We analysed registry-based data on 14,915 patients treated for pertrochanteric fracture obtained from the Finnish Health Care Register during the years 1999-2009. Data on the comorbidities, residential status and deaths of the cohort were extracted from several Finnish registries using patients' unique personal identification numbers. The use of intramedullary implants increased substantially during the study period. One-year mortality was slightly higher in the patients treated with intramedullary implant (26.6% vs. 24.9%; P=0.011). In the first year after the fracture, there were more new operations on hip and thigh in patients treated with an intramedullary implant (11.1% vs. 8.9%; P
Registry data highlight increased revision rates for endobutton/biosure HA in ACL reconstruction with hamstring tendon autograft: a nationwide cohort study from the Norwegian Knee Ligament Registry, 2004-2013.
Compared with a patellar tendon autograft (PT), a hamstring tendon autograft (HT) has an increased risk of revision after anterior cruciate ligament reconstruction (ACLR). There are no studies analyzing whether this can be explained by inferior fixation devices used in HT reconstruction or whether the revision risk of ACLR with an HT or a PT is influenced by the graft fixation.
To compare the risk of revision and the revision rates between the most commonly used combinations of fixation for HTs with PTs.
Cohort study; Level of evidence, 2.
This study included all patients registered in the Norwegian Knee Ligament Registry from 2004 through 2013 who underwent primary PT or HT ACLR with no concomitant ligament injury and known graft fixation. The 2-year revision rates were calculated using the Kaplan-Meier analysis. Hazard ratios (HRs) for revision at 2 years were calculated using multivariate Cox regression models.
A total of 14,034 patients with primary ACLR were identified: 3806 patients with PTs and 10,228 patients with HTs; the mean follow-up time was 4.5 years. In the HT group, 5 different combinations of fixation in the femur/tibia were used in more than 500 patients: Endobutton/RCI screw (n = 2339), EZLoc/WasherLoc (n = 1352), Endobutton/Biosure HA (n = 1209), Endobutton/Intrafix (n = 687), and TransFix II/metal interference screw (MIS) (n = 620). The crude 2-year revision rate for patients with PTs was 0.7% (95% CI, 0.4%-1.0%), and for patients with HTs, it ranged between the groups from 1.5% (95% CI, 0.5%-2.4%) for TransFix II/MIS to 5.5% (95% CI, 4.0%-7.0%) for Endobutton/Biosure HA. When adjusted for detected confounding factors and compared with patients with PTs, the HR for revision at 2 years was increased for all HT combinations used in more than 500 patients, and the combinations Endobutton/Biosure HA and Endobutton/Intrafix had the highest HRs of 7.3 (95% CI, 4.4-12.1) and 5.5 (95% CI, 3.1-9.9), respectively.
The choice of fixation after ACLR with an HT has a significant effect on a patient's risk of revision. In this study population, none of the examined combinations of HT fixation had a revision rate as low as that for a PT.
The results are reported on 214 patients treated for 270 mandibular fractures, using rigid internal fixation. Of these, 172 fractures (63.7%) in 131 patients had been re-evaluated at final follow-up in connection with plate and screw removal, on average 15.2 months, postoperatively. Although one-third of the patients had a history of alcohol abuse, and 86% were treated with a delay of more than 24 h (mean 3.2 days), good primary bone healing was observed in 93.9% of the patients. Infections, seen in 6.1% of the patients, were related exclusively to inadequate stability of the fracture. Malocclusion, observed in 18.2% of 159 dentate patients, was caused by incorrect plate bending and insufficient fracture reduction. Immediate postoperative dysfunction of the inferior alveolar nerve in 58.1% of the cases, and of the mandibular branch of the facial nerve in 12.7%, was followed by almost total recovery 1 year after operation. It is concluded that rigid internal fixation is a reliable method of treatment, especially indicated for patients with reduced healing capacity and poor co-operation.