Introduction

Most western countries have implemented fast-track hip fracture aiming at surgery within 24 hours, since the mortality rate hereafter rises markedly.

In Greenland, it is not achievable to operate within 24 hours. Arctic people live in sparsely populated areas and Greenland's population is scattered along the vast coastline. All patients must be chartered to Nuuk by airplane which can take up till several days to weeks, due to logistics and the Arctic weather. This presents a challenge regarding adhering to western guidelines. The operative delay may be acceptable though, as it is the impression that the Greenlandic population survives and endures better than patients of western populations.

However, as data are lacking, we aimed to describe mortality among hip fracture patients in Greenland taking frailty and comorbidities into account.

Study objective: To validate the Ottawa Ankle Rules (OAR) to predict significant fractures in a Danish clinical setting.

Methods: We designed an interventional clinical study in the emergency department, Kolding Hospital. The intervention and control groups consisted of all patients presenting with a blunt trauma of the ankle within 12 months. Patients in the first 6 months were included in the control group. The intervention consisted of a 45 minutes introduction to the OAR to the new group of junior doctors starting in the emergency department. Flyers and poster were distributed. There were 854 and 1006 patients respectively in the control and intervention group.

Results: The main outcome of the study was a reduction in the number of preformed radiographs and an increase in diagnostic sensitivity. In the control group 62% of the patients were referred to radiographs, while only 57% in the intervention group. OAR had a sensitivity of 0.988, while the usual examinations techniques in the control group resulted in a sensitivity of 0.969. The use of OAR resulted in an increase in diagnostic specificity from 0.442 in the control group to 0.513 in the intervention group. The negative predictive value of OAR was 0.995. The rules failed in identifying 2 ankle fractures: a shaft fracture of the fifth metatarsal and 6 mm avulsion of the distal fibula. Both were diagnosed within the first week and treated conservatively, when returning to the hospital, as the OAR recommended in cases of no clinical improvement. When using the OAR, the radiology department would approximately perform 176 ankles and midfoot x-rays less a year, which is equivalent to 16%.

Conclusion: Use of the OAR in a Danish clinical setting resulted in an increased diagnostic safety in detecting significant ankel fractures and in a reduction of unnecessary radiographs of the ankle and midfoot. We believe that the implementation of OAR could be beneficial to many emergency departments in Denmark and possibly in other similar settings.

In the litterature patients suffering Mb. Scheuermann (MS) have been reported to experience more back pain and other back related constrains compared to subjects matched for age and sex. We have been unable to find publications on health-related quality of life by SF-12 or SF-36 in MS. The aim of the present study was to compare health-related quality of life status in MS to the background population.

Materials and Methods: The present cohorts are derived from The Danish Twin Registry and consist of all Danish twins born from 1931 through 1982. This twin cohort has been shown to very closely resemble the general Danish population. A total of 46,418 twins received and 75% returned a questionnaire of which 34,007(97.3 %) answered the question ‘Have you been diagnosed with Scheuermann’s disease?’ Included in the questionnaire were the standardised questions for The Medical Outcome Study Short Form-12 (SF-12), from which we calculated the SF-12 Physical Component Summary scale (SF-12 PCS) and the SF-12 Mental Component Summary scale (SF-12 MCS) using the SF Health Outcomes Scoring Software. Nine-hundred-and-forty-three reported to have MS and the remaining 33,064 responders were used as controls.

Results: The mean(SD) age in the MS group was 43.7(11.9) years compared to 44.4(13.7) in the control group (NS). The overall self-reported prevalence of MS was 2.8% (95% c.i.l. 2.6–3.0), male : female prevalence was 3.6% (95% c.i.l. 3.2–4.1) : 2.1% (95% c.i.l. 1.9–2.3). In the controls male : female prevalence was 45.2% (n=14,953) : 54.8% (n=18,111).

Conclusion: The perceived health status from SF-12 PCS in self-reported MS was moderately though highly significantly worse than in controls in a big cohort of Danish twins. There was no difference in SF-12 MCS between the two groups.

Introduction: Implantation of a THA changes the strain distribution pattern in the proximal femur, with a massive loss of stress in the proximal part of the femur and an increase in stress at the distal part of the femoral component.

Aim: The purpose of this study was to quantify the changes in BMD during long-term follow-up, i.e. five years, after insertion of the collarless, two-side conical, cemented Exeter stem.

