Leiv M. Hove

EPIDEMIOLOGY OF SCAPHOID FRACTURES IN BERGEN, NORWAY

During a three-year period, 330 fractures of the scaphoid were diagnosed, 273 of these in subjects resident in Bergen, Norway. The population at risk was 211719, and 82% of the fractures occurred in male subjects. The mean (range) age was 25 (11-79) years. The annual incidence was 4.3/10000 people. The age-specific incidence for men was highest between the ages of 20-30 years followed by a rapid decrease. The age-specific incidence for men was significantly higher than the corresponding rates for women up to about 50 years of age, whereas the rates for men and women over 60 were similar. Fractures of the scaphoid accounted for about 2% of the total number of fractures in our area, 11% of the hand fractures, and 60% of the carpal fractures.

Fractures of the hand: distribution and relative incidence

One thousand consecutive fractures of the metacarpals, phalanges, and carpal bones have been recorded over a period of about 10 months in Bergen, Norway, to find out the relative incidence of these fractures in an unselected series: this corresponds well with the few other reports of the incidence of hand fractures that we could find. In the total series the metacarpals, phalanges, and carpal bones account for 36%, 46%, and 18% of the fractures, respectively. Fractures of the scaphoid make up 10.6% of the total, fractures of the neck of the fifth metacarpal 9.7%, and Bennetts fractures 1.4%. The outer areas of the hand are most commonly damaged,--the fifth ray, the thumb ray, and the distal phalanx of the third finger account for half of all fractures of the hand.

Open reduction and internal fixation of displaced intraarticular fractures of the distal radius: 31 patients followed for 3-7 years

We have used open reduction and internal fixation with a T-plate in 31 displaced, intraarticular fractures of the distal radius which were judged irreducible or in which closed reduction failed. The mean follow-up time was 4 (3-7) years. The dorsal angulation, the radial length, the articular step-off and the intraarticular gap between fragments were substantially improved after surgery. 30 patients had excellent or good extraarticular alignment, and only 1 patient had a postoperative intraarticular step-off of 2 mm. The function was excellent or good in 26 patients at follow-up. Complications occurred in 6 patients: 1 compartment syndrome, 1 postoperative wound infection, 2 ruptures of the extensor pollicis longus tendon, and 2 patients had median nerve paresthesias.

Childhood fractures in Bergen, Norway: identifying high-risk groups and activities.

In 1998 the authors conducted a prospective registration of children younger than 16 presenting with a new traumatic fracture in the city of Bergen, Norway. In this epidemiologic study, the authors registered a total of 1.725 fractures in children; the fracture incidence was 245 per 10,000 children below the age of 16. One fifth needed reduction, and the distal radius was the most common fracture site (27%). Activities associated with fracture were mostly soccer and bicycling, but compared with the total number of injuries associated with each activity, we found a doubled risk of fractures during rollerblading/skating or snowboarding (60%) compared with playing soccer (38%) or bicycling (33%). Scaphoid fracture, an infrequent fracture in children, was seen in 9% of all fractures due to rollerblading/skating. There was a doubled risk of fracture in boys aged 13 to 15 compared with their female peers. To make fracture prevention more efficient, it should be targeted at this risk group and these high-risk activities. Protection of the wrist region might prevent the most common fractures.

Fractures of the Distal Radius in a Norwegian City

During a prospective one-year study (1988) all fractures of the distal radius in people over 20 years old were registered in Bergen, Norway. Six hundred patients with 609 fractures were treated. The incidence was 38/10000 population, and 79% of the fractures occurred in women. The age-specific incidence in women increased rapidly after the menopause and reached a maximum between 60 and 69 years. The incidence for women over 60 years of age is the highest reported. Among women over 50 years the incidence of fractures caused by minor falls varied depending on the season. The mean number of fractures was 3.6 times higher on days when there was snow on the ground compared with days when there was no snow. More than half the distal radial fractures occurred while out walking. Possible strategies to prevent fractures must include prevention of falls, in particular among postmenopausal women on winter days.

Prediction of secondary displacement in Colles' fracture

In a prospective study, 645 consecutive Colles’ fractures treated conservatively were followed until union. The fractures subsequently lost some of their manipulated position during the immobilization period. However, the anatomical end result was significantly improved compared with the initial deformity. The mean shortening of the radius during plaster-cast treatment was 3 mm, and the mean increase of dorsal angulation was 7°. Multiple regression analyses showed that initial dorsal angulation, age, and Older type were important predictor variables for the end result of dorsal angulation. Initial radial length, age and initial dorsal angulation were of importance for the end result of radial length. The strongest linear relationship was found between the end result of radial length and the initial radial length (r = 0.67). This may indicate that the patients who will malunite with radial shortening are those with significant radial axial shortening at the initial presentation. Thus, these patients should be treated with a more stable fixation device.

