I’ve previously reported on Kukkonen et al’s excellent three-armed rotator cuff surgery RCT. They’ve now just published the 2-year follow-up where they still don’t see any difference in outcomes. Interestingly, they’ve added an MRI and noted that the cuff tear remains smaller among those that had surgery. This indicates that the intended surgery works but still too early to see any actual results. Continue reading
Category Archives: Orthopaedic surgery
Canakinumab – difficult to pronounce but useful for treating gout?
Gout can be incredibly painful where the main treatment option are nonsteroidal anti-inflammatory drugs (NSAID). Unfortunately NSAIDs are not the best alternative for elderly patients as it may induce heart & kidney failure. I was therefore thrilled to see that canakinumab recently was approved by Läkemedelsverket as a treatment alternative. Continue reading
The proximal humerus fracture – a lost cause?
Most orthopaedic surgeons have met patients with poor shoulder function after a proximal humerus fracture, and many of us have thought: if I’ve only done the other thing I was thinking of…. Unfortunately the outcome seems to be independent of what we do, at least according to Launonen et al’s meta-analysis and Rangan et al’s recent RCT on 250 patients. Continue reading
A bloody mess
In a recent RCT by Gregersen et al. they manage to complicate blood transfusions in orthopaedic patients even further. They suggest that orthopaedic patients from nursing homes fare better with liberal blood transfusions (> 113 g/L compared to >97 g/L). The concept is interesting, although the paper has some issues. Continue reading
Stop (em)bracing burst fractures?
Continuing on the theme of #2MuchMed (see BMJ’s campaign) I figured it may be worth highlighting two recent studies on stable compression fractures of the spine. Both failed to show any benefit with standard bracing treatment. As some patients experience the brace as claustrophobic and uncomfortable (from my own patients’ experience), I’m thrilled to have this option available. Continue reading
End of the blood reign?
As I have a weakness for studies that challenge the dogma, I was ecstatic when I stumbled upon Carson et al.’s bold study on blood transfusions. In their study they selected 2000 patients with cardiovascular disease that were undergoing surgery due to hip fracture. Interestingly, there was no difference in 3-year mortality when randomizing between transfusion Hemoglobin thresholds of 100 g/L or 80 g/L! Continue reading
Are the fancy locking plates for distal radius fractures nothing more than orthopaedic bling?
Costa et. al. performed recently a multi-center study including 18 trauma centers throughout the United Kingdom. They randomized patients with distal radius fractures to volar locking plates or Kirschner wires. They managed to randomize 461 patients and follow-up 90% after 1 year using self-reported scores. They could not find any difference after 1 year regarding their primary outcome, PRWE-score (−1.3 points, 95% CI -4.5 to 1.8). This was well below their stipulated minimally clinically important difference of 6 points. Could this be the end of the volar locking plate era? Continue reading
Confused on a higher level – the haunted degenerative meniscus
One, never-ending thread on this blog seems to be the degenerative meniscus. Gauffin et al. recently published a randomized controlled trial comparing surgery vs physiotherapy with favorable results for surgery regarding pain. Could this be the turnaround for one of the most controversial, but common orthopaedic procedures? Continue reading
We all have our trigger
Surgical treatment for trigger finger consists of cleaving the A1 pulley, a simple procedure, considered to be low risk. Even so, there can still be scar tenderness, nerve injury, tendon bowing, and infection. It is therefore nice to see Wojahn et al.’s paper on long-term follow-up after cortisone injections. Injection is a simple alternative that consists of an injection angling 45° distally at the A1 pulley with 1 mL 40 mg/mL Depo-Medrol. Continue reading
ACL-reconstruction in vain?
Nordenvall et al.  recently report in PLOS ONE an interesting study on cruciate ligament (CL) injuries where they could not find any protective effect on knee osteoarthritis (OA) from reconstructive surgery. It is a nation-wide study based on > 60,000 patients where they used the National Swedish Patient Register in order to find ICD-codes and surgical procedures code to identify patients with CL injury and those with a subsequent procedure. While the early results showed slightly less OA, there was an increased risk of 1.4 (95% confidence interval, 1.2 to 1.7) after > 10 years for those with surgery. Continue reading