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Biomedical subjects

I Bjerkreim

Publications and source records attributed to I Bjerkreim.

At least 19 recordsLinked to original sources
PubMed2001

[Complaints in orthopedics reported to the Norwegian Patient Compensation System 1993-99].

BACKGROUND: The Norwegian Patient Compensation System (NPCS) was started up in January 1988. By the end of 1999, a total of 15,552 complaints had been received. This paper reviews the outcome of the complaint procedures in the field of orthopaedics. MATERIAL AND METHODS: From 1993 to 1999, the NPCS assessed a total of 8,520 complaints of which 4,041 (47%) were in orthopaedics. On the basis of abstracts of these cases, we retrieved more detailed information. RESULTS: Over the period, 39% of orthopaedic complaints resulted in compensation, with a decline from 45% in 1993 to 32% in 1999. 328 orthopaedic patients were awarded compensation on the basis of infection; they constituted 8% of all compensated claims and 21% of all compensated orthopaedic claims. These ratios remained fairly constant throughout the period. Compensation was given to 291 patients with loosening of prostheses following use of Boneloc cement; these cases represented 7% of all orthopaedics claims and 18% of all compensated claims. Complaints were most numerous in 1996 and 1997; this reflected the use of this cement in the early 1990s. Rejected complaints were appealed with increasing frequency; in 1999, 46% of all NPCS cases were appealed, 33% of all orthopaedic cases. Rejections overruled following appeal were within a range of 16% (1994) and 11% (1995). When initial rejections overruled on appeal are included, the total compensation-to-claims ratio increases from 39% to 41%. INTERPRETATION: The high number of complaints in orthopaedics probably reflects the high frequency of musculoskeletal disorders in the population. It is to be hoped that evaluation of treatment injuries will result in a higher quality of patient treatment.

Databases, Factual↗
PubMed2001

[Analysis of 700 orthopedic complaints reported to the Norwegian Patient Compensation System].

BACKGROUND: In the 1993-99 period, the NPCS reached decisions on 4,041 orthopaedic injury cases. This paper reviews the complaints lodged. MATERIAL AND METHODS: We have analysed data from 700 randomly selected cases in order to elucidate the reasons for complaint. RESULTS: Complaints were lodged against all types of hospitals and primary health care providers. The most frequent primary diagnosis were osteoarthritis of the hip, lumbar disc herniation, and various fractures. Complaints were most commonly related to faulty treatment, continued pain, nerve injuries, reduced function, mistaken diagnosis, malposition of bone or joint, and infection. 84% of complaints were related to treatment and to operative treatment in particular. In 209 cases (30%), the complaints were heard. Of these 209, 43% were heard because of the treatment given, 21% because of infection, 18% because of diagnostic fault, and 6% because of defective follow-up. 491 complaints were rejected; in 70% of them because the injury was acceptable according to general rules, in 19% because the basic disorder had caused the injury, and in 7% because there was in fact no injury. INTERPRETATION: In our opinion, better knowledge about treatment injury cases represents valuable information that contributes to a higher quality of care.

Adolescent↗
PubMed1997

[Anisomelia. Clinical consequences and treatment].

The hypothesis that a causal relationship exists between unequal leg length and disorders in the back or lower extremities has been hard to prove. However, at the present time there is scientific documentation of an association between a difference in length of more than 1 cm and low back pain. Thus, in children with one leg one centimetre or more longer than the other, and in adults with symptoms, the discrepancy should be adjusted, especially if a lumbar scoliosis in the standing position has been documented radiographically. A difference in length of less than 2 cm should be treated by raising the shoe. An established or estimated difference of more than this is usually corrected by surgery, either by epiphysiodesis or by shortening or lengthening osteotomy. In adults with a moderate difference in leg length, a raised shoe test is recommended in order to evaluate the effect of a correction in practice before osteotomy is performed.

Adult↗
PubMed1996

Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases.

