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Vaartjes TP, Assink N, Nijveldt RJ, van Helden SH, Bosma E, El Moumni M, Duis KT, Hogervorst M, Doornberg JN, de Vries JPPM, Hoekstra H, IJpma FFA. Functional Outcome After Nonoperative Management of Tibial Plateau Fractures in Skeletally Mature Patients: What Sizes of Gaps and Stepoffs Can be Accepted? Clin Orthop Relat Res 2022; 480:2288-2295. [PMID: 35638902 PMCID: PMC9653182 DOI: 10.1097/corr.0000000000002266] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/12/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gap and stepoff measurements provide information about fracture displacement and are used for clinical decision-making when choosing either operative or nonoperative management of tibial plateau fractures. However, there is no consensus about the maximum size of gaps and stepoffs on CT images and their relation to functional outcome in skeletally mature patients with tibial plateau fractures who were treated without surgery. Because this is important for patient counseling regarding treatment and prognosis, it is critical to identify the limits of gaps and stepoffs that are well tolerated. QUESTIONS/PURPOSES (1) In patients treated nonoperatively for tibial plateau fractures, what is the association between initial fracture displacement, as measured by gaps and stepoffs at the articular surface on a CT image, and functional outcome? (2) What is the survivorship of the native joint, free from conversion to a total knee prosthesis, among patients with tibial plateau fractures who were treated without surgery? METHODS A multicenter cross-sectional study was performed in all patients who were treated nonoperatively for a tibial plateau fracture between 2003 and 2018 in four trauma centers. All patients had a diagnostic CT scan, and a gap and/or stepoff more than 2 mm was an indication for recommending surgery. Some patients with gaps and/or stepoffs exceeding 2 mm might not have had surgery based on shared decision-making. Between 2003 and 2018, 530 patients were treated nonoperatively for tibial plateau fractures, of which 45 had died at follow-up, 30 were younger than 18 years at the time of injury, and 10 had isolated tibial eminence avulsions, leaving 445 patients for follow-up analysis. All patients were asked to complete the validated Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire consisting of five subscales: symptoms, pain, activities of daily living (ADL), function in sports and recreation, and knee-related quality of life (QOL). The score for each subscale ranged from 0 to 100, with higher scores indicating better function. A total of 46% (203 of 445) of patients participated at a mean follow-up of 6 ± 3 years since injury. All knee radiographs and CT images were reassessed, fractures were classified, and gap and stepoff measurements were taken. Nonresponders did not differ much from responders in terms of age (53 ± 16 years versus 54 ± 20 years; p = 0.89), gender (70% [142 of 203] women versus 59% [142 of 242] women; p = 0.01), fracture classifications (Schatzker types and three-column concept), gaps (2.1 ± 1.3 mm versus 1.7 ± 1.6 mm; p = 0.02), and stepoffs (2.1 ± 2.2 mm versus 1.9 ± 1.7 mm; p = 0.13). In our study population, the mean gap was 2.1 ± 1.3 mm and stepoff was 2.1 ± 2.2 mm. The participating patients divided into groups with increasing fracture displacement based on gap and/or stepoff (< 2 mm, 2 to 4 mm, or > 4 mm), as measured on CT images. ANOVA was used to assess whether an increase in the initial fracture displacement was associated with poorer functional outcome. We estimated the survivorship of the knee free from conversion to total knee prosthesis at a mean follow-up of 5 years using a Kaplan-Meier survivorship estimator. RESULTS KOOS scores in patients with a less than 2 mm, 2 to 4 mm, or greater than 4 mm gap did not differ (symptoms: 83 versus 83 versus 82; p = 0.98, pain: 85 versus 83 versus 86; p = 0.69, ADL: 87 versus 84 versus 89; p = 0.44, sport: 65 versus 64 versus 66; p = 0.95, QOL: 70 versus 71 versus 74; p = 0.85). The KOOS scores in patients with a less than 2 mm, 2 to 4 mm, or greater than 4 mm stepoff did not differ (symptoms: 84 versus 83 versus 77; p = 0.32, pain: 85 versus 85 versus 81; p = 0.66, ADL: 86 versus 87 versus 82; p = 0.54, sport: 65 versus 68 versus 56; p = 0.43, QOL: 71 versus 73 versus 61; p = 0.19). Survivorship of the knee free from conversion to total knee prosthesis at mean follow-up of 5 years was 97% (95% CI 94% to 99%). CONCLUSION Patients with minimally displaced tibial plateau fractures who opt for nonoperative fracture treatment should be told that fracture gaps or stepoffs up to 4 mm, as measured on CT images, could result in good functional outcome. Therefore, the arbitrary 2-mm limit of gaps and stepoffs for tibial plateau fractures could be revisited. The survivorship of the native knee free from conversion to a total knee prosthesis was high. Large prospective cohort studies with high response rates are needed to learn more about the relationship between the degree of fracture displacement and functional recovery after tibial plateau fractures. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Thijs P. Vaartjes
- University Medical Center Groningen, Department of Trauma Surgery, University of Groningen, Groningen, the Netherlands
| | - Nick Assink
- University Medical Center Groningen, Department of Trauma Surgery, University of Groningen, Groningen, the Netherlands
| | | | | | - Eelke Bosma
- Martini Hospital, Department of Trauma Surgery, Groningen, the Netherlands
| | - Mostafa El Moumni
- University Medical Center Groningen, Department of Trauma Surgery, University of Groningen, Groningen, the Netherlands
| | - Kaj ten Duis
- University Medical Center Groningen, Department of Trauma Surgery, University of Groningen, Groningen, the Netherlands
| | - Mike Hogervorst
- University Medical Center Groningen, Department of Trauma Surgery, University of Groningen, Groningen, the Netherlands
| | - Job N. Doornberg
- University Medical Center Groningen, Department of Trauma Surgery, University of Groningen, Groningen, the Netherlands
| | - Jean-Paul P. M. de Vries
- University Medical Center Groningen, Department of Surgery, University of Groningen, Groningen, the Netherlands
| | - Harm Hoekstra
- University Hospitals Leuven, Department of Trauma Surgery, Leuven, Belgium
| | - Frank F. A. IJpma
- University Medical Center Groningen, Department of Trauma Surgery, University of Groningen, Groningen, the Netherlands
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Ten Brinke JG, Slinger G, Slaar A, Saltzherr TP, Hogervorst M, Goslings JC. Correction to: Increased and unjustified CT usage in paediatric C‑spine clearance in a level 2 trauma centre. Eur J Trauma Emerg Surg 2021; 47:791-794. [PMID: 33462647 PMCID: PMC8187194 DOI: 10.1007/s00068-020-01557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The original version of this article unfortunately contained mistakes.
