Whereas operative treatment of the distal radius fracture in adults has gained much attention, th... more Whereas operative treatment of the distal radius fracture in adults has gained much attention, there are only a few reports on the associated fracture of the distal ulna head or neck. Little guidance on how to manage these fractures exists. This can result in inadequate treatment and contribute to less favorable results. Understanding the effect of the two-bone fracture on the stability of the forearm complex is important in proper management of these fractures. The length, alignment, and rotation have to be reestablished and maintained. By providing stable fixation of these fractures, function may be preserved and late complications minimized. During the last decade, an improved management of these challenging distal forearm fractures has followed with the introduction of locking plate technology.
Abstract Objective Hand surgery makes up a large proportion of procedures, ranging from simple to... more Abstract Objective Hand surgery makes up a large proportion of procedures, ranging from simple to complex. Increased complexity places greater demand on hand surgery competence. Furthermore, when surgical expertise is not matched to the procedure complexity, treatment injuries might occur. The purpose of this study was to assess patient-reported claims submitted to The Norwegian System of Patient Injury Compensation (NPE). Methods We examined all hand surgery claims submitted to NPE between 1 January 2007 and 30 June 2017. NPE records patient demography and variables, such as diagnosis, type of injury, injury location, the reason for the compensation claim, and whether a claim was accepted or rejected. Results NPE received 1321 claims related to treatment injuries from hand surgery at a steady rate throughout the study period. A total of 532 claims were accepted (40.3%). The approval rate for trauma cases was significantly higher than for elective cases (45.5 vs. 34.2%, p < .05). The most common diagnoses were hand fractures, dislocations and ligament injuries, carpal tunnel syndrome and arthrosis of the first carpometacarpal joint. Tendon injuries had the highest percentage of accepted claims (52.6%). The most common reason for claims being accepted was ‘failure of treatment’. 19.7% of these involved a disability percentage >15%. Elective surgery accounted for ⅔ of the approved disability cases. Conclusions/interpretation This is the first national study of patient-reported injuries after hand surgery treatment in Norway. The proportion of accepted claims is similar to that seen for orthopaedics. Acceptance levels were, however, higher for hand trauma cases than for disorders treated electively. Abbreviations NPE: Norwegian system of patient injury compensation; SD: standard deviation; CT: computed tomography; MRI: magnetic resonance imaging; UiT: University of Tromsø – Arctic University of Norway.
I Norge er håndleddsbrudd (distale radiusfrakturer) den vanligste bruddtypen, med en forekomst på... more I Norge er håndleddsbrudd (distale radiusfrakturer) den vanligste bruddtypen, med en forekomst på ca. 15000 per år. Ved brudd med ingen eller lite feilstilling er det vanlig å behandle med gips. Ved brudd med feilstilling er det aktuelt med mer avanserte teknikker. Det er imidlertid uklart hvilke pasienter som bør opereres og hvem som bør få annen behandling, samt hvilke operasjons-metoder som har best effekt. Videre er det uklart hva som er de(n) optimale reposisjons-metoden(e), og hvilke rehabiliteringstiltak som er best egnet for pasienter med håndleddsbrudd. Resultatet er at det per i dag er stor behandlingsvariasjon i Norge
Journal of the American Academy of Orthopaedic Surgeons, 2013
In light of the Norwegian Orthopaedic Association&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more In light of the Norwegian Orthopaedic Association&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s wish to prepare guidelines for treatment of distal radius fractures, we have reviewed the knowledge base for the provision of such treatment. The paper is based on systematic reviews of treatment of distal radius fractures from literature search in the following databases: the Cochrane Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE Cochrane), the Health Technology Assessment (HTA) database, PreMedline, Medline and Embase. There is evidence for recommending percutaneous pinning of unstable, dorsally displaced distal radius fractures rather than conservative treatment, but which pinning method is best remains uncertain. There is also documentation to support the use of external fixation rather than conservative treatment. There is insufficient documentation available to draw conclusions regarding the relative efficacy of the various methods of external fixation, but external fixation in combination with adjuvant pinning of the fracture fragment enhances the result compared to external fixation alone. The evidence indicates that plates may enhance functional short-term results for unstable distal radius fractures compared to external fixation. There is evidence in support of differentiated treatment of distal radius fractures. However, many questions remain unanswered, and good prospective, randomised multi-centre trials are needed.
