Niels Wisbech Pedersen

Intra-osseous pressure and oxygen tension in avascular necrosis and osteoarthritis of the hip.

The intra-osseous pressure, PO2, and PCO2 were measured in 32 hips (21 patients) which were painful but showed no severe degenerative changes. Pre-operative scintigraphy and radiography was performed in all patients. Thirteen hips showed early osteoarthritis, eight had early osteonecrosis, and 11 had no changes. Core biopsies were performed and the bone was examined histologically and graded for necrosis. Histologically, necrosis was present in 27 specimens. Scintigraphic findings did not correlate with the histological results but were more closely related to the radiographic findings. The intra-osseous pressure in hips with histological necrosis (mean 47 mmHg) was significantly higher than in hips without necrosis (mean 26 mmHg). The PO2 was lower in bone with histological necrosis (mean 44 mmHg) than in bone without (mean 71 mmHg). PO2 increased and intra-osseous pressure decreased after decompression. The results confirm that ischaemia plays a central role in the development of necrotic changes in bone. Histological necrosis was found in hips with radiographic signs of osteonecrosis and in those with osteoarthritis. Radiography, and scintigraphy are shown to be insensitive methods for differentiating between those disorders.

eHealth: individualisation of infliximab treatment and disease course via a self‐managed web‐based solution in Crohn's disease

Infliximab (IFX) maintenance therapy for Crohns disease (CD) is administered every 8 weeks, but inter‐patient variation in optimal treatment intervals may exist.

Nutrition as a prognostic indicator in amputations: A prospective study of 47 cases

The nutritional status was evaluated prospectively in 47 consecutive patients who were amputated for lower extremity ischemia. It was good in 13 patients, reduced in 18, and poor in 16. Malnourished patients had a higher frequency of impaired wound healing, and an increased risk of postoperative cardiopulmonary and septic complications; all 6 deaths occurred in these groups.

Core decompression in femoral head osteonecrosis: 18 Stage I hips followed up for 1–5 years

In a prospective study, we performed 18 core decompressions for Stage I primary osteonecrosis of the femoral head. Only 5 patients (six hips) seemed to have benefited from the intervention for more than 1 year.

Intraosseous pressure, oxygenation, and histology in arthrosis and osteonecrosis of the hip.

We compared intraosseous pressure, partial pressure of oxygen and carbon dioxide, and histopathology in 10 hips with arthrosis and in seven hips with nontraumatic necrosis of the femoral head. Hypoxia of the subchondral bone was present in both conditions. In arthrosis the intraosseous pressure was normal, whereas intraosseous hypertension was present in necrosis. Partial pressure of carbon dioxide was normal in both conditions. Identical signs of subchondral medullary and trabecular necrosis were found in both conditions.

Serum Alkaline Phosphatase as an Indicator of Heterotopic Bone Formation Following Total Hip Arthroplasty

Serum alkaline phosphatase (SAP) was analyzed in 193 patients treated with total hip arthroplasty (THA) and correlated with the degree of heterotopic bone formation (HBF) one year after surgery. The influence of indomethacin on changes in SAP related to the development of heterotopic bone was studied. Ninety-eight patients received 25 mg of indomethacin three times daily for the first six postoperative weeks; the remaining 95 patients received a placebo treatment. No further anti-inflammatory drugs were allowed during the six weeks. SAP was measured preoperatively and six weeks and 12 weeks after surgery. No patients at risk for developing heterotopic bone after THA could be identified from the preoperative level of SAP. The level of SAP six weeks after THA gradually increased with the amount of HBF. A rise in SAP above 250 IU/liter 12 weeks after surgery was associated with the development of severe heterotopic bone in 13 of 17 patients. Indomethacin inhibited the development of heterotopic bone associated with a rise in SAP following THA. Future studies on HBF and SAP following THA should include information on patient use of anti-inflammatory drugs in the early postoperative period.

Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases.