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Affiliation(s)
- Joost G Ten Brinke
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. .,Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
| | | | - Annelie Slaar
- Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | | | - Mike Hogervorst
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Ten Brinke JG, Slinger G, Slaar A, Saltzherr TP, Hogervorst M, Goslings JC. Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre. Eur J Trauma Emerg Surg 2020; 47:781-789. [PMID: 33108476 PMCID: PMC8187214 DOI: 10.1007/s00068-020-01520-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre. METHODS We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging. RESULTS We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first. CONCLUSION Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.
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Affiliation(s)
- Joost G Ten Brinke
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. .,Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
| | | | - Annelie Slaar
- Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | | | - Mike Hogervorst
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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de Vries EN, Gardenbroek TJ, Ammerlaan H, Steenstra F, Vervest AMJS, Hogervorst M, van Velde R. The optimal approach in hip hemiarthroplasty: a cohort of 1009 patients. Eur J Orthop Surg Traumatol 2019; 30:569-573. [DOI: 10.1007/s00590-019-02610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/13/2019] [Indexed: 01/11/2023]
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Hogervorst M, van Berkel M, Oort C, Marinkovich M, Keene D, Ritsema T, Swildens J, Haisma I. 371 The use of human skin equivalents to evaluate the effectivity of QR-313, an antisense oligonucleotide, in gel formulation. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ten Brinke JG, Gebbink WK, Pallada L, Saltzherr TP, Hogervorst M, Goslings JC. Value of prehospital assessment of spine fracture by paramedics. Eur J Trauma Emerg Surg 2018; 44:551-554. [PMID: 28779433 PMCID: PMC6096622 DOI: 10.1007/s00068-017-0828-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current guidelines state that trauma patients at risk of spine injury should undergo prehospital spine immobilization to reduce the risk of neurological deterioration. Although this approach has been accepted and implemented as a standard for decades, there is little scientific evidence to support it. Furthermore, the potential dangers and sequelae of spine immobilization have been extensively reported. The role of the paramedic in this process has not yet been examined. The aim of this study was to evaluate the accuracy of prehospital evaluations for the presence of spine fractures made by paramedics. METHODS All patients who presented with prehospital spine immobilization at our level II trauma center between January 2013 and January 2014 were prospectively included in a database. Prior to the diagnosis, paramedics recorded the probability of a spine fracture after a prehospital examination. These predictions were compared with patient outcomes. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS One hundred and thirty-nine patients were included that positive predictive value was 22%, negative predictive value was 95%, sensitivity was 92%, specificity was 30%, and accuracy was 41%. CONCLUSIONS The results of this study suggest that paramedics cannot accurately predict spinal fractures.
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Affiliation(s)
- J G Ten Brinke
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - W K Gebbink
- Department of Surgery, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands
| | - L Pallada
- Department of Surgery, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands
| | - T P Saltzherr
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Hogervorst
- Department of Surgery, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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ten Brinke J, Saltzherr T, Panneman M, Hogervorst M, Goslings J. Incidence of spinal fractures in the Netherlands 1997-2012. J Clin Orthop Trauma 2017; 8:S67-S70. [PMID: 29339845 PMCID: PMC5761692 DOI: 10.1016/j.jcot.2017.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED : To determine time trends of emergency department (ED) visits, hospitalization rates, spinal cord lesions and characteristics of patients with spinal fractures in the Netherlands. METHODS In an observational database study we used the Dutch Injury Surveillance System to analyse spinal fracture-related ED visits, hospitalization rates and spinal cord lesions between 1997 and 2012. RESULTS The total number of ED visits associated with spinal fractures increased from 4,507 in 1997 to 9,690 in 2012 (115% increase). The increase in the total number of fractures occurred in all age groups independently of gender. However, incidence rates increased more strongly with age and were higher in young males and ageing females. The hospitalization rate of diagnosed spinal fractures remained stable between 62 and 67%. The incidence of spinal cord lesions varied between 13.8 and 20.3 per million of the population over a period of 15 years. CONCLUSION Spinal fracture-related ED visits are increasing in the Dutch population, independently of age or gender. The hospitalization rate and the absolute numbers of spinal cord lesions have remained stable over a period of 15 years. These findings are relevant for public health decision-making and resource allocation.
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Affiliation(s)
- J.G. ten Brinke
- Trauma Unit Department of Surgery, Academic Medical Center Amsterdam, The Netherlands,Corresponding author at: Trauma Unit Department of Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - T.P. Saltzherr
- Department of Surgery, Gelre Hospitals, Apeldoorn, The Netherlands
| | | | - M. Hogervorst
- Department of Surgery, Gelre Hospitals, Apeldoorn, The Netherlands
| | - J.C. Goslings
- Trauma Unit Department of Surgery, Academic Medical Center Amsterdam, The Netherlands
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Zwart S, Hogervorst M, Brouwer M, Rodrigues A, Hameetman L, El Ghalbzouri A. 549 In vitro superficial and full thickness wound models to study re-epithelialization processes. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Beeres FJP, Hogervorst M, Den Hollander P, Rhemrev SJ. Diagnostic Strategy for Suspected Scaphoid Fractures in the Presence of Other Fractures in the Carpal Region. ACTA ACUST UNITED AC 2016; 31:416-8. [PMID: 16716469 DOI: 10.1016/j.jhsb.2006.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 03/30/2006] [Accepted: 04/03/2006] [Indexed: 11/30/2022]
Abstract
Bone scintigraphy will identify up to 25% of occult scaphoid bone fractures after negative scaphoid X-rays. Consequently, it deserves a place in the diagnostic process of suspected scaphoid fractures. However, the role of bone scintigraphy is less clear if scaphoid X-rays show other fractures in the carpal region. We analysed 111 consecutive patients with a suspected scaphoid fracture on physical examination. Scaphoid X-rays revealed 61 fractures. Fifty-five patients had scaphoid fractures only and six patients had other fractures in the carpal region but no scaphoid fracture. In 50 cases, no bone injury was seen on these X-rays. In three out of the six patients with other fractures in the carpal region, bone scintigraphy revealed four occult concomitant fractures: one scaphoid, one scaphoid and trapezial and one capitate fracture. In conclusion, bone scintigraphy is required when scaphoid X-rays do not confirm a suspected scaphoid fracture, even in the presence of other fractures in the carpal region.