During the years 1988-1991, we performed 25 total hip replacements for completely dislocated hips in 15 women and 4 men with a median age of 54 (17-67) years. In all cases, femoral shortening at the subtrochanteric level was performed to obtain reduction of the hip. The patients have been followed for 3-7 years. 1 patient experienced sciatic nerve palsy, 1 a delayed union and 1 a malunion at the osteotomy site. There were no signs of mechanical failure. All patients were satisfied. According to the Charnley hip score, function was excellent in 15 cases, good in 9 and fair in 1. The median Harris hip score improved from 43 at the time of operation to 93 at follow-up. 7 hips had a positive and 18 a negative Trendelenburg test. Before operation, all patients had a Trendelenburg limp. Our intermediate results indicate that femoral shortening at the subtrochanteric level is a suitable adjunct to total arthroplasty for a completely dislocated hip.

Adolescent↗
PubMed1995

[Intraoperative and postoperative autologous transfusion in orthopedic surgery].

Information was collected retrospectively on three comparable groups, 25 patients in each, who had been operated on for thoracic scoliosis. Group 1 received homologous transfusions only. Group 2 and group 3 were transfused postoperatively with drained whole blood (Solcotrans orthopaedics). Group 3 received in addition peroperatively washed packed red blood cells (Haemolite 2 Cell Saver) recirculated. The need for homologous transfusions was reduced from 119 units to 23 patients in group 1, to 36 units to 14 patients in group 2 and 34 units to 13 patients in group 3. Three of the first 15 patients in group 2 experienced chills and fever reactions in connection with the autologous transfusion. No reactions were seen after infusion when we scrapped the last 50 to 100 ml of drained blood.

Adolescent↗
PubMed1995

Total hip arthroplasty for arthrodesed hips. 5- to 13-year results.

The functional outcome of total hip arthroplasty for arthrodesed hips was evaluated. During the years 1979 to 1988, 55 arthrodesed hips were converted to total hip arthroplasties. Thirty-seven women and nine men were followed for a minimum of 5 years. Thirteen of the patients were very much satisfied with the operation, 19 were much satisfied, 7 were satisfied, 3 were less satisfied, and 4 were unsatisfied. The Harris hip score was improved from 51-83 at the time of operation to 53-93 at the follow-up examination. Before conversion, none of the patients used crutches. At the follow-up examination, 10 patients used two crutches, 24 used one crutch, and 12 did not need support. Muscle strength of the abductors ranged from 1 to 4. In 26 patients with major low back pain before conversion, the pain score improved from 3-10 at the time of operation to 0-8 at the follow-up examination. This study shows that with conversion of an arthrodesed hip to arthroplasty, most patients need support for walking; however, they are generally grateful for their new mobility, maneuverability, and improved ability to sit comfortably.

Adult↗
PubMed1995

Unchanged muscle function after bilateral femoral lengthening. A prospective study of 9 patients with a 2-year follow-up.

We performed pre- and 2-3.5-year postoperative isokinetic knee-testing to assess thigh muscle function in 9 patients undergoing bilateral femoral lengthening by callotasis. The median femoral lengthening was 17 (12-18) percent. The angular testing velocities were 60 degrees/sec (strength) and 180 degrees/sec (endurance). Only small changes in muscle strength were found postoperatively. Except for peak torque at 60 degrees/sec on the last-operated side (median 2 years follow-up), there were no differences between the pre- and postoperative isokinetic measurements. There were 3 major complications, 2 fractures and 1 varus deformity. 2 patients had problems with patellar pain. All patients achieved normal range of motion. They judged the final result as very good and underlined the psychological effect and the practical advantages of being taller.

Adolescent↗
PubMed1994

Muscle function after femoral shortening osteotomies at the subtrochanteric and mid-diaphyseal level. A follow-up study.

Relative femoral shortening length at the subtrochanteric (ST) and mid-diaphyseal (MD) level was compared with isokinetic muscle strength more than 2 years postoperatively. For the ST level no upper limit for shortening length could be detected. For MD osteotomies the relative shortening length was negatively correlated to muscle strength. There was a significant difference at the MD level between those shortened more or less than 10%, indicating an upper limit of 10% of the femoral length for regaining normal muscle strength. For correction of leg length inequality and for shortening of unaccepted tallness, these results should be taken into account when choosing the level for osteotomy.

Body Height↗
PubMed1994

Muscle function after mid-shaft femoral shortening. A prospective study with a two-year follow-up.

