Session 9: Trauma
16. November
13:30 - 15:00
Lokale: 01+02
Chair: Arvind Von Keudell and Katrine Borum
74. Team-based Digital Communication Reduces Patient-initiated Phone Calls to the Hospital After Discharge: Preliminary Results from a Randomized Clinical Trial
Lili Worre Høpfner Jensen1, Søren Kold1, Hans-Christen Husum1, Ole Rahbek1
Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg,
Denmark
Background: Digital communication solutions open up new
opportunities for asynchronous post-discharge
communication between patients and
healthcare professionals. Concerns have been
raised about an increased consumption of
resources when patients are provided with easy
digital access, e.g., that digital contact leads to
more phone calls or double contacts.
Aim: We aimed to investigate the effects of a GDPR-
safe team-based digital communication solution
between orthopaedic surgery patients and
healthcare professionals after hospital
discharge (eDialogue) on phone calls to the
hospital after discharge.
Materials and Methods: In a randomized clinical trial (n=70), we
compared the number of phone calls to the
hospital two months after discharge in patients
randomized to standard communication
pathways (n=35) or eDialogue (n=35). A
secondary outcome was patients’ perceptions of
continuity of care, measured by The Patient
Continuity of Care Questionnaire (PCCQ). The
intervention group was given access to
eDialogue and the control group used standard
communication pathways after discharge,
typically by phone. All patients answered weekly
questionnaires regarding phone calls to the
hospital. PCCQ was collected at baseline on the
day of discharge (27 items) and four weeks after
(14 items).
Results: Preliminary results four weeks after discharge
shows that the intervention group had
significantly less phone calls to the hospital than
the control group (8 vs 50, p<0.05). The
proportion of patients who called the hospital
after discharge was 14% in the intervention
group versus 46% in the control group (p<0.05).
Patients in both groups reported similar
perceptions of continuity of care at baseline and
four weeks after discharge.
Interpretation / Conclusion: The study demonstrates that providing patients
access to eDialogue can significantly reduce the
number of phone calls to hospitals after
discharge, while patients’ perception of
continuity of care remains the same.
75. THE KNEE INJURY AND OSTEOARTHRITIS OUTCOME SCORE (KOOS) FOR TIBIAL SHAFT FRACTURES
Rasmus Stokholm1, Peter Larsen 1,2, Juozas Petruskevicius3, Jan D. Rölfing3, Morten K. Rasmussen4, Steffen S. Jensen4, Rasmus Elsøe1
1. Department of Orthopaedic Surgery, Aalborg University Hospital;
2. Department of Occupational Therapy and Physiotherapy, Aalborg
University Hospital;
3. Department of Orthopaedic Surgery, Aarhus University Hospital;
4. Department og Orthopaedic Surgery, Viborg Hospital
Background: In recent years patient-reported outcome
measures (PROMs) have become
prominent when evaluating the effect of
treatment and patient satisfaction following
orthopaedic disorders. Several generic and
body region-specific PROMs have been
used to assess patients with tibial shaft
fractures. However, evidence is lacking in
psychometric properties such as validity,
reliability, responsiveness, and minimal
clinically important difference when
assessing patients with a tibial shaft fracture
Aim: To establish validity, reliability and
responsiveness and to estimate the minimal
clinically important difference (MICD) for
each of the five KOOS subscales in patients
with closed tibial shaft fractures.
Materials and Methods: This study is a multicentered prospective
clinical trial including consecutive patients
with closed tibial shaft fractures (AO 42-).
Primary outcome measurement was the
KOOS subscales pain, symptoms, ADL,
sport and recreational activities (sport/rec)
and QOL. Follow-up was repeated at 14
days, 6 weeks, and 3, 6 and 12 months
postoperatively. Content validity was
evaluated by patients ranking relevance of
all the items in the KOOS questionnaíre,
test-retest reliability by interclass correlation
coefficient, responsiveness by effect size
end estimation of minimal clinical important
difference (MCID) by the anchor-base
method.
Results: A total of 35 patients were included in the
study. Mean age of patients was 46.2 with a
range from 20 to 72. Female sex represents
11 of the 35 patients. Results indicated an
acceptable content validity of all the KOOS
subscales. The test-retest reliability was
high for all the five subscales, with ICCs
ranging 0.8-0.9. At follow-up 6- and 12-
months responsiveness shows moderate to
large effect sizes for the subscales pain,
ADL, symptoms, and sport/rec, ranging 0.5-
1.2. The MCID of the KOOS subscales
were: pain 5.2, symptoms 7.1, ADL 2.7,
sport/rec 8.8 and QOL 8.8.
