Validation of Navigation Ultrasound for Clavicular Length Measurement

Accurate clavicular length measurement is considered important for the selection of patients requiring surgical treatment after a midclavicular fracture. As radiographic length measurements can be inaccurate to varying degrees, new measurement methods are needed. Use of novel technology, navigation ultrasound, to deliver accurate measurements seems promising. To examine the reliability and validity of navigation ultrasound for length measurements of the clavicle, a study was performed using length measurements performed before forensic autopsies from 2012 to 2013. In total, 38 bodies with a median age of 52.5 (range: 21-78 y) were included. Navigation ultrasound exhibited high reliability (intra-class correlation coefficient: 0.942-0.997, standard error of the mean: 0.7-2.9 mm, minimal detectable change: 2.3-8.1 mm) and validity (measurement error: 1.3%-1.8%, limits of agreement (95% confidence interval): approximately ± 7.5 mm, Pearson's correlation R: 0.948-0.974). Navigation ultrasound can measure clavicular length with an intra-rater reliability matching that of 3-D rendered computed tomography scans and with high validity. Its use could spread to other fields requiring accurate musculoskeletal length measurements.

A retrospective study of acute kidney injury in hip arthroplasty patients receiving gentamicin and dicloxacillin

Background and purpose - Acute kidney injury is a known complication of antibiotic use. Antibiotic prophylaxis is essential to prevent periprosthetic infections after total hip replacement. We experienced a rise in the incidence of acute kidney injury (AKI), and in an effort to solve this problem, we changed our antibiotic prophylaxis protocol. We investigated whether removing gentamicin from our antibiotic protocol would cause fewer and less severe cases of renal impairment. Patients and methods - We performed a retrospective study involving 136 cases of total hip replacement, with 66 patients receiving dicloxacillin and gentamicin and 70 patients receiving dicloxacillin alone. Results - We found less cases of AKI in the dicloxacillin group (p = 0.03): the mean creatine level in the dicloxacillin/gentamicin group was 126 (25-422) μmol/L whereas it was 93 (39-278) μmol/L in the group that received dicloxacillin alone. We also found that cases were less severe in the dicloxacillin group than in the dicloxacillin/gentamicin group (p = 0.02). The relative risk of developing AKI was 3 times higher if dicloxacillin and gentamicin were both used (p = 0.02). Interpretation - After removing gentamicin, there were fewer and less severe cases of acute kidney injury.

[The significance of appearance in physician-nurse collaboration]

INTRODUCTION

According to nurses' assessment, physician-nurse collaboration is problematic. The aim of the study was to investigate whether nurses believe physicians' appearances is significant for their ability to collaborate.

MATERIAL AND METHODS

This is a single-blinded, quasi-experimental intervention study. All physicians included will undergo a total plastic surgical body makeover. Half of the included physicians are to be operated with a view to enhance their physical features, half to weaken their physical features. Multifactorial ANOVA analysis will be used to secure the division. The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration will be used for baseline and follow-up study of the nurses' assessment.

RESULTS

Due to ethical considerations, researchers had difficulties finding surgeons prepared to perform procedures aiming at weakening the physicians' physical features. Furthermore, it proved difficult to find physicians willing to undergo surgery with a view to weaken their physical features. Consequently, the study was never realized. Additionally, the study experienced difficulties raising the funding needed to cover surgery costs for all included physicians.

CONCLUSION

We conclude that physicians often have difficulties collaborating with nurses, regardless of their appearance. It seems that physicians are not interested in improving the collaboration with nurses, and further studies are therefore needed to improve physician-nurse collaboration. We recommend in-depth interviews to achieve harmonic interaction leading to a prolific and close future collaboration.

Pesticide-induced surface migration by lumbricid earthworms in grassland: life-stage and species differences

Pesticide-induced changes in surface migration by earthworms in grassland were investigated using trapping and the fungicide benomyl. Traps were tended daily for 15 days after spraying, resulting in 2152 earthworms, five species, and juvenile predominance which reflected species/life-stage composition in the soil. Significant increases in migration (all worms) occurred already by day 2 due to spraying, final treatment level being 2.8 x control. Life-stage composition indicated an increased juvenile proportion from 55% to 75% due to treatment. Spraying caused surfacing juveniles to increase significantly by day 2, reaching a final level 3.8 x control, whereas for mature worms a significant increase did not occur until day 4. Species rank-order was Aporrectodea longa>A. rosea>Lumbricus terrestris>A. caliginosa in control areas, but A. longa>L. terrestris>A. rosea>A. caliginosa in sprayed areas; spraying altered the rank-order such that the anecic A. longa and L. terrestris dominated, jointly increasing from 59% to 78%. At species level, L. terrestris and A. longa exhibited significant increases of 4.6 x and 3.6 x in final migration levels in treated areas, the endogeic A. rosea and A. caliginosa having trends for increase. Species-specific differences for reaction time occurred, with significantly elevated migration already by day 1 for L. terrestris, and day 2 for A. longa and A. caliginosa. For each species, juveniles consistently showed greater increases than mature worms due to spraying, significantly so for juvenile L. terrestris, A. longa, and A. caliginosa, the two anecics reaching as high as 5.3 x and 4.7 x. The response of mature worms differed: A. longa and A. rosea increased surfacing due to treatment, L. terrestris showed a delayed reaction, whereas A. caliginosa exhibited suppressed migration. Results are discussed relative to behavior, ecological category, and risk of toxic exposure.

Occupational therapy and Colles' fractures

In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups at any time. It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary.