We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4–11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children clinically after median 1.5 (1–3) years. Their median hospital stay was 6 (2–20) days. All fractures were radiographically united at a median of 7 (5–9) weeks. The nails were removed in 29 children after a median of 22 (6–38) weeks postoperatively. At follow-up, we found a leg-length discrepancy up to 1 cm in 6 children and 10 degrees of internal rotational deformity in 1 child. No angular deformity had occurred. Elastic stable intramedullary nailing seems to be a safe method for the treatment of femoral shaft fractures in children between 4 and 11 years of age.

Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy: Intra-rater reliability and agreement across two repeated sessions

The Gait Deviation Index (GDI) and Gait Profile Score (GPS) are the most used summary measures of gait in children with cerebral palsy (CP). However, the reliability and agreement of these indices have not been investigated, limiting their clinimetric quality for research and clinical practice. The aim of this study was to investigate the intra-rater reliability and agreement of summary measures of gait (GDI; GPS; and the Gait Variable Score (GVS) derived from the GPS). The intra-rater reliability and agreement were investigated across two repeated sessions in 18 children aged 5-12 years diagnosed with spastic CP. No systematic bias was observed between the sessions and no heteroscedasticity was observed in Bland-Altman plots. For the GDI and GPS, excellent reliability with intraclass correlation coefficient (ICC) values of 0.8-0.9 was found, while the GVS was found to have fair to good reliability with ICCs of 0.4-0.7. The agreement for the GDI and the logarithmically transformed GPS, in terms of the standard error of measurement as a percentage of the grand mean (SEM%) varied from 4.1 to 6.7%, whilst the smallest detectable change in percent (SDC%) ranged from 11.3 to 18.5%. For the logarithmically transformed GVS, we found a fair to large variation in SEM% from 7 to 29% and in SDC% from 18 to 81%. The GDI and GPS demonstrated excellent reliability and acceptable agreement proving that they can both be used in research and clinical practice. However, the observed large variability for some of the GVS requires cautious consideration when selecting outcome measures.

Combined treatment with indomethacin and low-dose heparin after total hip replacement. A double-blind placebo-controlled clinical trial

We studied the safety of combining the postoperative use of a non-steroidal anti-inflammatory drug with low-dose heparin. In a double-blind, placebo-controlled clinical trial we reviewed the complications in 235 patients after total hip replacement, all treated with low-dose heparin and either indomethacin or a placebo. The incidence and type of complications in the two groups were nearly equal; indomethacin-treated patients had no increase in complications related to bleeding. Postoperative bleeding into drains was marginally greater in the indomethacin group, although the difference was not statistically significant. We conclude that treatment with indomethacin and low-dose heparin after hip replacement does not significantly increase the bleeding or other complications. We also found that patients receiving indomethacin were mobilised an average of one day before those on placebo.

Radial neck fractures in children treated with the centromedullary Métaizeau technique.

BACKGROUND Radial neck fracture in children is infrequent but when not managed accurately can lead to complications. Different methods have been developed for the reduction and fixation of this fracture. The purpose of this retrospective study is to evaluate our results using the Métaizeau centromedullary technique. MATERIALS AND METHOD Our series comprises 19 children with displaced radial neck fractures treated in our institution in the period 2004-2008. One patient was excluded because of a very complex fracture dislocation of the elbow (exclusion criteria). Two patients refused to participate in the follow-up leaving 16 who were treated with this technique. Patients were evaluated clinically and radiologically. For the clinical evaluation, we used the Métaizeaus classification. The subjective evaluation was done using the DASH score, and the Steeles classification was used for the evaluation of the radiological results. FINDING/RESULTS: We found good clinical and radiological outcomes. The mean DASH score was 3.06. Patients who had undergone open reduction had inferior outcome. CONCLUSION Our results are comparable to other studies. This study confirms the Métaizeau technique as an excellent treatment option for displaced paediatric radial neck fractures.