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Affiliation(s)
- F J P Beeres
- Department of Trauma Surgery, Medisch Centrum Haaglanden, The Hague, The Netherlands.
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Burgers PTPW, Poolman RW, Van Bakel TMJ, Tuinebreijer WE, Zielinski SM, Bhandari M, Patka P, Van Lieshout EMM, Devereaux PJ, Guyatt GH, Einhorn TA, Thabane L, Schemitsch EH, Koval KJ, Frihagen F, Poolman RW, Tetsworth K, Guerra-Farfan E, Walter SD, Sprague S, Swinton M, Scott T, McKay P, Madden K, Heels-Ansdell D, Buckingham L, Duraikannan A, Silva H, Heetveld MJ, Van Lieshout EMM, Burgers PT, Zura RD, Avram V, Manjoo A, Williams D, Antoniou J, Ramsay T, Bogoch ER, Trenholm A, Lyman S, Mazumdar M, Bozic KJ, Luborsky M, Goodman S, Muray S, Korley R, Buckley R, Duffy P, Puloski S, Carcary K, Lorenzo M, McKee MD, Hall JA, Nauth A, Whelan D, Daniels TR, Waddell JP, Ahn H, Vicente MR, Hidy JT, MacNevin MT, Kreder H, Axelrod T, Jenkinson R, Nousiainen M, Stephen D, Wadey V, Kunz M, Milner K, Cagaanan R, MacNevin M, O’Brien PJ, Blachut PA, Broekhuyse HM, Guy P, Lefaivre KA, Slobogean GP, Johal R, Leung I, Coles C, Leighton R, Richardson CG, Biddulph M, Gross M, Dunbar M, Amirault JD, Alexander D, Coady C, Glazebrook M, Johnston D, Oxner W, Reardon G, Wong I, Trask K, MacDonald S, Furey A, Stone C, Parsons M, Stone T, Zomar M, McCormack R, Apostle K, Boyer D, Moola F, Perey B, Viskontas D, Moon K, Moon R, Laflamme Y, Benoit B, Ranger P, Malo M, Fernandes J, Tardif K, Fournier J, Vendittoli PA, Massé V, Roy AG, Lavigne M, Lusignan D, Davis C, Stull P, Weinerman S, Weingarten P, Lindenbaum S, Hewitt M, Danielwicz R, Baker J, Mont M, Delanois DE, Kapadia B, Issa K, Mullen M, Sems A, Foreman B, Parvizi J, Morrison T, Lewis C, Caminiti S, Tornetta P, Creevy WR, Lespasio MJ, Carlisle H, Marcantonio A, Kain M, Specht L, Tilzey J, Garfi J, Mehta S, Esterhai JL, Ahn J, Donegan D, Horan A, McGinnis K, Roberson J, Bradbury T, Erens G, Webb K, Mullis B, Shively K, Parr A, Ertl J, Worman R, Webster M, Cummings J, Frizzell V, Moore M, Jones CB, Ringler JR, Sietsema DL, Walker JE, Kanlic E, Abdelgawad A, Shunia J, DePaolo C, Sutherland S, Alosky R, Zura R, Manson M, Strathy G, Peter K, Johnson P, Morton M, Shaer J, Schrickel T, Hileman B, Hanes M, Chance E, Heinrich EM, Dodgin D, LaBadie M, Zamorano D, Tynan M, Schwarzkopf R, Scolaro JA, Gupta R, Bederman S, Bhatia N, Hoang B, Kiester D, Jones N, Rafijah G, Alavekios D, Lee J, Mehta A, Schroder S, Chao T, Colin V, Dang P(P, Heng SK, Lopez G, Galle S, Pahlavan S, Phan DL, Tapadia M, Bui C, Jain N, Moore T, Moroski N, Pourmand D, Kubiak EN, Gililland J, Rothberg D, Peters C, Pelt C, Stuart AR, Corbey K, Shuler FD, Day J, Garabekyan T, Cheung F, Oliashirazi A, Salava J, Morgan L, Wilson-Byrne T, Cordle MB, Elmans LH, van den Hout JA, Joosten AJP, van Beurden AFA, Bolder SBT, Eygendaal D, Moonen AF, van Geenen RCI, Hoebink EA, Wagenmakers R, van Helden W, van Jonbergen HPW, Roerdink H, Reuver JM, Barnaart AFW, Flikweert ER, Krips R, Mullers JB, Schüller H, Falke MLM, Kurek FJ, Slingerland ACH, van Dijk JP, van Helden WH, Bolhuis HW, Bullens PHJ, Hogervorst M, de Kroon KE, Jansen RH, Steenstra F, Raven EEJ, Fontijne WPJ, Wiersma SC, Boetes B, ten Holder EJT, van der Heide HJL, Nagels J, van der Linden-van der Zwaag EH, Keizer SB, Swen JWA, den Hollander PHC, Thomassen BJW, Molekamp WJK, de Meulemeester FR, Kleipool AEB, Haverlag R, Simons MP, Mutsaerts EL, Kooijman R, Postema RR, Bleker RJ, Lampe HIH, Schuman L, Cheung J, van Bommel F, Winia WP, Haverkamp D, van der Vis H, Nolte PA, van den Bekerom MPJ, de Jong T, van Noort A, Vergroesen DA, Schutte BG, van der Vis HM, Beimers L, de Vries J, Zurcher AW, Albers GR, Rademakers M, Breugem S, van der Haven I, Jan Damen P, Bulstra GH, Campo MM, Somford MP, Haverkamp D, Liew S, Bedi H, Carr A, Chia A, Csongvay S, Donohue C, Doig S, Edwards E, Esser M, Freeman R, Gong A, Li D, Miller R, Ton L, Wang O, Young I, Dowrick A, Murdoch Z, Sage C, Page R, Bainbridge D, Angliss R, Miller B, Thomson A, Brown G, Williams S, Eng K, Bowyer D, Skelley J, Goyal C, Beattie S, Guerado E, Cruz E, Cano JR, Froufe MA, Serra LM, Al-dirra S, Martinez C, Tarazona Santabalbina FJ, Serra JT, Hernandez JT, Garcia MA, Garcia VM, Barrera S, Garrido M, Nordsletten L, Clarke-Jenssen J, Hjorthaug G, Brekke AC, Vesterhus EB, Skaugrud I, Tripathi P, Katiyar S, Shukla P, Swiontkowski M, Guyatt G, Jeray K, Walter S, Viveiros H, Truong V, Koo K, Zhou Q, Maddock D, Simunovic N, Agel J, Zielinski SM, Rangan A, Hanusch BC, Kottam L, Clarkson R, Della Rocca GJ, Slobogean G, Katz J, Gillespie B, Greendale GA, Hartman C, Rubin C, Waddell J, Lemke HM, Oatt A, Buckley RE, Korley R, Johnston K, Powell J, Sanders D, Lawendy A, Tieszer C, Murnaghan J, Nam