Plaster cast compared with bridging external fixation for distal radius fractures of the Colles' type

We compared two different treatments for displaced distal radius Colles' type fractures (Older type 3 and 4), at two hospitals. We found bridging external fixation superior to reduction and fixation in a dorsal plaster cast regarding both the end-anatomic results at 3 months and the functional scores at 3 and 9 months (modified Gartland and Werley).

Diagnosis of scaphoid fracture and dedicated extremity MRI

We evaluated the value of dedicated extremity magnetic resonance imaging (E-MRI) in patients with clinical suspicion of a scaphoid fracture and normal initial radiographs. 52 patients underwent E-MRI within a mean of 4 (2-10) days after trauma. Follow-up radiographs were performed at average 11 (8-14) weeks after trauma, and these images were used as the "gold standard". A T1-weighted turbo gradient echo 3D and a tau short inversion recovery STIR were performed, both in coronal planes. The imaging time was less than 10 min. The images were evaluated independently by two radiologists. E-MRI detected occult fractures of the scaphoid in 9 patients, and of the distal radius in a further 6 patients. All these fractures were confirmed at follow-up radiographs. Furthermore, E-MRI revealed a fracture of the capitate bone in 1 patient, and of the triquetrum in 2 patients, and in 8 patients, bone bruise in 1 or more of the carpal bones. However, these fractures and bone lesions could not be confirmed by the follow-up radiographs. The agreement between the two examiners was high (kappa = 0.8) for E-MRI detection of fractures. E-MRI seems to be better than radiographs in the early diagnosis of occult fractures of the scaphoid bone and the wrist.

Are hard-copy prints from peroperative fluoroscopy images useful as documentation?

We have examined the applicability of peroperative image documentation, in promoting early mobilization after osteosynthesis and saving the standard X-ray examination. One hundred and twenty-three patients with proximal femoral fractures were included in the investigation. Hard-copy reprints were recorded from peroperative fluoroscopy images by Fuji Film Thermal Imaging System FTI 200. These reprints were compared with the standard X-rays to assess the quality of the osteosynthesis and possible restriction in mobilization. The specificity of finding an unstable osteosynthesis was 0.40, whereas the sensitivity of finding a stable osteosynthesis was 0.96. In all, four unstable osteosyntheses were overlooked on the hard copy reprints. The specificity of finding patients in need of restricted mobilization was 0.44 and the sensitivity of finding patients allowed free mobilization was 0.93. Eight patients needing restricted mobilization were overlooked on the reprints. Hard-copy images do not safely reveal unstable osteosynthesis and cannot replace the standard X-rays taken postoperatively.

Length of immobilisation after fractures of the distal radius

Thirty-three patients with undisplaced fractures of the distal radius were included in a clinical controlled trial with the purpose of evaluating whether it was safe to reduce the time of immobilisation in a plaster splint from 5 to 3 weeks. We did not find any difference in radiological healing at 3 months or in the functional scores after 3 and 9 months.

Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb

The results after operations for rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb are reported to be good. Few authors describe the measurements used to assess the postoperative function of the thumb. We review the results of 15 patients, who underwent surgery between 1982 and 1987. We found that the number of patients satisfied with the operation was consistent with that reported in the literature. On the other hand, we found poor agreement between the subjective complaints and the objective findings. We therefore propose and describe a scoring system to assess subjective impressions of the result and the objective findings. Surgical procedures are not discussed. However, the duration of immobilization of the thumb should, perhaps, be reconsidered. Further studies may show that a shorter period of immobilization in plaster, the use of dynamic bandaging, or early starting of physiotherapy produce better results.

Diagnostic value of ultrasound in scaphoid fractures

Diagnostic ultrasound was used in 103 patients with a clinically suspected fracture of the scaphoid bone in order to achieve an early diagnosis. There were 48 women and 55 men aged 10-75 years (mean 31.4 years) tested with ultrasound. Of the patients, 72 were tested within 3 days after injury the remainder between 4 and 42 days. Fracture was confirmed radiologically in 27. We found that the ultrasound test, applied with a frequency of 1 MHz and intensity of 0.5 W/cm2 and 2.0 W/cm2 for 30s, had a sensitivity of 37 per cent and a specificity of 61 per cent. We thus conclude that ultrasound is not suitable for early diagnosis of scaphoid fracture.

[Information to women applying for sterilization]

On the basis of a questionnaire investigation among the general practitioners in the County of Frederiksborg, the authors have compared the information given to women applying for sterilization with information in the available literature about the nature of the intervention, its sequelae and the risks involved. The authors found that under half of the practitioners gave informations about disturbances of menstruation, dyspareunia and altered sexual life. In the literature, it is stated that these occur in 10-60%, 3-11% and 4-48% of the women. Less than one third of the practitioners gave information about the risk of perforation of an organ or vessels, tearing of the ovarian tubes and postoperative pain. In the literature, it is stated that these occur in 0.1-2.5%, 0.28-9% and 24% of the women depending on the operative method used. The authors recommend revision of our knowledge on these subjects and alterations in the written information provided.

[Unwanted pregnancy after removal of the IUD]

Four cases of unwanted pregnancy occurring in the same cycle as removal of an IUD are presented. The duration of ovum transport from the Fallopian tube into the uterine cavity, survival of spermatozoa in the female genital tract and timing of ovulation, which may be delayed in women with IUDs are variables which influence the probability of pregnancy and should be taken into consideration when removing an IUD. Unless pregnancy is desired, it is recommended when possible not to remove an IUD after the ninth day of the menstrual cycle unless another contraceptive method has been initiated.