Interpretation / Conclusion: The KOOS appears to be a valid and useful
questionnaire to capture patient perceived
outcome within one year follow a closed
tibial shaft fracture in adults. The
questionnaire showed high content validity,
high reliability, and acceptable
responsiveness.
76. ESTABLISHING CONSTRUCT VALIDITY OF A NOVEL SIMULATOR FOR GUIDE WIRE NAVIGATION IN ANTEGRADE FEMORAL INTRAMEDULLARY NAILING
Jan Duedal Rölfing1,2, Lisa Beicker Salling1, Steven Long3, Bjoern Vogt4, Donald D. Anderson3,5,6, Geb W. Thomas3,6, Rune Dall Jensen1
1. Corporate HR, MidtSim,Aarhus, Denmark;
2. Department of Orthopaedics, Aarhus University Hospital;
3. Department of Orthopedics and Rehabilitation, University of Iowa
Hospitals and Clinics;
4. Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery,
Muenster University Hospital;
5. Department of Biomedical Engineering, University of Iowa;
6. Department of Industrial and Systems Engineering, University of
Iowa.
Background: Antegrade femoral intramedullary
nailing (IMN) is a common orthopedic procedure
that residents are exposed to early in their training.
A key component to this procedure is placing
the initial guide wire with fluoroscopic guidance.
A simulator was developed to train residents on
this key skill, building off an existing simulation
platform originally developed for wire navigation
during a compression hip screw placement.
Aim: The objective of this study was to assess the
construct validity of the IMN simulator.
Materials and Methods: Thirty orthopedic surgeons participated
in the study: 12 had participated in fewer than
10 hip fracture or IMN related procedures and
were categorized as novices; 18 were faculty,
categorized
as experts. Both cohorts were instructed
on the goal of the task, placing a guide wire for
an IM nail, and the ideal wire position reference
that their wire placement would be graded against.
Participants completed 2 assessments with the
simulator. Performance was graded on the distance
from the ideal starting point, distance from the
ideal end point, wire trajectory, duration, fluoroscopy
image count, and other elements of surgical
decision making. A two-way ANOVA analysis was
used to analyze the data looking at experience level
and trial number.
Results: The expert cohort performed significantly
better than the novice cohort on all metrics
but one (overuse of fluoroscopy). The expert cohort
had a more accurate starting point and completed
the task while using fewer images and less overall
time.
Interpretation / Conclusion: This initial study shows that the
IMN application of a wire navigation simulator
demonstrates good construct validity. With such
a large cohort of expert participants, we can be
confident that this study captures the performance
of active surgeons today. Implementing a training
curriculum on this simulator has the potential
to increase the performance of the novice level
residents prior to their operating on a vulnerable
patient.
77. Using smartphones for remote monitoring of orthopaedic patients' physical activities during the perioperative period
Arash Ghaffari1, Rikke Emilie Kildahl Lauritsen1, Michael Christensen2, Trine Rolighed Thomsen3, 4, Harshit Mahapatra2, Robert Heck4, Søren Kold1, Ole Rahbek1
1. Interdisciplinary Orthopaedics, Aalborg University Hospital;
2. Alexandra Institute, Aarhus N, Denmark;
3. Department of Chemistry and Bioscience, Aalborg University;
4. The Danish Technological Institute, Aarhus C, Denmark.
Background: Smartphones are often equipped with inertial
sensors capable of measuring individuals'
physical activities. Their role in monitoring the
patients' physical activities in telemedicine,
however, needs to be explored.
Aim: The main objective of this study was to explore
the correlation between a participant's daily step
counts and the daily step counts reported by their
smartphone.
Materials and Methods: This prospective observational study was
conducted on patients undergoing lower limb
orthopedic surgery and a group of non-
patients. The data collection period was from
2 weeks before until four weeks after the
surgery for the patients and two weeks for the
non-patients. The participants’ daily steps
were recorded by physical activity trackers
employed 24/7, and an application recorded
the number of daily steps registered by the
participants' smartphones. We compared the
cross-correlation between the daily steps
time-series taken from the smartphones and
physical activity trackers in different groups of
participants. We also employed mixed
modeling to estimate the total number of
steps.
Results: Overall, 1067 days of data were collected from
21 patients (11 females) and 10 non-patients (6
females). The cross-correlation coefficient
between the smartphone and physical activity
tracker was 0.70 [0.53–0.83]. The correlation in
the non-patients was slightly higher than in the
patients (0.74 [0.60–0.90] and 0.69 [0.52–0.81],
respectively).