Background The skin microcirculation may be evaluated noninvasively by laser Doppler flowmetry an... more Background The skin microcirculation may be evaluated noninvasively by laser Doppler flowmetry and iontophoresis with acetylcholine and sodium nitroprusside. Wavelet transform of the perfusion signal shows periodic oscillations of five characteristic frequencies in the interval 0.0095-1.6 Hz. The aim of the current study was to investigate alterations in skin microcirculation induced by brachial plexus block, with emphasis on the periodic oscillations. Methods Healthy nonsmokers undergoing hand surgery (n = 13) were anesthetized with brachial plexus block, using bupivacaine, lidocaine, and epinephrine. Skin microcirculation was evaluated by laser Doppler flowmetry and iontophoresis with acetylcholine and sodium nitroprusside before and after brachial plexus block. Wavelet transform of the perfusion signal was performed. As a control group, 10 healthy nonsmokers were included. Results In the anesthetized arm, skin perfusion after brachial plexus block increased from 19 (12-30) to 24 ...
ABSTRACT En 56-årig mand kom til skadestuen efter et fald på 1,5 meter fra en fiskerbåd og ned på... more ABSTRACT En 56-årig mand kom til skadestuen efter et fald på 1,5 meter fra en fiskerbåd og ned på en havnekaj. Den første røntgenoptagelse (til venstre) viste en anterior luksation af højre skulderled, hvor den posterolaterale del af caput humeri var presset op i labrum glenoidale og fastlåst i denne stilling. Forsøg på reponering i let sedation og intraartikulær analgesi var uden succes, og luksationen blev derfor reponeret i generel anæstesi. Det unikke ved billedet til venstre er, at det særlig tydeligt viser de mekaniske kræfters virkning i det traume, der danner den såkaldte Hill...
Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist frac... more Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation w...
Whereas operative treatment of the distal radius fracture in adults has gained much attention, th... more Whereas operative treatment of the distal radius fracture in adults has gained much attention, there are only a few reports on the associated fracture of the distal ulna head or neck. Little guidance on how to manage these fractures exists. This can result in inadequate treatment and contribute to less favorable results. Understanding the effect of the two-bone fracture on the stability of the forearm complex is important in proper management of these fractures. The length, alignment, and rotation have to be reestablished and maintained. By providing stable fixation of these fractures, function may be preserved and late complications minimized. During the last decade, an improved management of these challenging distal forearm fractures has followed with the introduction of locking plate technology.
Abstract Objective Hand surgery makes up a large proportion of procedures, ranging from simple to... more Abstract Objective Hand surgery makes up a large proportion of procedures, ranging from simple to complex. Increased complexity places greater demand on hand surgery competence. Furthermore, when surgical expertise is not matched to the procedure complexity, treatment injuries might occur. The purpose of this study was to assess patient-reported claims submitted to The Norwegian System of Patient Injury Compensation (NPE). Methods We examined all hand surgery claims submitted to NPE between 1 January 2007 and 30 June 2017. NPE records patient demography and variables, such as diagnosis, type of injury, injury location, the reason for the compensation claim, and whether a claim was accepted or rejected. Results NPE received 1321 claims related to treatment injuries from hand surgery at a steady rate throughout the study period. A total of 532 claims were accepted (40.3%). The approval rate for trauma cases was significantly higher than for elective cases (45.5 vs. 34.2%, p < .05). The most common diagnoses were hand fractures, dislocations and ligament injuries, carpal tunnel syndrome and arthrosis of the first carpometacarpal joint. Tendon injuries had the highest percentage of accepted claims (52.6%). The most common reason for claims being accepted was ‘failure of treatment’. 19.7% of these involved a disability percentage >15%. Elective surgery accounted for ⅔ of the approved disability cases. Conclusions/interpretation This is the first national study of patient-reported injuries after hand surgery treatment in Norway. The proportion of accepted claims is similar to that seen for orthopaedics. Acceptance levels were, however, higher for hand trauma cases than for disorders treated electively. Abbreviations NPE: Norwegian system of patient injury compensation; SD: standard deviation; CT: computed tomography; MRI: magnetic resonance imaging; UiT: University of Tromsø – Arctic University of Norway.
