Rasmus Elsøe

Population-Based Epidemiology of Tibial Plateau Fractures

Although epidemiologic studies of tibial plateau fractures have been conducted, none have included geographically defined populations or a validated fracture classification based on computed tomography (CT). The goals of this study were to provide up-to-date information on the incidence and basic epidemiology of tibial plateau fractures in a large unselected patient population and to report the mechanisms of injury involved and the distribution of fractures according to a validated CT-based fracture classification. The authors conducted a population-based epidemiologic study of all patients treated for tibial plateau fracture over a 6-year period from 2005 to 2010. The study was based on an average background population of 576,364 citizens. A retrospective review of hospital records was performed. During this time, a total of 355 patients were treated for tibial plateau fracture. This group included 166 men and 189 women, and mean age was 52.6 years (SD, 18.3). The most common fracture type was AO type 41-B3, representing 35% of all tibial plateau fractures. The second most common fracture type was AO type 41-C3, representing 17% of all tibial plateau fractures. The incidence of tibial plateau fractures was 10.3 per 100,000 annually. Compared with women, men younger than 50 years had a higher incidence of fractures. The incidence of fractures increased markedly in women older than 50 years but decreased in men older than 50 years. In both sexes, the highest frequency was between the ages of 40 and 60 years.

Incidence and epidemiology of tibial shaft fractures

INTRODUCTION The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and complete population and report the distribution of fracture classification, trauma mechanism and patient baseline demographics. METHODS Retrospective reviews of clinical and radiological records. RESULTS A total of 196 patients were treated for 198 tibial shaft fractures in the years 2009 and 2010. The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. CONCLUSION This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures.

Incidence and Epidemiology of Patellar Fractures.

The literature lacks large-scale, up-to-date, population-based epidemiology studies on the incidence of patellar fractures based on complete populations. The purpose of this study was to provide up-to-date information concerning the incidence of patellar fractures in a large and complete population spanning a decade and to report on the distribution of fracture classification, trauma mechanisms, and patient baseline demographics. A retrospective review of clinical and radiological records of 756 patellar fractures treated between 2005 and 2014 was conducted. Mean age at the time of fracture was 54±21 years. Mean age was 46±22 years for males and 61±18 years for females. The sex distribution was 425 (56%) females and 331 (44%) males. The incidence of patellar fractures between 2005 and 2014 was 13.1/100,000/ year with a year-to-year variation between 10.5 and 16.5/100,000/year during the 10-year observation period. The distribution of incidence shows an increase with increasing age. Males have the highest incidence of fracture in the 10-to-19-year age group, approximately 15.4/100,000/year. Females in the 60-to-80-year age group have the highest incidence, approximately 36/100,000/year. AO type 34-C3 was the most common fracture type, representing 25% of all patellar fractures, followed by AO type 34-C1, representing 23%. [Orthopedics. 2016; 39(6):e1154-e1158.].

Population-based epidemiology of 9767 ankle fractures

BACKGROUND The purpose was to provide up-to-date information concerning the incidence of ankle fractures in a large and complete population including all age groups, spanning a decade, and report the distribution of fractures, trauma mechanism and patient baseline demographics. METHODS Population-based epidemiological study of all patients treated for an ankle fracture in a 10-year period from 2005 to 2014. RESULTS A total of 9767 patients with ankle fractures were treated between 2005 and 2014. The mean age at time of fracture was 41.4 (24.3 SD) years. The mean incidence of ankle fractures between 2005 and 2014 was 168.7/100,000/year. Years with cold winters showed increased incidences compared with years with normal winters. For males, the incidence was 157.1/100,000/year, and for females, 179.5/100,000/year. The incidence shows a peak incidence among adolescents in both genders with a male predominance. After the age of 19 the male incidence declines with age, which is in contrast to females, who experience an increasing incidence. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%). CONCLUSION This study shows an incidence of 168.7/100,000/year spanning a decade. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%).

Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing

OBJECTIVES Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postoperatively after intramedullary nailing of tibial shaft fracture. METHODS A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed bilaterally by pain pressure thresholds (PPTs). RESULTS The mean age at the time of fracture was 42.9 years. Twelve months after surgery, the pain intensity for worst pain during the last 24 hours was 1.8 ± 2.7 cm. The PPTs progressively increased from 6 weeks after surgery to 12 months postoperatively for all PPT sites except for the forearm (P < 0.012). Moreover, the PPTs on the leg were generally reduced on the injured side compared with the non-injured side (P < 0.04). CONCLUSIONS This study suggests that localized, distal, and bilateral hyperalgesia are common following an isolated tibial shaft fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.

A novel tool for measuring ankle dorsiflexion: A study of its reliability in patients following ankle fractures

BACKGROUND Assessment of ankle joint movement in a weight bearing position has important clinical implications. The lunge ankle dorsiflexion measurement device (LAD) has been developed with the aim of facilitating ease of and standardisation of the measurement of ankle joint movement. The literature lacks studies evaluating the reliability of weight bearing measurements of the ankle joint in study groups with ankle disabilities. The objective of this study was to examine the intra- and inter-tester reliability of ankle dorsiflexion measured with the novel LAD in patients following a fracture of the ankle. METHOD This study was a randomized intra- and inter-tester reliability study with blinding of testers and participants. All participants were tested twice by each tester, with the order of testers randomized. The intra- and inter-tester reliability was assessed by the calculation of interclass correlation coefficients (ICC). RESULTS The study sample consisted of 24 patients: 15 females and nine males post-immobilisation following surgery for ankle fractures. The mean age was 51.0 years, ranging from 22 to 92 years. All patients had sustained an AO classification 44- fracture of the ankle. The mean follow-up time was 9.3 months (16.2 SD) after the time of fracture. The inter-tester reliability was high, with an ICC of 0.984 (95%CI: 0.963-0.993) and SEmeas of 0.14cm. The ICC for Tester A was 0.989 (95%CI: 0.974-0.995) and SEmeas 0.10cm. The ICC for Tester B was 0.990 (95%CI: 0.977-0.996) and SEmeas 0.09cm. CONCLUSION This study shows a high inter- and intra-tester reliability for measuring ankle dorsiflexion with the LAD following a fracture of the ankle.

Long-Lasting Hyperalgesia Is Common in Patients Following Patella Fractures

Background The objective was to investigate the long-term development of pain and hyperalgesia after patella fractures. The secondary objective was to report the association between tibiofemoral and patellofemoral osteoarthritis, pain, and hyperalgesia. Methods The study used a cohort design. Patients who were treated for patella fractures between January 2006 and December 2009 were identified. Patients age 20 to 78 years were included. The main outcome was the pain pressure threshold (PPT). Moreover, visual analog scale (VAS) for pain, radiological outcomes of patellofemoral and tibiofemoral osteoarthritis, and the pain subscale of the WOMAC and EQ-5D questionnaires were used. Results Forty-nine patients were included, with a mean age of 53.9 years and a mean follow-up time of 8.5 years. The injured knee region showed significantly decreased PPT levels (P < 0.046), but decreases in PPT were not found for the forearm region (P = 0.24). The VAS score for the worst pain during the last 24 hours was reported, with a mean of 2.9 ± 2.4 cm. The EQ-5D-5L-pain scale was reported, with a mean score of 2.4 (95% confidence interval [CI] = 2.0-2.7). The WOMAC Pain score was reported, with a mean score of 3.9 (95% CI = 2.8-4.9). Moderate correlations were found between the VAS scores and PPT levels (R = 0.428, P = 0.002). Weak correlations were found between VAS scores and PPT levels for site 7 (forearm; R = 0.313, P = 0.03). Conclusions The present study suggests that long-lasting local hyperalgesia following a patella fracture is common. No side-to-side difference at the forearms were observed, indicating that the observed local hyperalgesia was not part of a generalized sensitization.