Interpretation / Conclusion: Considering the ubiquity, convenience, and
practicality of smartphones, the high correlation
between the smartphones and the total daily step
time-series highlights the potential usefulness of
smartphones in detecting the change in the step
counts in remote monitoring of the patient's
physical activity.
78. Trends in Non-Operative Management of Low-Impact Pelvic Fracture Using the Nationwide Inpatient Sample from 2011 to 2018
Alexander Farid1, Stephen Stearns1, Joseph Atarere1, Nishant Suneja1, Michael Weaver1, Arvind Von Keudell1, 2
1Department of Orthopaedic Surgery, Brigham and Women’s Hospital,
Harvard Medical School, Boston, MA, USA.
2Department of Orthopaedic Trauma, Bispebjerghospitalet, University of
Copenhagen, 2400 Copenhagen, Denmark.
Background: Nonoperative treatment remains the more
common treatment modality for low-impact
pelvic fractures.
Aim: In this study, we aim to better characterize
the epidemiology of the population treated
nonoperatively following low-energy pelvic
fracture, while identifying recent trends in
management of these patients.
Materials and Methods: We evaluated data from the Nationwide
Inpatient Sample database, the largest
inpatient care database in the United
States, from 2011 to 2018. We selected for
all adult patients with ICD-9 or -10 codes for
pelvic fracture, excluding acetabular
fracture, femoral fracture, and polytrauma to
better isolate low-impact mechanisms. We
then excluded operative patients. We
collected data on baseline demographics
and outcomes (length of stay, in-hospital
mortality, hospital disposition) and assessed
for change over time.
Results: 123,936 patients underwent nonoperative
management of pelvic fracture. Mean age
was 68.7. 70% were female, decreasing
from 75% to 66% during our time frame.
59% of fractures featured pubic bone
involvement. Average CCI was 3.83 with a
stable trend. 62.4% of patients received
care at an urban teaching hospital. Mean
length of stay was 6.3 days. 62.8% of
patients were discharged to a skilled
nursing facility (SNF) (62.1-65.0%), while
2.0% (18.4-21.1%) were discharged home.
Mean in-hospital mortality was 3.28%,
stable over time, with increased mortality
among men (5.1%, versus 2.5% among
women) and those of Asian descent (3.8%).
Interpretation / Conclusion: Demographic trends have remained
relatively stable, indicating the majority of
patients being treated nonoperatively
following low-impact pelvic fracture are
female, in their mid-60s, with relatively low
comorbidity. There was a relatively high rate
of in-hospital mortality at 3.28%, particularly
with male patients and patients of Asian
descent, suggesting the need for higher
surveillance for additional injury in patients
with these characteristics. Patients were
more often discharged to a SNF rather than
home, indicating necessity for prolonged
rehabilitation in this patient population. This
persistent trend is notable in the setting of
increasing consideration of cost of inpatient
admissions and improvement in outpatient
management of orthopedic injuries.
79. Etiologies of non-traumatic extremity compartment syndrome: A multi-center retrospective review
Richard Smith1,2, Dafang Zhang1, Michael Weaver1, Arvind Von Keudell1,3
1. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical
School, Boston, MA, USA
2. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, USA
3. Bispebjerg Hospital, Department of Orthopaedic surgery, University of Copenhagen,
Copenhagen, Denmark
Background: Compartment syndrome is a disorder of increased
intracompartmental pressure leading to decreased
perfusion and tissue necrosis. Compartment
syndrome often develops because of trauma. While
less common, non-traumatic causes also exist.
Etiologies of non-traumatic extremity compartment
syndrome (NTECS) are often insidious and can
occur when patients have altered levels of
consciousness. Therefore, a high index of suspicion
should be maintained.
Aim: The aim of this study is to determine the different
etiologies of NTECS, understand the demographics
of NTECS patients, and establish their rate of in-
hospital mortality.
Materials and Methods: This is a retrospective cohort study of all patients
diagnosed with NTECS at two level 1 trauma
centers between January 2006-December 2019.
Data related to the etiology of NTECS, patient
demographics, and in-hospital mortality were
collected from electronic medical records.
Results: Six hundred and four patients were included in this
study with an average age of 54.6±9.0 years. The
causes of NTECS for each patient was broadly
categorized into one of seven etiologies. These
included 243 hypercoagulable states, 132 found-
down secondary to substance use, 64 perioperative
positioning, 60 shock, 60 hypocoagulable states, 29
infection, and 16 IV infiltration. The IV infiltration
etiology of NTECS had the highest percentage of
female patients (50%) whereas the etiology of found
down secondary to substance use had the highest
percentage of male patients (71%). In-hospital
mortality was highest in patients who developed
NTECS due to hypercoagulable states (36%), shock
(33%), and hypocoaguable states (25%). The
average in hospital-mortality for all NTECS
etiologies was 22%.
