Introduction: Distal radius fracture in postmenopausal women is often the first clinical symptom of osteoporosis. Both patients and family physicians are generally unaware of this. It is estimated that only 15–25% of postmenopausal women with a distal radius fracture are further referred to perform a bone density examination. The purpose of the current study was to examine whether a simple intervention by the hospital staff would increase the percentage of patients that undergo diagnostic workup after suffering a fracture in the distal radius.

Patients and Methods: This prospective study included 99 women aged 48–70 seen in the emergency room for a distal radius fracture. All patients were contacted 6–8 weeks after the ER visit and asked as to whether they had received an explanation from the hospital or from the family physician about the significance of the fracture for osteoporosis, and whether they had been referred to a bone density examination. 49 patients served as a control group. The intervention group (50 patients) were then given a detailed explanation regarding the implications of the fracture for osteoporosis, and in addition, received a letter with an explanatory leaflet and an appeal to the family physician with recommendations and an article on osteoporosis.

An additional telephone survey was conducted 6–8 weeks after the first conversation to assess the influence of the intervention.

Results: 15 patients in the intervention group and 14 patients in the control group were lost to follow up or were already treated for osteoporosis before the fracture. At the second phone call 24 patients (72.7%) from the intervention group had contacted their family physician after the intervention, compared to 8 patients (22.9%) in the control group (p=0.0003). 14 patients (42.4%) from this group underwent a bone density examination, compared to 5 patients (14.3%) in the control group (p=0.0003).

Conclusion: It is of great importance that patients understand the connection between the current problem for which they are receiving treatment in the emergency setting and the possibility that there is an underlying cause. In addition the connection between the hospital and the community is very important in increasing the number of patients diagnosed and treated.

Introduction. Back pain is one of the most common health problems in the industrialized world. Although using insoles appears to be common clinical practice, there is no hard data to support its effectiveness in prevention of low back pain. As a part of a Cochrane review, we conducted a literature search to determine the effectiveness of shoe insoles in the prevention and treatment of non-specific back pain compared to placebo, no intervention, or other interventions.

Materials and methods. We identified relevant clinical trials by searching The Cochrane Back Group Specialized Registry, The Cochrane Central Register, MED-LINE, EMBASE and CINAHL. All retrieved abstracts were blinded and were assessed by two independent investigators who decided on their inclusion. All these were again assessed by two different independent investigators, using the eleven items reflecting internal validity recommended by the Cochrane Back Review Group. A trial was considered to be of high quality if six or more out of eleven criteria were met.

Results. Our search found a total of 324 references. 8 papers, meeting the predetermined inclusion criteria, were retrieved of which six were found suitable for final evaluation. The clinical trials described in the papers included more than 2400 patients who used insoles for 3–5 months. Two articles with 199 patients demonstrated improvement in low back pain, while three larger studies found no difference between using insoles or no using insoles.

Discussion. There is no evidence for recommending the use of insoles for prevention of back pain. Additional high quality trials must be done to determine if they are effective in the treatment of low-back pain.

Introduction. Ankle and midfoot injuries are one of the most common orthopaedic complaints, both in the general medicine and the orthopedic practice. The percentage of fractures among these is small, however many of them will undergo an xray. Ottawa ankle rules are clinical guidelines developed for the use of radiography in these cases. This aim of this prospective study was to examine these rules’ implementation in the Israeli emergency medicine department and our ability both to predict a fracture and to reduce the amount of unnecessary xrays.

Materials and methods. 92 consecutive patients with ankle injuries attending our emergency medicine department were divided in two groups. Study group included 32 patients who arrived during the morning shift and were examined by an internal medicine specialist according to the Ottawa ankle rules. Patients discharged without an xray were followed in the clinic or by telephone communication. Control group included 60 patients who were examined during the evening and night shifts by orthopedic residents unaware of the study.

The mean age in the study group was 24 years and in the control group – 26 years. There was good acceptance of the study in patients of the study group. Only 2 of them insisted on the xrays and were excluded from the study. Rest 30 patients were followed as described.

Results. 9 patients (30%) in the study group underwent an xray as opposed to 55 patients (92%) in the control group (p< 0.001). There was one fracture diagnosed in each group. In the study group, no fractures were found later in patients discharged without an xray. The mean time spent in the emergency department was 58 minutes in the study group and 98 minutes in the control group (p< 0.002).

Discussion. The Ottawa ankle rules were developed as a simple “yes/no” decision tool as to whether to xray the ankle. In our emergency department, these rules were proved both accurate and safe. They can be effectively used by professionals not trained in trauma. It can save radiation and patient waiting time without jeopardizing the treatment.