Patella fractures are not associated with an increased risk of mortality in elderly patients

INTRODUCTION The modern literature includes only limited information regarding mortality rates and cumulative survival following patella fractures. The aim was to report the 30-day, six-month, and one-year mortality of patients with patella fractures and compare this to the mortality of a matched reference population. METHODS All patients who sustained a patella fracture in Denmark between 1996 and 2000 were included in the study. The survival status of these patients was monitored until 2015. We compare the mortality with a ten-fold reference population matched on age and gender without a prior patella fracture. RESULTS 6096 patients were treated for 6114 patella fractures. The mean age of patients was 48.9 years. The overall mortality rates at 30 days, six months, and one year were 0.7%, 1.8%, and 2.8%. The mortality rates for patients > 65 years at 30 days, six months, and one year were 1.3%, 3.9%, and 6.2%. The mortality rates for patients at ≤ 65 years at 30 days, six months, and one year were 0.4%, 0.9%, and 1.3%. Compared to the matched reference population, the relative risk of mortality in patients > 65 years at 30 days, six months, and one year were 1.9 (95% CI 1.2-2.9), 1.0 (95% CI 0.8-1.3), and 0.9 (95% CI 0.7-1.1). CONCLUSION The overall one-year mortality rate of patella fractures was 2.8% and this was increased to 6.2% in patients older than 65 years. In elderly patients above 65 years, the relative risk of death was 0.9, indicating that patella fractures in elderly patients were not associated with an increased mortality rate.

Surgical versus conservative treatment for ankle fractures in adults – A systematic review and meta-analysis of the benefits and harms

INTRODUCTION Despite fractures of the ankle being very common, there is a lack of clarity regarding the relative effectiveness of conservative versus surgical treatment. The purpose of this systematic review and meta-analysis was to investigate the clinical effects, benefits, and harms of surgical versus conservative treatment of ankle fractures in adults. METHODS A systematic search strategy was conducted in the databases: Pubmed, Embase, Web of Science, and Cochrane up until the 16th of August 2017. Eight available randomized controlled trials, regardless of fracture type, reported on patient-reported ankle-specific functional outcome and were included. Analyses were based on random effects models. RESULTS The 8 included studies randomly allocated 1237 patients to either surgical or conservative treatment. Mean age of patients ranged from 38.1 to 71.4 years. Five studies evaluated short-term patient-reported ankle function, with no significant difference between surgery and conservative treatment (SMD=-0.14, 95%CI=-0.57 to 0.29, P=0.51, I2=84%). Three studies evaluated health-related quality of life, with no significant difference in treatment effect between surgery or conservative treatment (SMD=0.13, 95%CI=-0.01 to 0.27, P=0.06, I2=0%). CONCLUSIONS The best available current evidence supports that clinicians can manage ankle fractures by both surgical and conservative means with equal short-term results in selected patient groups with stable and unstable nondisplaced ankle fractures. However, more research is needed including high-quality RCTs investigating the long-term effects. This is especially the case in younger patients, before making significant interpretations about clinical practice.

Asymmetry in gait pattern following bicondylar tibial plateau fractures—A prospective one-year cohort study

INTRODUCTION Despite the high number of studies evaluating outcomes following tibial plateau fractures, the literature lacks studies including the objective assessment of gait pattern. The purpose of the present study was to evaluate asymmetry in gait patterns at 12 months after frame removal following ring fixation of a tibial plateau fracture. PATIENTS AND METHODS The study design was a prospective cohort study. The primary outcome measurement was the gait patterns 12 months after frame removal measured with a pressure-sensitive mat. The mat registers footprints and present gait speed, cadence, as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. RESULTS Twenty-three patients were included with a mean age of 54.4 years (32-78 years). Patients presented with a shorter step-length of the injured leg compared to the non-injured leg (asymmetry of 11.3%). Analysis of single-support showed shorter support time of the injured leg compared to the non-injured leg (asymmetry of 8.7%). Moreover, analysis of swing-time showed increased swing-time of the injured leg (asymmetry of 8.9%). Compared to a healthy reference population, increased asymmetry in all gait patterns was observed. The association between asymmetry and health-related quality of life (HRQOL) showed moderate associations (single-support: R=0.50, P=0.03; step-length: R=0.43, P=0.07; swing-time: R=0.46, P=0.05). CONCLUSION Compared to a healthy reference population, gait asymmetry is common 12 months after frame removal in patients treated with external ring fixation following a tibial plateau fracture of the tibia.