Interpretation / Conclusion: Many etiologies of NTECS exist. The etiologies are
often insidious and associated with high rates of
mortality. On average, more than 1 in 5 patients who
develop NTECS will die during their hospitalization.
Raising awareness, in addition to future research
efforts, are necessary to improve clinical outcomes
for these patients.
80. Risk of re-operation after treatment of distal femoral fractures with locking plates. A retrospective single-center cohort study
Adalet Corap1, Fatma Kandela1, Yasemin Corap1, Bjarke Viberg1, Michael Brix1, Martin Lindberg-Larsen1
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark
Background: The incidence of distal femoral fractures and periprosthetic distal femoral fractures seems to be increasing, especially after the age of 60 years. There is currently no treatment algorithm regarding native and periprosthetic distal femoral fractures, however many cases are treated with internal fixation such as a locked compression plating (LCP). The risk of reoperation in hip fractures treated with internal fixation has been reported to be 21% within 1 year postoperatively
Aim: The aim of this study is to report the reoperation rate after treatment of distal femoral fractures with locked compression plating
Materials and Methods: We retrospectively identified 263 patients by procedure codes (KNFJ64, KNFJ65, KNFJ84, KNFJ85) and diagnosis codes (DS723, DS724, DS728, DS729) in a single institution from 2011 to 2022. Indications for surgery were native distal femoral fracture(n=117) and periprosthetic femoral fractures(n=45). A reoperation was defined as an amputation, new or re-osteosynthesis, primary or revision knee arthroplasty, or soft tissue revision within 1 year after native treatment. A major reoperation was defined as an amputation or a knee arthroplasty
Results: Out of the 162 eligible patients, 125 (77%) were female. The study population had a mean age of 74.8 years (SD 16.4). Overall, 37(23%) patients underwent reoperation within the follow-up period, 30 (18%) patients underwent reoperation within 1 year after surgery, 35 (21%) within 2 years, and all 37 patients underwent a reoperation within 5 years (23%). Causes of reoperation were infection(n=13), non-or malunion (n=5), pain (n=7), periprosthetic fracture(n=3), mechanical failure (n=3) or other (n=6). Only 6 patients underwent a major reoperation. 3 patients underwent more than 1 reoperation
Interpretation / Conclusion: The overall reoperation rate was 22.8% and the 1year reoperation rate were 18.5% % after treatment of distal femoral fractures with LCP. The overall reoperation rate was similar to the overall reoperation rate of 21% reported after operative management of hip fractures 1 year postoperatively hence, further analysis of causes of reoperations and risk factors are needed, and the treatment of distal femoral fractures with LCP should be monitored closely
81. Risk of complications and the influence on patient-reported outcome following patella fractures
Marie Arildsen1,2, Peter Larsen1,2, Kasper Kristensen1,2, Kristian Damgaard Lyng1,3, Rasmus Elsøe1,2
1. Department of Orthopaedics, Aalborg University Hospital
2. Interdisciplinary Orthopaedics, Aalborg University Hospital
Background: Although a high rate of both early and late
complications following surgical treatment of patella
fractures is common, current literature lacks large-
scale clinical studies investigating the incidence of
complications. The impact of early and late
complications on patient-reported outcomes also
lacks evidence.
Aim: The present study aimed to investigate the incidence
of early and late complications following surgical
treatment of patella fractures.
Secondary aims were to investigate the association
between early and late complications and the
patient-reported outcome.
Materials and Methods: Cross-sectional study including all patients recorded
with a patella fracture residing in the Northern
Region of Denmark between 2010 and 2020. Early
(before three months) and late complications were
investigated by retrospective review of charts and x-
rays. All patients were invited to participate in the
study by reporting current knee-specific symptoms
using the Knee Injury and Osteoarthritis outcome
score (KOOS).
Results: 798 patients were included in the study. A total of
532 (67%) patients were treated conservatively,
and 266 (33%) patients underwent surgery. The
mean age at the time of fracture was 66.8,
ranging from 6–103 years of age. The mean
follow-up time was 6.4 years, ranging from 1.1–
12.3 years follow-up. Overall, the rate of
complications was 26%. Overall, the rate of
complication for the surgical group was 57%.
The most common early complication was the
loss of reduction followed by the removal of
symptomatic hardware. The most common late
complication was the removal of symptomatic
hardware and knee arthroscopy. In all the five
KOOS subscales (Pain, Symptoms, ADL, sport,
and QOL), patients presenting with early and late
complications reported statistically significantly
worse scores than those without complications.