Osteoporosis is a very common disease in the elderly, generally undertreated. Hip fracture is often the first clinical painful symptom of osteoporosis. It would seem that hip fracture should be a good opportunity to convince the patient of the importance of osteoporosis treatment. We conducted this study to check whether a simple intervention improved the compliance of osteoporosis treatment.

100 consecutive elderly patients with osteoporotic hip fracture received, during postoperative hospital stay, a 5–10 minutes long explanation about osteoporosis, its sequelae, treatment options and their effectiveness in further fracture prevention. Patients received an explanatory brochure and a letter to family physician that included a recent article on fracture rate reduction with osteoporosis treatment. Compliance was examined by telephone survey 3 and 6 months postoperatively.

100 consecutive patients with similar demographic characteristics who were treated for hip fracture prior to intervention served as a historical control. All patients received a recommendation for osteoporosis treatment in the discharge letter.

At follow up, 40% of patients in the study group were receiving biphosphonates, as opposed to 20% in the control group (p< 0.01). 77% of control patients received no treatment for osteoporosis compared to 37% of patients after intervention (p< 0.01).

Giving the patient a short explanation about osteoporosis combined with a letter to family physician, resulted in a significant improvement in their compliance The orthopaedic surgeon, who treats the patient at the first painful symptom of osteoporosis, has an excellent opportunity to improve patient’s understanding of the disease and her or his compliance to treatment.

Introduction: Currently patients who had undergone lower limb arthroplasty are discharged a few days after surgery, at which stage they still need anticoagulation treatment. The transition from hospital to the community is a sensitive period and is susceptible to mistakes and misunderstandings. Patients may underestimate the importance of the continuing treatment and their inconvenience to self-administrate subcutaneous treatment might decrease their compliance. The purpose of this prospective cohort study was to investigate the continuity of the treatment with subcutaneous low molecular weight heparin at the transition period from the hospital to the community.

Materials and Methods: 209 consecutive consenting patients who had undergone lower limb arthroplasty were recruited. Ten were excluded from the study since they were subscribed oral anticoagulation; 4 patients developed pulmonary embolism and were not included, and 8 patients were lost to follow up. 187 patients were followed weekly by phone and were asked about their adherence to the daily treatment, about clinical signs suggesting a thromboembolic event and whether they sought medical assistance. Three months later there was another clinical follow up.

Results: Of the 187 patients, 174 (93%; 95% CI 88.9% < p < 96.4%) were compliant. The percentage of doctor visits by TKR patients was statistically significantly higher, (p=0.007) than by THR patients. There was no significant difference in the compliance of patients who live with their families and patients who live alone. Patients with 0–6 years of education tend to search medical advice statistically significantly more (p=0.004) than patients with more than 7 years of education.

Discussion: The rate of compliance to anticoagulation treatment with subcutaneous low molecular weight heparin was encouraging. It demonstrates that the patients understand the necessity and importance of the treatment.

Introduction: Ankle and midfoot injuries are one of the most common orthopaedic complaints, both in the general medicine and the orthopedic practice. The percentage of fractures among these is small, however many of them will undergo an x-ray. Ottawa ankle rules are clinical guidelines developed for the use of radiography in these cases. This aim of this prospective study was to examine these rules’ implementation in the Israeli emergency medicine department and our ability both to predict a fracture and to reduce the amount of unnecessary x-rays.

Materials and Methods: Ninty-two consecutive patients with ankle injuries attending our emergency medicine department were divided in two groups. Study group included 32 patients who arrived during the morning shift and were examined by an internal medicine specialist according to the Ottawa ankle rules. Patients discharged without an x-ray were followed in the clinic or by telephone communication. Control group included 60 patients who were examined during the evening and night shifts by orthopedic residents unaware of the study.

The mean age in the study group was 24 years and in the control group – 26 years. There was good acceptance of the study in patients of the study group. Only 2 of them insisted on the xrays and were excluded from the study. Rest 30 patients were followed as described.

Results: Nine patients (30%) in the study group underwent an x-ray as opposed to 55 patients (92%) in the control group (p< 0.001). There was one fracture diagnosed in each group. In the study group, no fractures were found later in patients discharged without an x-ray. The mean time spent in the emergency department was 58 minutes in the study group and 98 minutes in the control group (p< 0.002).

Discussion: The Ottawa ankle rules were developed as a simple “yes/no” decision tool as to whether to x-ray the ankle. In our emergency department, these rules were proved both accurate and safe. They can be effectively used by professionals not trained in trauma. It can save radiation and patient waiting time without jeopardizing the treatment.