D, Yee A, Whelan DB, Wild LM, Khan RM, Coady C, Amirault D, Richardson G, Dobbin G, Bicknell R, Yach J, Bardana D, Wood G, Harrison M, Yen D, Lambert S, Howells F, Ward A, Zalzal P, Brien H, Naumetz V, Weening B, Wai EK, Papp S, Gofton WT, Kingwell SP, Johnson G, O’Neil J, Roffey DM, Borsella V, Oliver TM, Jones V, Endres TJ, Agnew SG, Jeray KJ, Broderick JS, Goetz DR, Pace TB, Schaller TM, Porter SE, Tanner SL, Snider RG, Nastoff LA, Bielby SA, Switzer JA, Cole PA, Anderson SA, Lafferty PM, Li M, Ly TV, Marston SB, Foley AL, Vang S, Wright DM, Marcantonio AJ, Kain MSH, Iorio R, Specht LM, Tilzey JF, Lobo MJ, Garfi JS, Vallier HA, Dolenc A, Robinson C, Prayson MJ, Laughlin R, Rubino LJ, May J, Rieser GR, Dulaney-Cripe L, Gayton C, Gorczyca JT, Gross JM, Humphrey CA, Kates S, Noble K, McIntyre AW, Pecorella K, Davis CA, Lindenbaum S, Schwappach J, Baker JK, Rutherford T, Newman H, Lieberman S, Finn E, Robbins K, Hurley M, Lyle L, Mitchell K, Browner K, Whatley E, Payton K, Reeves C, Cannada LK, Karges D, Hill L, Esterhai J, Horan AD, Kaminski CA, Kowalski BN, Keeve JP, Anderson CG, McDonald MD, Hoffman JM, Tarkin I, Siska P, Gruen G, Evans A, Farrell DJ, Irrgang J, Luther A, Cross WW, Cass JR, Sems SA, Torchia ME, Scrabeck T, Jenkins M, Dumais J, Romero AW, Sagebien CA, Butler MS, Monica JT, Seuffert P, Hsu JR, Ficke J, Charlton M, Napierala M, Fan M, Tannoury C, Archdeacon M, Finnan R, Le T, Wyrick J, Hess S, Brennan ML, Probe R, Kile E, Mills K, Clipper L, Yu M, Erwin K, Horwitz D, Strohecker K, Swenson TK, Schmidt AH, Westberg JR, Aurang K, Zohman G, Peterson B, Huff RB, Baele J, Weber T, Edison M, McBeth J, Ertl JP, Parr JA, Moore MM, Tobias E, Thomas E, DePaolo CJ, Shell LE, Hampton L, Shepard S, Nanney T, Cuento C, Cantu RV, Henderson ER, Eickhoff LS, Hammerberg EM, Stahel P, Hak D, Mauffrey C, Gibula D, Gissel H, Henderson C, Zamorano DP, Tynan MC, Lawson D, Crist BD, Murtha YM, Anderson LK, Linehan C, Pilling L, Lewis CG, Sullivan RJ, Roper E, Obremskey W, Kregor P, Richards JE, Stringfellow K, Dohm MP, Zellar A, Segers MJM, Zijl JAC, Verhoeven B, Smits AB, de Vries JPPM, Fioole B, van der Hoeven H, Theunissen EBM, de Vries Reilingh TS, Govaert L, Wittich P, de Brauw M, Wille J, Go PM, Ritchie ED, Wessel RN, Hammacher ER, Visser GA, Stockmann H, Silvis R, Snellen JP, Rijbroek B, Scheepers JJG, Vermeulen EGJ, Siroen MPC, Vuylsteke R, Brom HLF, Rijna H, de Rijcke PAR, Koppert CL, Buijk SE, Groenendijk RPR, Dawson I, Tetteroo GWM, Bruijninckx MMM, Doornebosch PG, de Graaf EJR, van der Elst M, van der Pol CC, van’t Riet M, Karsten TM, de Vries MR, Stassen LPS, Schep NWL, Ben Schmidt G, Hoffman WH, van der Heijden FH, Willems WJ, van der Hart CP, Turckan K, Festen S, de Nies F, Out NJM, Bosma J, van Kampen A, Biert J, van Vugt AB, Edwards MJR, Blokhuis TJ, Frölke JPM, Geeraedts LMG, Gardeniers JWM, Tan ET, Poelhekke LM, de Waal Malefijt MC, Schreurs B, Roukema GR, Josaputra HA, Keller P, de Rooij PD, Kuiken H, Boxma H, Cleffken BI, Liem R, Rhemrev SJ, Bosman CHR, de Mol van Otterloo A, Hoogendoorn J, de Vries AC, Meylaerts SAG, Verhofstad MHJ, Meijer J, van Egmond T, van der Brand I, Patka P, Eversdijk MG, Peters R, Den Hartog D, Van Waes OJF, Oprel P, Campo M, Verhagen R, Albers GR, Simmermacher RKJ, van Mulken J, van Wessem K, van Gaalen SM, Leenen LPH, Bronkhorst MW, Guicherit OR, Goslings JC, Ponsen KJ, Bhatia M, Arora V, Tyagi V, Gupta A, Jain N, Khan F, Sharma A, Sanghavi A, Trivedi M, Rai A, Subash, Rai K, Yadav V, Singh S, Prasad AS, Mishra V, Sundaresh DC, Khanna A, Cherian JJ, Olakkengil DJ, Sharma G, Dadi A, Palla N, Ganguly U, Rai BS, Rajakumar J, Hull P, Lewis S, Evans S, Nanda R, Logishetty R, Anand S, Bowler C, Jennings A, Chuter G, Rose G, Horner G, Clark C, Eke K, Reed M, Herriott C, Dobb C, Curry H, Etherington G, Jain A, Moaveni A, Russ M, Donald G, Weinrauch P, Pincus P, Yang S, Halliday B, Gervais T, Holt M, Flynn A, Pirpiris M, Love D, Bucknill A, Farrugia RJ, Ianssen T, Amundsen A, Brattgjerd JE, Borch T, Bøe B, Flatøy B, Hasselund S, Haug KJ, Hemlock K, Hoseth TM, Jomaas G, Kibsgård T, Lona T, Moatshe G, Müller O, Molund M, Nicolaisen T, Nilsen F, Rydinge J, Smedsrud M, Stødle A, Trommer A, Ugland S, Karlsten A, Ekås G, Pape HC, Knobe M, Pfeifer R. Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for elderly patients with a femoral neck fracture. J Bone Joint Surg Am 2015; 97:751-7. [PMID: 25948522 DOI: 10.2106/jbjs.n.00542] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. METHODS Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older. RESULTS The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%). CONCLUSIONS The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations. CLINICAL RELEVANCE The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.