Material & Methods: Eighteen patients (all women), aged 55 to 80 years, undergoing THA were included in the study after informed consent. BMD was measured in 7 regions of interest according to Gruen et al., using Dual Energy X-ray Absorptiometry postoperatively, after 18 and 60 months of follow-up. At the same time, the contra lateral hip and spine were scanned. Results were tested using Wilcoxon matched-pairs signed-rank test. P values below 0.05 were considered significant.

Results: During the first 18 months, a significant decrease in BMD was present in Gruen zones 2, 3, 6, and 7. No significant changes were seen in BMD of the zones 4, and 5 in the contra lateral hip, nor at the spine. In zone 1 there was a small but significant rise in BMD.

From 18 to 60 months of follow up we observed a significant rise in BMD in all Gruen zones but zone 4 and 7. Despite this the total periprostetic BMD decreased during the study periode. There was no significant decrease in BMD in the contra lateral hip. In the spine, we observed a significant rise in BMD.

Conclusion: During short-term follow-up (i.e. 18 months) after THA, BMD decreased in Gruen zones 2, 3, 6 and 7. The bone loss is similar to findings in other implants and seems to be related to the changes in stress pattern within the proximal femur. During long-term follow-up (i.e. 5 years) BMD increased again in these zones, however, BMD remained lower than baseline.

Introduction: Clubfoot – Congenital talipes equinovarus (CTEV) – is one of the most common congenital conditions requiring orthopaedic surgery. However little is known about the impact on health-related quality of life in these patients. A score on physical- and mental-health is used for this purpose.

The aim of the present study was to compare health-related quality of life in CTEV to a background population.

Materials and Methods: The Odense based Danish Twin Registry (DTR) is unique as it contains data on all 73,000 twin pairs born in Denmark over the last 130 years. All 46,418 twins born from 1931 through 1982 received an Omnibus questionnaire in the spring of 2002. The incidence of CTEV was self-reported. Included in the questionnaire were questions for The Medical Outcome Study Short Form-12 (SF-12). We calculated SF-12 Physical Component Summary scale (SF-12 PCS) and SF-12 Mental Component Summary scale (SF-12 MCS) using the SF Health Outcomes Scoring Software.

80 reported to have CTEV and the remaining 29,516 were used as controls.

Results: 46,418 twins received and 34,944 (75%) returned the questionnaire. 34,485 (99% of the responders) answered the question ‘Were you born with club-foot?’ The sex distribution in these was 15,731 (46%) males and 18,754 (54%) females.

The self-reported prevalence of CTEV was 0.0027 (95% confidence interval 0.0022–0.0034).

80 reported to have CTEV and the remaining 29,516 were used as controls.

In the CTEV group SF-12 PCSmean was 50.18 (SD 11.19) vs 53.09 (SD 8.11) in the controls.

p< 0.0007.

In the CTEV group SF-12 MCSmean was 50.58 (SD 10.52) vs 51.78 (SD 8.47) in the controls.

NS.

Conclusion: The impact of congenital clubfoot on health-related quality of life was significant only on the physical scale. The clubfoot patients scoring lower than the controls. There was no difference in the mental scale between the two groups.

The aetiology of congenital club foot is unclear. Although studies on populations, families and twins suggest a genetic component, the mode of inheritance does not comply with distinctive patterns.

The Odense-based Danish Twin Registry contains data on all 73 000 twin pairs born in Denmark over the last 130 years. In 2002 all 46 418 twins born between 1931 and 1982 received a 17-page questionnaire, one question of which was ‘Were you born with club foot?’ A total of 94 twins answered ‘Yes’, giving an overall self-reported prevalence of congenital club foot of 0.0027 (95% confidence interval (CI) 0.0022 to 0.0034). We identified 55 complete twin pairs, representing 12 monozygotic, 22 dizygotic same sex (DZ_ss), 18 dizygotic other sex (DZ_os) and three unclassified. Two monozygotic and 2 DZ_ss pairs were concordant. The pairwise concordance was 0.17 (95% CI 0.02 to 0.48) for monozygotic, 0.09 (95% CI 0.01 to 0.32) for DZ_ss and 0.05 (95% CI 0.006 to 0.18) for all dizygotic (DZ_tot) twins.

We have found evidence of a genetic component in congenital club foot, although non-genetic factors must play a predominant role.