The external fixation test of the lumbar spine: 30 complications in 25 of 100 consecutive patients

We retrospectively analyzed the rate and character of complications in a series of 100 consecutive external fixation tests during 1985-1991. There were 30 complications in 25 patients. The most common was pin tract infection, which was definite in 12 cases and probable in 6. Altogether 12 patients developed complications that resulted in removal or reapplication of the device. 8 cases had an incorrect position of a Schanz screw; 3 of these had neurological complications. The only variable having a significant association with complications was the duration of the test. Because of this complication rate, the indications for the test should be carefully considered.     

Individually fitted sports shoes for overuse injuries among newspaper carriers

OBJECTIVES: The aim of the study was to determine the effectiveness of new, individually fitted sports shoes against overuse injuries to the lower limb among newspaper carriers. METHODS: Patients (N = 176) with lower-limb overuse injuries were randomly assigned to use new, individually adjusted footwear with good shock absorbing properties (test group = 86) or the subjects' own, used footwear (control group = 90). The main outcome measurements were lower-limb pain intensity during walking, as rated on a visual analogue scale (0-100), number of painful days, subjective assessment of global improvement, foot fatigue, number of hyperkeratotic skin lesions and diagnosed overuse injuries, and costs of foot care as compared between the treatment groups. RESULTS: At the 6-month follow-up there was a difference in favor of the test group with respect to lower-limb pain intensity and number of painful days, when compared with the control group. At 1 year, 53% and 33% of the test and control groups, respectively, thought they were better than at the time of the baseline examination (number needed to treat being 5 between the test and control groups). The test subjects had less foot fatigue and fewer hyperkeratotic skin lesions. There was no difference in the number of diagnosed overuse injuries between the groups. During the year of follow-up, the all-inclusive mean costs of foot care were USD 70 and USD 158 in the test and control groups, respectively. CONCLUSIONS: Individually adjusted shock-absorbing shoes offer slight health benefits for lower-limb overuse injuries. Proper shoes may decrease the need to use health care resources.     

The Effect of Waiting Time on Health-Related Quality of Life, Pain, and Physical Function in Patients Awaiting Primary Total Hip Replacement: A Randomized Controlled Trial

Objective:  This prospective randomized study assessed the effect of waiting time (WT) on health outcomes in Finnish patients admitted to hospital for primary total hip replacement (THR).
Methods:  A total of 395 consecutive patients with a need for a primary THR because of osteoarthritis and who were placed on the waiting list between August 2002 and November 2003. After placement on the waiting list, the patients were randomly assigned to a short WT (≤3 months) group (n = 174) or a nonfixed WT group (n = 221). The patients completed self-administered questionnaires at the time of placing on the waiting list and at hospital admission. Health-related quality of life was measured by the generic 15D instrument. Hip pain and function were measured by the patient self-report Harris hip score (HHS).
Results:  Of the 395 patients, 312 (79%) completed the follow-up (140 patients with short and 172 with nonfixed WT). At admission, the mean 15D scores for patients with short and nonfixed WT were 0.784 and 0.783, respectively. In the intention-to-treatment analysis, the difference between the groups (Δ0.001, 95% confidence interval [CI]: –0.019 to 0.021) was not statistically significant or clinically important. The mean self-report HHS in patients with short WT was 43.5, and among those with nonfixed WT was 41.9. The difference (Δ1.6, 95% CI: –1.77 to 4.87) was not statistically significant.
Conclusions:  Both generic and disease-specific measures revealed that longer WTs did not result in poorer health status at admission.     

Intervertebral disc changes in adolescents with isthmic spondylolisthesis.

The lower lumbar discs in adolescent patients with isthmic L5 spondylolisthesis requiring operative treatment were evaluated by means of plain radiography, discography, and magnetic resonance imaging (MRI). There were 14 girls and 13 boys, mean age on admission 14.4 (range, 11-18) years. The mean slip in girls was 45 +/- 23% and in boys 27 +/- 17% (p less than 0.05). Discography was performed in 23 patients (42 discs) and MRI in 16. In 12 patients, both examinations were made. In plain radiographs, normal presacral disc height was seen in 11 patients with mean 14.5% slip, narrowing of the disc height less than 50% in four patients with mean 24% slip, and greater than 50% in 12 patients with mean 52.6% slip. In discograms and MRIs, the presacral disc was pathologic in all patients. Pathologic changes of the fourth lumbar disc were frequent. Concerning disc degeneration, there was poor correlation between findings in plain radiography compared with those seen in MRI or discography. MRI findings correlated with those of discography in most cases. However, MRI was normal in two discs with a pathologic discogram.     

Erratum to: Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial

European Spine Journal -     

Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial

We randomised a total of 94 patients with long-standing moderate lumbar spinal stenosis (LSS) into a surgical group and a non-operative group, with 50 and 44 patients, respectively. The operative treatment comprised undercutting laminectomy of stenotic segments, augmented with transpedicular-instrumented fusion in suspected lumbar instability. The primary outcome was the Oswestry disability index (ODI), and the other main outcomes included assessments of leg and back pain and self-reported walking ability, all based on questionnaire data from 85 patients at the 6-year follow-up. At the 6-year follow-up, the mean difference in ODI in favour of surgery was 9.5 (95% confidence interval 0.9–18.1, P-value for global difference 0.006), whereas the intensity of leg or back pain did not differ between the two treatment groups any longer. Walking ability did not differ between the treatment groups at any time. Decompressive surgery of LSS provided modest but consistent improvement in functional ability, surpassing that obtained after non-operative measures.     

The significance of arthroscopy and examination under anaesthesia in the diagnosis of fresh injury haemarthrosis of the knee joint

Arthroscopy and examination under anaesthesia were performed for 328 consecutive knee injuries with haemarthrosis. These examinations were grouped according to a modified classification (Jackson and Abe, 1972) into very useful (117/328, 36 per cent), useful (98/328, 30 per cent) and useless (113/328, 34 per cent) categories. The probability of arthroscopy being useful was estimated mathematically. The factors which made this procedure useful were knee pain on exertion before the injury (P = 0.0561), the mechanism of the injury (P less than 0.0001) and the clinical stability of the patella (P = 0.0007). On arrival in the emergency department it was first decided whether the leg should be mobilized, immobilized in a plaster cast, operated on or, if a definitive diagnosis could not be reached, arthroscopy was deemed necessary. This resulted in the treatment following arthroscopy, and examination under anaesthesia, being altered from conservative to operative (P less than 0.0001). Results suggest that arthroscopy and examination under anaesthesia should always be considered to help in the diagnosis of acute injury haemarthrosis of the knee especially after a valgus or varus strain.