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Affiliation(s)
- Paul T P W Burgers
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Rudolf W Poolman
- Joint Research, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, the Netherlands. E-mail address:
| | - Theodorus M J Van Bakel
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Wim E Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Stephanie M Zielinski
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Mohit Bhandari
- Department of Clinical Epidemiology and Biostatistics, McMaster University, HSC 2C, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. E-mail address:
| | - Peter Patka
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address:
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
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Winkelhagen J, van den Bekerom MPJ, Bolhuis HW, Hogervorst M. Preliminary results of cannulated screw fixation for isolated pubic ramus fractures. Strategies Trauma Limb Reconstr 2012; 7:87-91. [PMID: 22547056 PMCID: PMC3535133 DOI: 10.1007/s11751-012-0134-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 04/09/2012] [Indexed: 11/26/2022] Open
Abstract
Isolated pubic ramus fractures are common fractures in the elderly, and treatment is typically non-operative. Up to 35 % of patients have a prolonged hospital stay due to pain. A small number of these patients do not respond to standard (non-operative) treatment. We retrospectively reviewed six patients with isolated pubic ramus fractures and persistent pain who were treated with percutaneous retrograde pubic ramus screw fixation. The study group consisted of six women with an average age of 81 years (72–86 years). Patients with symptomatic posterior pelvic ring injuries were excluded. All patients showed improvement after surgery, with three patients pain free and three patients with reduced pain. The mean time spent in the hospital was 9 days (range 3–18 days). There were complications post-operatively: two patients had pneumonia, two with confusional states, and one patient had a urinary tract infection. Despite these events, which are associated with surgery in patients with comorbidites from advanced age, retrograde pubic ramus screw fixation is an effective treatment option for patients with persistent pain from isolated pubic fractures.
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Affiliation(s)
- Jasper Winkelhagen
- Department of General Surgery and Traumatology, Gelre Hospitals, Location Lukas, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - Michel P. J. van den Bekerom
- Department of General Surgery and Traumatology, Gelre Hospitals, Location Lukas, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - Hugo W. Bolhuis
- Department of General Surgery and Traumatology, Gelre Hospitals, Location Lukas, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - Mike Hogervorst
- Department of General Surgery and Traumatology, Gelre Hospitals, Location Lukas, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands
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Abstract
Fractures of the ankle are fairly common injuries. Open ankle fractures are much less common and associated with severe injuries to surrounding tissues. We have performed a systematic review of the literature concerning the clinical results and complication rates in the treatment of open ankle fractures. We conducted a search limited to the following databases: Pubmed/Medline, Cochrane Database of Systematic Reviews, Cochrane Clinical Trial Register and Embase. These were searched from 1968 to April 2010 to identify studies relating to the treatment of open ankle fractures. Fifteen articles concerning 498 patients with treatment of an open ankle fracture were identified. The number of included patients varied from 11 to 64. There were 2 prospective and 13 retrospective studies. All articles were case series and classified as Level IV evidence. In 373 cases, open ankle fractures were treated by immediate internal fixation. In 125 cases, a conservative treatment or delayed/other fixation treatment was followed. Of those patients treated by immediate internal fixation, 81% had satisfactory result. Poor results (15%) were most commonly due to non-anatomic reductions, articular surface damage or deep infection. When conservative treatment was followed, 76% had satisfactory results. The most reported complications after immediate internal fixation were deep infection (8%) and skin necrosis (14%). There is a lack of high quality literature concerning the (operative) treatment of patients with open ankle fractures. Remarkable is that most authors reported satisfactory results after performance of their treatment protocol. Based on the available literature, we formulated guidelines regarding: timing of operative treatment, wound irrigation, the role of internal fixation, wound coverage and closure, the use of antibiotics and additional therapies.
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Affiliation(s)
- Caroline C. C. Hulsker
- Department of General Surgery, Academic Medical Centre, P.O. Box 22660, Amsterdam, DD 1100 The Netherlands
| | - Sanne Kleinveld
- Department of General Surgery, Academic Medical Centre, P.O. Box 22660, Amsterdam, DD 1100 The Netherlands
| | | | - Mike Hogervorst
- Department of General Surgery, Gelre Hospitals, Apeldoorn, The Netherlands
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13
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Rhemrev SJ, Beeres FJP, van Leerdam RH, Hogervorst M, Ring D. Clinical prediction rule for suspected scaphoid fractures: A prospective cohort study. Injury 2010; 41:1026-30. [PMID: 20510414 DOI: 10.1016/j.injury.2010.03.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/19/2010] [Accepted: 03/26/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND The low prevalence of true fractures amongst suspected fractures magnifies the shortcomings of the diagnostic tests used to triage suspected scaphoid fractures. PURPOSE The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a scaphoid fracture than others who lacked the subset criteria. METHODS Seventy-eight consecutive patients diagnosed with a suspected scaphoid fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination. RESULTS Analysis revealed three significant independent predictors: extension <50%, supination strength ≤ 10% and the presence of a previous fracture. CONCLUSION Clinical prediction rules have the potential to increase the prevalence of true fractures amongst patients with suspected scaphoid fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage.