Interpretation / Conclusion: The overall incidence of complications in patients
presenting with a patella fracture was 26%, with a
mean follow-up time of 6.4 years. In the surgical
group, 57% of patients experience at least one
complication during the follow-up period. Early and
late complications were significantly associated with
worse patient-reported KOOS outcome scores.
82. Individual comorbid diseases as predictors of infection after surgery for hip fracture: a population-based cohort study among 87,593 patients
Nadia R. Gadgaard1, Claus Varnum2,3, Rob Nelissen4, Christina Vandenbroucke-Grauls1,5, Henrik T. Sørensen1, Alma B. Pedersen1
1. Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University,
Denmark;
2. Department of Orthopedic Surgery, Lillebaelt Hospital – Vejle, Denmark;
3. Department of Regional Health Research, University of Southern Denmark, Denmark;
4. Department of Orthopedics, Leiden University Medical Center, The Netherlands;
5. Department of Medical Microbiology and Infection Control, Amsterdam University
Medical Center, Amsterdam, The Netherlands;
Background: Comorbidity level is strongly associated with risk of
infection up to one year after hip fracture surgery.
However, the impact of individual comorbidities as
predictors of infection in patients with hip fracture is
poorly understood.
Aim: We aimed to investigate individual comorbidities as
predictors of infection among hip fracture patients.
Materials and Methods: Utilizing Danish population-based medical
registries we obtained data on patients
undergoing hip fracture surgery (2004-2017).
Information on 27 comorbidities with prevalence
of =1% was obtained 5 years prior to surgery.
The main outcome was any hospital-treated
infection within the first postoperative year and
secondary outcomes were hospital-treated
pneumonia and urinary tract infection (UTI).
Cumulative incidence of infection was calculated
considering death a competing risk. We used
logistic regression to compute crude odds ratios
(OR) with 95% confidence interval for infection.
Results: Of 87,593 hip fracture patients, 71% were female
and the median age was 83 years. Most
prevalent comorbidities were hypertension
(23%), heart arrhythmia (15%), and
cerebrovascular disease (14%).
Among patients without any comorbidity, one-
year incidence of any infection was 21%.
Incidences of any infection were highest among
patients with renal disease (43%), chronic
pulmonary disease (43%), and hypotension
(41%), and lowest for patients with dementia
(28%), solid tumor (30%), and cerebrovascular
disease (34%). ORs of any infection varied
between 1.1 (1.0-1.1) for dementia and 2.1 (2.0-
2.2) for chronic pulmonary disease.
Highest ORs for pneumonia was 2.9 (95% CI:
2.7-3.0) for chronic pulmonary disease, 1.9 (95%
CI: 1.7-2.2) for pulmonary circulation disorders,
and 1.9 (95% CI: 1.6-2.1) for hypotension.
Highest ORs for UTI was 1.8 (95% CI: 1.6-2.1)
for hypotension, 1.6 (95% CI: 1.5-1.8) for
depressions/anxiety, and 1.5 (95% CI: 1.4-1.7)
for complicated diabetes.
Interpretation / Conclusion: Most comorbidities were predictors of infection
among hip fracture patients. Doctors should be
aware of the risk of infection, particularly in patients
with renal disease, chronic pulmonary disease, or
hypotension given the high incidence of infection in
these patients.
83. KKR 2023: Treatment of displaced unstable ankle fractures in patients above 70 years of age–fibular nail or ORIF?
Rasmus Elsøe1, Morten Schultz Larsen2, Rasmus Jørgensen3, Lasse Bayer4, Simone Dalskov5
1. Ortopædkirurgisk afdeling, Aalborg Universitets Hospital;
2. Ortopædkirurgisk afdeling, Odense Universitets Hospital;
3. Ortopædkirurgisk afdeling, Aarhus Universitets Hospital;
4. Ortopædkirurgisk afdeling, Nordsjællands Hospital, Hillerød;
5. Ortopædkirurgisk afdeling, Aalborg Universitets Hospital
Background:Ankle fractures can be treated by ORIF or minimal invasive fibular nail.
Aim:This KKR was conducted to evaluate if unstable ankle fractures in patients above 70 years of age should be treated with fibular nail or ORIF.
Materials and Methods:
Results:The evidence level was low and showed comparable results regarding functional outcome between the two treatment modalities and conflicting evidence regarding complications
Interpretation / Conclusion:Hence, no recommendations regarding treatment of unstableankle fractures in patients above 70 years with regards to treatment with fibula nails or ORIF canbe made