adults over 60 years, soft tissue injuries in the ages between. The highest dislocation incidence rates were found in young males. A rotator cuff tear was diagnosed in 4% of the injuries. CONCLUSION Which shoulder structures that are affected by injury vary substantially with age and gender. The shoulder injury incidence rates of young men and the elderly are high. The findings are important for the understanding of the shoulder and the diagnostic process in A&Es.

294 Bicycle injuries in Oslo: injury pattern in 2014 trends since 2003

Background Interest for bicycling is increasing for transport, and also for health promotion. In cities with demanding traffic pattern, bicycling might be a dangerous activity. Due to lack of knowledge health and traffic authority financed an in-depth investigation of bicycle injuries treated in Oslo University Hospital (OUH), both as in and out patients. Continuous injury monitoring in the AED since 2003 gave possibility to follow trends. Methods The study was a one-year prospective in-depth investigation with 20 variables. All patients contacting the AED due to a bicycle injury filled in a one-page form with description of 14 variables of the accident and a free text. Health personnel collected relevant information for patients arriving by ambulance and those not able to fill in form themselves. Based on previous studies it is estimated that about 85% of all injured persons from the Oslo population are treated at OUH. Results 2184 persons were treated due a bicycle accident in 2014, 71% were single accidents. 65% were men. Median age was 34 years, for women 32 years. 20% were head injuries, 33% fractures, higher than average fracture rate in all injuries. 80 injuries were serious (AIS 3), 8 severe (AIS 4) and 3 critical (AIS 5). 60% of the injured had used helmet, and got fewer head injuries than those without helmets. 10% were influenced by alcohol/drugs. 77% (N = 1673) happened in “inner” city, 13% in wooden areas in the city, 7% in other municipalities, and 3% abroad. In 10% (N = 164) of injuries in “inner city”, tram rails were involved. Police registered 125 bicycle injuries in “inner city” during 2014, 7% of injuries treated at OUH. Since 2003, population of Oslo has increased by 22%, bicycle injuries by 21%. Conclusions Incidence of bicycle injuries in the population of Oslo seems to be rather stable during the last 12 years. They are more severe than injuries in average. Patients without helmets have more head injuries than patients with helmets.

[Scandinavian guidelines for the acute management of adult patients with minimal, mild, or moderate head injuries].

BACKGROUND In 2000, the Scandinavian Neurotrauma Committee (SNC) published evidence-based guidelines for the management of minimal, mild or moderate head injuries. Since then, considerable new evidence has emerged on the clinical use of these guidelines and on the radiation risks associated with computer tomographic (CT) examinations. The SNC has recently published updated Scandinavian guidelines. Here we present the Norwegian version of the updated guidelines with emphasis on the professional recommendations and the reasons the new guidelines were necessary, plus comments from the Norwegian authors.MATERIALS AND METHODS A task force appointed by the SNC compiled recommendations based on a systematic, evidence-based review. These recommendations were revised through consensus in the SNC and through consultation with relevant clinical experts.RESULTS A blood test of the brain injury biomarker S100B is for the first time recommended as an initial diagnostic measure for mild head injury patients with low risk. Of these patients, CT examination is only recommended for those who show a pathologically elevated S100B. CT examination is still the recommended routine for moderate head injury patients and for mild head injury patients with medium to high risk. An updated information sheet on head injuries has also been compiled for patients and their relatives.CONCLUSION The SNC recommends the implementation of these guidelines in Norway.