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Affiliation(s)
- S J Rhemrev
- Department of Surgery, Medisch Centrum Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands
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Mehta AM, Muller SOL, Hogervorst M, van der Sijp JRM. Persisting pleural effusion caused by intrahepatic biloma after penetrating abdominal trauma. J Trauma 2008; 65:E49-E52. [PMID: 18277289 DOI: 10.1097/01.ta.0000215348.06012.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Akash M Mehta
- Department of Surgery, Medisch Centrum Haaglanden, Westeinde location, the Hague, The Netherlands
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15
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Buskens CJ, Gratama JWC, Hogervorst M, van Leeuwen RB, Rommes JH, Spronk PE. Encephalopathy and MRI abnormalities in fat embolism syndrome: a case report. Med Sci Monit 2008; 14:CS125-CS129. [PMID: 18971877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Fat embolization and fat embolism syndrome are poorly understood complications of skeletal trauma. Fat embolism syndrome is a clinical diagnosis, and patients typically present with a classic triad of petechial rash, pulmonary distress, and neurologic dysfunction. The incomplete form of the syndrome (i.e., cerebral fat embolism) is a more challenging clinical diagnosis in which brain magnetic resonance imaging may be a valuable tool. Fat embolism syndrome can be a life-threatening condition, but the latent form that occurs 24 to 72 hours after the trauma is frequently described as a self-limiting condition. CASE REPORT In this report, we present the case of a 32-year-old man with fat embolism syndrome and a prolonged coma with persistent cerebral dysfunction. Brain magnetic resonance imaging revealed multiple white and grey matter lesions suggestive of vasogenic edema and punctuate hemorrhage, consistent with a diagnosis of cerebral fat emboli. CONCLUSIONS The pathogenesis and treatment options of fat embolism syndrome are reviewed based on available literature, and the usefulness of brain magnetic resonance imaging is discussed.
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Beeres FJP, Rhemrev SJ, den Hollander P, Kingma LM, Meylaerts SAG, le Cessie S, Bartlema KA, Hamming JF, Hogervorst M. Early magnetic resonance imaging compared with bone scintigraphy in suspected scaphoid fractures. ACTA ACUST UNITED AC 2008; 90:1205-9. [PMID: 18757961 DOI: 10.1302/0301-620x.90b9.20341] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We evaluated 100 consecutive patients with a suspected scaphoid fracture but without evidence of a fracture on plain radiographs using MRI within 24 hours of injury, and bone scintigraphy three to five days after injury. The reference standard for a true radiologically-occult scaphoid fracture was either a diagnosis of fracture on both MRI and bone scintigraphy, or, in the case of discrepancy, clinical and/or radiological evidence of a fracture. MRI revealed 16 scaphoid and 24 other fractures. Bone scintigraphy showed 28 scaphoid and 40 other fractures. According to the reference standard there were 20 scaphoid fractures. MRI was falsely negative for scaphoid fracture in four patients and bone scintigraphy falsely positive in eight. MRI had a sensitivity of 80% and a specificity of 100%. Bone scintigraphy had a sensitivity of 100% and a specificity of 90%. This study did not confirm that early, short-sequence MRI was superior to bone scintigraphy for the diagnosis of a suspected scaphoid fracture. Bone scintigraphy remains a highly sensitive and reasonably specific investigation for the diagnosis of an occult scaphoid fracture.
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Affiliation(s)
- F J P Beeres
- Medical Centre Haaglanden, Postbus 432, 2501 CK The Hague, The Netherlands.
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Beeres FJP, Hogervorst M, Rhemrev SJ. Reply to letter to the Editor: Beeres FJP, Hogervorst M, Rhemrev SJ. A prospective comparison for suspected scaphoid fractures: Bone scintigraphy versus clinical outcome [Injury 2007;38(7):769-74]. Injury 2008; 39:815-6. [PMID: 18541245 DOI: 10.1016/j.injury.2007.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 12/06/2007] [Accepted: 12/12/2007] [Indexed: 02/02/2023]
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18
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van den Bekerom MPJ, Hogervorst M, Bolhuis HW, van Dijk CN. Operative aspects of the syndesmotic screw: review of current concepts. Injury 2008; 39:491-8. [PMID: 18316086 DOI: 10.1016/j.injury.2007.11.425] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 11/17/2007] [Indexed: 02/02/2023]
Abstract
The distal tibiofibular syndesmosis is important for stability of the ankle mortise and thus for weight transmission and walking. Syndesmotic injuries are most commonly associated with fibular fractures, but they can also occur in isolation or with damage to the lateral ankle ligament after traumatic supination. The need for trans-syndesmotic fixation of the distal tibiofibular joint has been controversial. The goal of this review was to collect evidence on the technical aspects of performing an osteosynthesis using a syndesmotic screw and to formulate some recommendations for clinical practice.
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Abstract
Syndesmotic ruptures associated with ankle fractures are most commonly caused by external rotation of the foot, eversion of the talus within the ankle mortise, and excessive dorsiflexion. The distal tibiofibular syndesmosis consists of the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and interosseous ligament, and it is essential for stability of the ankle mortise. Despite the numerous biomechanical and clinical studies pertaining to ankle fractures, there are no uniform recommendations regarding the use of the syndesmotic screw for specific injury patterns and fracture types. The objective of this review was to formulate recommendations for clinical practice related to the use of syndesmotic screw placement.