Delayed rupture of the thumb extensor tendon. A 5-year study of 18 consecutive cases

18 consecutive cases of delayed rupture of the extensor pollicis longus tendon were recorded during 5 years; 4 were spontaneous, and 14 after distal radius fracture, most of which were undisplaced or only slightly displaced. 15 cases were operated upon with tendon transfers: 13 had extensor indicis proprius transfer, 1 transfer of the extensor carpi radialis longus, and 1 reoperated with the extensor communis to the little finger as a motor unit. Subjectively, nearly complete satisfaction was reported; all patients were able to elevate the thumb to the level of the palm and full independent index finger movements were noted. In this 5-year-period 4,400 patients with distal radius fractures were treated, giving an incidence of delayed tendon rupture after distal radius fracture of 0.3 percent.

Osteoporosis as a Risk Factor for Distal Radial Fractures. A Case-Control Study

BACKGROUND Distal radial fractures occur earlier in life than hip and spinal fractures and may be the first sign of osteoporosis. The aims of this case-control study were to compare the prevalence of osteopenia and osteoporosis between female and male patients with low-energy distal radial fractures and matched controls and to investigate whether observed differences in bone mineral density between patients and controls could be explained by potential confounders. METHODS Six hundred and sixty-four female and eighty-five male patients who sustained a distal radial fracture, and 554 female and fifty-four male controls, were included in the study. All distal radial fractures were radiographically confirmed. Bone mineral density was assessed with use of dual x-ray absorptiometry at the femoral neck, total hip (femoral neck, trochanter, and intertrochanteric area), and lumbar spine (L2-L4). A self-administered questionnaire provided information on health and lifestyle factors. RESULTS The prevalence of osteoporosis was 34% in female patients and 10% in female controls. The corresponding values were 17% in male patients and 13% in male controls. In the age group of fifty to fifty-nine years, 18% of female patients and 5% of female controls had osteoporosis. In the age group of sixty to sixty-nine years, the corresponding values were 25% and 7%, respectively. In adjusted conditional logistic regression analyses, osteopenia and osteoporosis were significantly associated with distal radial fractures in women. Osteoporosis was significantly associated with distal radial fractures in men. CONCLUSIONS The prevalence of osteoporosis in patients with distal radial fractures is high compared with that in control subjects, and osteoporosis is a risk factor for distal radial fractures in both women and men. Thus, patients of both sexes with an age of fifty years or older who have a distal radial fracture should be evaluated with bone densitometry for the possible treatment of osteoporosis.

Results of 189 wrist replacements. A report from the Norwegian Arthroplasty Register.

Background and purpose There is very little literature on the long-term outcome of wrist replacements. The Norwegian Arthroplasty Register has registered wrist replacements since 1994. We report on the total wrist replacements and their revision rates over a 16-year period. Material and methods 189 patients with 189 primary wrist replacements (90 Biax prostheses (80 of which were cementless), 23 cementless Elos prostheses, and 76 cementless Gibbon prostheses), operated during the period 1994–2009 were identified in the Norwegian Arthroplasty Register. Prosthesis survival was analyzed using Cox regression analyses. The 3 implant designs were compared and time trends were analyzed. Results The 5-year survival was 78% (95% CI: 70–85) and the 10-year survival was 71% (CI: 59–80). Prosthesis survival was 85% (CI: 78–93) at 5 years for the Biax prosthesis, 77% (CI: 30–90) at 4 years for the Gibbon prosthesis, and 57% (CI: 33–81) at 5 years for the Elos prosthesis. There was no statistically significant influence of age, diagnosis, or year of operation on the risk of revision, but females had a higher revision rate than males (RR = 3, CI: 1–7). The number of wrist replacements performed due to osteoarthritis increased with time, but no such change was apparent for inflammatory arthritis. Interpretation The survival of the total wrist arthroplasties studied was similar to that in other studies of wrist arthroplasties, but it was still not as good as that for most total knee and hip arthroplasties. However, a failed wrist arthroplasty still leaves the option of a well-functioning arthrodesis.

Nerve entrapment and reflex sympathetic dystrophy after fractures of the distal radius

In a series of 542 conservatively-treated fractures of the distal radius 30 patients (5,5%) developed compression neuropathy: of the median nerve (n = 23), of the ulnar nerve (n = 5), and of the radial nerve (n = 2). Three patients required decompression of the carpal tunnel, and one patients ulnar symptoms were relieved after shortening osteotomy of the ulna. The remaining neuropathies resolved spontaneously over a period of three months. Five patients developed typical reflex sympathetic dystrophy with diffuse pain, loss of hand function, and significant autonomic dysfunction. None of them had specific signs of compression neuropathy anteceding the development of reflex dystrophy. All five had their joints mobilised under regional intravenous block combined with regional perfusion of soluble corticosteroid.