I Norge er håndleddsbrudd (distale radiusfrakturer) den vanligste bruddtypen, med en forekomst på... more I Norge er håndleddsbrudd (distale radiusfrakturer) den vanligste bruddtypen, med en forekomst på ca. 15000 per år. Ved brudd med ingen eller lite feilstilling er det vanlig å behandle med gips. Ved brudd med feilstilling er det aktuelt med mer avanserte teknikker. Det er imidlertid uklart hvilke pasienter som bør opereres og hvem som bør få annen behandling, samt hvilke operasjons-metoder som har best effekt. Videre er det uklart hva som er de(n) optimale reposisjons-metoden(e), og hvilke rehabiliteringstiltak som er best egnet for pasienter med håndleddsbrudd. Resultatet er at det per i dag er stor behandlingsvariasjon i Norge
Journal of the American Academy of Orthopaedic Surgeons, 2013
In light of the Norwegian Orthopaedic Association&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more In light of the Norwegian Orthopaedic Association&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s wish to prepare guidelines for treatment of distal radius fractures, we have reviewed the knowledge base for the provision of such treatment. The paper is based on systematic reviews of treatment of distal radius fractures from literature search in the following databases: the Cochrane Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE Cochrane), the Health Technology Assessment (HTA) database, PreMedline, Medline and Embase. There is evidence for recommending percutaneous pinning of unstable, dorsally displaced distal radius fractures rather than conservative treatment, but which pinning method is best remains uncertain. There is also documentation to support the use of external fixation rather than conservative treatment. There is insufficient documentation available to draw conclusions regarding the relative efficacy of the various methods of external fixation, but external fixation in combination with adjuvant pinning of the fracture fragment enhances the result compared to external fixation alone. The evidence indicates that plates may enhance functional short-term results for unstable distal radius fractures compared to external fixation. There is evidence in support of differentiated treatment of distal radius fractures. However, many questions remain unanswered, and good prospective, randomised multi-centre trials are needed.
Background The skin microcirculation may be evaluated noninvasively by laser Doppler flowmetry an... more Background The skin microcirculation may be evaluated noninvasively by laser Doppler flowmetry and iontophoresis with acetylcholine and sodium nitroprusside. Wavelet transform of the perfusion signal shows periodic oscillations of five characteristic frequencies in the interval 0.0095-1.6 Hz. The aim of the current study was to investigate alterations in skin microcirculation induced by brachial plexus block, with emphasis on the periodic oscillations. Methods Healthy nonsmokers undergoing hand surgery (n = 13) were anesthetized with brachial plexus block, using bupivacaine, lidocaine, and epinephrine. Skin microcirculation was evaluated by laser Doppler flowmetry and iontophoresis with acetylcholine and sodium nitroprusside before and after brachial plexus block. Wavelet transform of the perfusion signal was performed. As a control group, 10 healthy nonsmokers were included. Results In the anesthetized arm, skin perfusion after brachial plexus block increased from 19 (12-30) to 24 ...
ABSTRACT En 56-årig mand kom til skadestuen efter et fald på 1,5 meter fra en fiskerbåd og ned på... more ABSTRACT En 56-årig mand kom til skadestuen efter et fald på 1,5 meter fra en fiskerbåd og ned på en havnekaj. Den første røntgenoptagelse (til venstre) viste en anterior luksation af højre skulderled, hvor den posterolaterale del af caput humeri var presset op i labrum glenoidale og fastlåst i denne stilling. Forsøg på reponering i let sedation og intraartikulær analgesi var uden succes, og luksationen blev derfor reponeret i generel anæstesi. Det unikke ved billedet til venstre er, at det særlig tydeligt viser de mekaniske kræfters virkning i det traume, der danner den såkaldte Hill...
Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist frac... more Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation w...
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