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Beeres FJP, Hogervorst M, Rhemrev SJ, den Hollander P, Jukema GN. A prospective comparison for suspected scaphoid fractures: bone scintigraphy versus clinical outcome. Injury 2007; 38:769-74. [PMID: 17307177 DOI: 10.1016/j.injury.2006.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 12/06/2006] [Accepted: 12/12/2006] [Indexed: 02/02/2023]
Abstract
UNLABELLED Early diagnosis and treatment of scaphoid fractures limits the number of delayed and non-unions. Bone scintigraphy proved to be a sensitive diagnostic tool for the detection of occult scaphoid fractures. However, the results have to be interpreted with care. OBJECTIVE To prospectively correlate the results of bone scintigraphy with clinical outcome. METHODS In a prospective study, we analysed 50 consecutive patients with signs of a scaphoid fracture at physical examination but no evidence of a scaphoid fracture on scaphoid radiographs. All patients had a protocolised follow up at fixed intervals. The clinical outcome was defined according to a standardised algorithm. MAIN RESULTS Bone scintigraphy revealed 32% (16/50) occult scaphoid fractures and 40% (20/50) occult other fractures. Clinical outcome proved that bone scintigraphy was false positive in five patients and in one case false negative for a scaphoid fracture. CONCLUSION Bone scintigraphy in combination with protocolised physical examination is the gold standard for patients with signs of a scaphoid fracture that cannot be proven on scaphoid radiographs.
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Affiliation(s)
- F J P Beeres
- Department of Surgery, Medisch Centrum Haaglanden, The Hague, The Netherlands.
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Sosef N, Stobbe I, Hogervorst M, Mommers L, Verbruggen J, van der Elst M, Rhemrev S. The Polarus intramedullary nail for proximal humeral fractures: outcome in 28 patients followed for 1 year. Acta Orthop 2007; 78:436-41. [PMID: 17611861 DOI: 10.1080/17453670710014040] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND One of the new treatment options for proximal humeral fractures is the minimally invasive intramedullary nail. In this study, we reviewed the early clinical results after 1 year. PATIENTS AND METHODS 35 patients with proximal humeral fractures were treated using the Polarus nail. In 14 cases the initial treatment was operative; the other 21 patients were initially treated nonoperatively. 19 patients had a 2-part fracture, 5 had a 3-part fracture and 2 had a 4-part fracture. In 9 patients the fracture extended metaphyseally. The functional outcome was assessed by the Constant score. RESULTS 28 patients were available for 1-year followup. 17 patients showed excellent functional outcome (with an average Constant score of 81%). 6 patients required revision surgery, 1 because of nonunion and 1 because of an avascular necrosis. 4 others were reoperated because of inadequate position of the osteosynthesis or migration of the screws. INTERPRETATION The Polarus nail is of value for (displaced) 2-, 3-, and even 4-part proximal humeral fractures and enables early postoperative mobilization with a limited amount of pain.
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Affiliation(s)
- Nico Sosef
- Department of Surgery and Traumatology, Medical Centre Haaglanden, the Hague
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Beeres FJP, Rhemrev SJ, Hogervorst M, den Hollander P, Jukema GN. [Scaphoid fractures: diagnosis and therapy]. Ned Tijdschr Geneeskd 2007; 151:742-7. [PMID: 17471775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
An adequate management of scaphoid fractures requires fast and reliable diagnosis. In this, proper history taking and physical examination are essential. Routine scaphoid x-rays miss over 20% of all scaphoid fractures. Therefore, in patients with a clinically suspected scaphoid fracture that cannot be proven by scaphoid x-rays, further diagnostic investigation is indicated. Which supplemental diagnostic tool (bone scintigraphy, MRI, CT) is preferred remains unclear. A below-the-elbow cast without immobilisation of the thumb is an adequate treatment for stable fractures. Unstable fractures and all proximal pole fractures are candidates for open or percutaneous treatment. In addition to the type of fracture, patient-specific requirements are important in deciding which type of management is the most suitable.
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Affiliation(s)
- F J P Beeres
- Leids Universitair Medisch Centrum, afd. Heelkunde, Leiden
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Sturms LM, Hoogeveen JM, Le Cessie S, Schenck PE, Pahlplatz PVM, Hogervorst M, Jukema GN. Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry. Langenbecks Arch Surg 2006; 391:343-9. [PMID: 16699803 DOI: 10.1007/s00423-006-0057-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 03/28/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Since 1999, the Dutch trauma care has been regionalized into ten trauma systems. This study is the first to review such a trauma system. The aim was to examine the sensitivity of prehospital triage criteria [triage revised trauma score (T-RTS)] in identifying major trauma patients and to evaluate the current level of trauma care of a regionalized Dutch trauma system for major trauma patients. PATIENTS AND METHODS Major trauma patients (n=511) (June 2001-December 2003) were selected from a regional trauma registry database. The prehospital T-RTS was computed and standardized W scores (Ws) were generated to compare observed vs expected survival based on contemporary US- and UK-norm databases. RESULTS The T-RTS showed low sensitivity for the prehospital identification of major trauma patients [34.1% (T-RTS< or =10)]. Nevertheless, 78.0% of all major trauma patients were directly managed by the trauma center. These patients were more severely injured than their counterparts at non-trauma-center hospitals (p<0.001). No significant difference emerged between the mortality rates of both groups. The Ws {-0.46 calculated on the US model [95% confidence interval (CI) ranging from -1.99 to 1.07]} [0.60 calculated on the UK model (95% CI ranging from -1.25 to 2.44)] did not differ significantly from zero. CONCLUSION The trauma center managed most of the major trauma patients in the trauma system but the triage criteria need to be reconsidered. The level of care of the regional trauma system was shown to measure up to US and UK benchmarks.
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Affiliation(s)
- Leontien M Sturms
- Trauma Center West-Netherlands, Section of Traumatology, Department of Surgery, K6-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Beeres FJP, Hogervorst M, den Hollander P, Rhemrev S. Outcome of routine bone scintigraphy in suspected scaphoid fractures. Injury 2005; 36:1233-6. [PMID: 15979624 DOI: 10.1016/j.injury.2005.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Revised: 02/04/2005] [Accepted: 02/07/2005] [Indexed: 02/02/2023]
Abstract
UNLABELLED Undisplaced scaphoid fractures are easily missed on conventional scaphoid radiographs, but these occult fractures may seriously impair hand function. Routine bone scintigraphy (BS) is often advocated if there are clinical signs of a scaphoid fracture without radiological evidence. However, the results require careful therapeutic management. OBJECTIVE To determine the diagnostic value of BS in daily practice for clinically suspected scaphoid fractures. METHODS We evaluated our protocol of routine BS in suspected scaphoid fractures. SUBJECTS In a retrospective study, we analysed 111 consecutive cases with signs of a scaphoid fracture on physical examination. Radiographs revealed 55 fractures, the remaining 56 patients all underwent BS. MAIN RESULTS On average, the BS was performed after 4 days. It showed a fracture in 38/56 of the patients. The distribution of fractures was: scaphoid bone 15, distal radius 11, other carpal bones 9 and metacarpal bones 3. CONCLUSION If there is a strong clinical suspicion of a scaphoid fracture, which cannot be confirmed by conventional radiology, BS is a valuable diagnostic tool.
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Affiliation(s)
- F J P Beeres
- Department of Traumatology, Medisch Centrum Haaglanden, The Hague, The Netherlands.
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Hermus JPS, Laan CA, Hogervorst M, Rhemrev SJ. Fixation of a Pipkin fracture with bio-absorbable screws. Case report and a review of the literature. Injury 2005; 36:458-61. [PMID: 15710167 DOI: 10.1016/j.injury.2004.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2004] [Indexed: 02/02/2023]
Affiliation(s)
- Joris P S Hermus
- Department of Trauma Surgery, Lijnbaan 322501 CK, The Hague, The Netherlands.
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Pronk WG, Hogervorst M, Kingma LM. [Diagnostic image (187) A teenager in shock three weeks after a gunshot injury. Bleeding from a delayed renal artery pseudoaneurysm]. Ned Tijdschr Geneeskd 2004; 148:883. [PMID: 15152390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 15-year-old boy was hospitalised because of injuries caused by a gunshot. After three weeks shock developed due to bleeding from a renal artery pseudoaneurysm.
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Affiliation(s)
- W G Pronk
- Afd. Kindergeneeskunde, Medisch Centrum Haaglanden, locatie Westeinde, Postbus 432, 2501 CK s-Gravenhage
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Abstract
OBJECTIVE Evaluation of the functional outcome after unstable pelvic ring fractures stabilized with internal fixation. METHODS Between January 1, 1990, and September 1, 1997, 37 patients were treated with internal fixation for unstable pelvic fracture. Demographic data, type of accident, Hospital Trauma Index-Injury Severity Score, and fracture type according to Tile classification were scored. One patient died the day after the accident from neurologic injury. A Short Form-36 health questionnaire and a form regarding functional result after pelvic trauma, adapted from Majeed et al., were returned by 31 of 36 patients (86%). Twenty-eight patients (78%) were seen for physical and radiologic examination. RESULTS Twenty-six men and 11 women, with an average age of 34.7 years (range, 15-66 years) were included. The mean Injury Severity Score reached 30.4 (range, 16-66). According to the Tile classification, there were 16 type B fractures and 21 type C fractures. Seven patients were treated with open reduction and internal fixation of the pubic arch, 10 patients were treated with a combination of anterior open reduction and internal fixation with additional external fixation to increase the stability of the posterior ring. Nineteen patients underwent internal fixation of both anterior and posterior arch. In the remaining case, percutaneous posterior screw fixation was combined with anterior external fixation, because of estimated infectious risk. The average follow-up time was 35.6 months. Patients scored 78.6 of 100 on the Majeed score. Remarkable was the reported change in sexual intercourse in 12 patients (40%). Only 12 patients (40%) did not have complaints when sitting. On the SF-36 scales physical and social functioning, role limitations due to physical problems and vitality were limited compared with the averages for the Dutch population. Patients treated with combined anterior and posterior internal fixation scored significantly better on both the Majeed score and on the categories physical functioning, pain, general health and social functioning compared with patients with similar fractures treated with a combination of anterior internal fixation with external fixation. At the physical examination, 11 of 28 patients (39%) did not have any abnormality. Nineteen patients (68%) were back at their original job, which was physically demanding in 9 cases. There was a suspicion of nonunion of the posterior arch in two patients, which could be confirmed with a computed tomographic scan. CONCLUSION In general, limitations in functioning are reported, even after long-term follow-up. In partially unstable fractures, solitary anterior fixation gives good results. In completely unstable fractures, patients treated with combined internal fixation anterior as well as posterior scored a better outcome compared with combined internal and external fixation. Therefore, this technique is recommended as treatment of first choice in completely unstable fractures.
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Affiliation(s)
- E W Van den Bosch
- Leiden University Medical Center, Department of Traumatology, Rotterdam, The Netherlands
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Bartlema KA, Hogervorst M, Akkersdijk GJ, Seelen J, Hoogland P, de Vries AC. Isolated abdominal aortic dissection in a patient with Turner's syndrome. Surgery 1995; 117:116-7. [PMID: 7809828 DOI: 10.1016/s0039-6060(05)80241-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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de Ridder VA, de Lange S, Kingma L, Hogervorst M. Results of 75 consecutive patients with an acetabular fracture. Clin Orthop Relat Res 1994:53-7. [PMID: 8050247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
From 1988 to 1991, 75 consecutive patients with an acetabular fracture were treated. Follow up was for a minimum of 2 years (average, 3 years; range, 2-5 years). Sixty five patients had a solitary acetabular fracture, and in 10 the acetabular fracture was associated with a pelvic fracture (52 men and 23 women; average age, 46 years; range, 17 to 99 years). Twenty four patients were treated nonoperatively (average age, 46 years; range, 12 to 99 years), and 51 underwent surgery (average age, 45 years; range, 17 to 92 years). The indications for surgery were: displacement of the fracture of > 2 mm; an intraarticular fragment interfering with joint movement; posterior instability of the joint with a luxating femoral head; insufficient roof arc; or to prepare the joint for total hip replacement. The patients were classified according to Letournel. Nonoperative treatment consisted of traction or nonweightbearing mobilization during an average period of 2 weeks. The surgical approaches used were: the Kocher-Langenbeck (22); the ilioinguinal (18); and the extended iliofemoral (4). More than 1 approach was used in 3 cases; external fixation was used in 4. All patients received prophylactic treatment of indomethacin. Six developed heterotopic ossification. Preoperatively, 6 patients had a paresis or paralysis from which 5 recovered. Pre- and postoperative nerve lesions occurred in 3 patients from which 2 recovered. One patient died perioperatively of pulmonary embolus. In 2 patients a collapse of the posterior wall resulted in a total hip replacement. The results were good to excellent according to the d'Aubigne scale in 76% of all patients.
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Affiliation(s)
- V A de Ridder
- Department of Traumatology, Westeinde Hospital, Den Haag, The Netherlands
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