We performed isokinetic knee testing to assess thigh muscle function in ten patients (12 legs) before and after mid-shaft femoral shortening averaging 46 mm (27 to 70). Tests were at angular velocities of 60 degrees/sec and 180 degrees/sec, and were performed preoperatively and after 3, 6, 12 and 24 months. Isokinetic tests at two years showed a significant reduction in muscle function in both quadriceps and hamstrings, but recovery of function was significantly better for the hamstrings. There was a linear relationship with correlation of r2 = 0.31 to 0.86 between loss of muscle force at two years and the magnitude of shortening. Long-term loss of muscle force should be expected after a mid-shaft shortening of the femur of more than 10%.

Adolescent↗
PubMed1993

Perfusion in the anterior tibial muscle measured by laser Doppler flowmetry after graded periods of hindlimb ischemia in rats.

In the present study laser Doppler flowmetry was used to evaluate skeletal muscle perfusion before and after acute hindlimb ischemia in rats. Three laser Doppler microprobes were placed in the anterior tibial muscles of both legs. Six animals were used as non-ischemic controls and 22 animals were subjected to complete ischemia in the left hindlimb for 0.5 to 4.5 hr. By calculating a perfusion index based on recordings from the left and the right leg, a continuous measurement of relative perfusion could be performed. Reactive hyperemia was demonstrated after ischemia of shorter than 2 hr duration. After longer occlusion periods, the reperfusion decreased with increasing duration of ischemia. It is concluded that the use of laser Doppler microprobes offers possibility for continuous evaluation of relative microvascular blood flow in normal and postischemic skeletal muscle, and that the technique would be useful in experimental studies concerning ischemia-reperfusion injury of skeletal muscles.

Animals↗
PubMed1992

Bilateral femoral shortening for unaccepted tallness.

We performed bilateral femoral shortening operations on 15 skeletally mature patients (11 women and four men). Their mean height pre-operatively was 193.5 cm and they were shortened by 5 to 9 cm. We used a subtrochanteric Z-osteotomy with an AO condylar plate in 11 patients, and mid-diaphyseal osteotomy with an intramedullary locking nail in four. After an average follow-up of 8.1 years, isokinetic muscle testing showed that muscle strength was reduced bilaterally in five patients. The strength ratio between hamstrings and quadriceps muscles was normal in all those treated by subtrochanteric shortening; in those shortened at the mid-shaft the quadriceps was relatively weaker. The result was rated as excellent by 11 patients, very good by three, and good by one.

Adolescent↗
PubMed1989

Limb lengthening by physeal distraction.

I evaluated 10 consecutive lengthenings through the upper tibial physis in 9 patients. A bilateral frame consisting of two small-sized Wagner devices and two pairs of 4-mm transfixing pins with 5-mm-diameter central threads were used. The median lengthening was 6.7 cm. Complications were frequent. The risk of a growth disturbance is very high, and physeal distraction should therefore only be applied towards the end of the growth period.

Adolescent↗
PubMed1988

Limb lengthening by diaphyseal corticotomy, callus distraction, and dynamic axial fixation. An experimental study in the ovine femur.

Limb lengthening of the left femur was performed in 12 sheep, 7-8 months of age. After weakening of the cortex by drill holes, a controlled fracture was created in the diaphysis. The bone segments were fixed in reduced position using a unilateral external fixation device. The fixator was left in neutral position for 10 days postoperatively when lengthening started. By means of daily distraction at a rate of 1.0 mm once a day for 3 weeks, an average lengthening of 1.9 cm (11.9%) was obtained. Two weeks after distraction had been discontinued, distinct callus bridging of the lengthening zone was confirmed radiographically in all animals. At this time the rigid state of fixation was converted to a system allowing axial compression by loading in half the animals. The other half of the animals served as controls with the fixator remaining unchanged. The external device was left on until 5 weeks after the end of distraction. At this time the animals were killed. Both femora of all animals were tested mechanically in torsion. The average ultimate torsional strength of the elongated femur compared with control was 71% in the group with dynamic axial fixation and 65% in the control group. No significant difference in relative strength of the tested bones in the two groups was found. We conclude that intermittent axial compression by loading during consolidation had no significant effect on the bone-healing process evaluated by radiography and mechanical testing.

Animals↗
PubMed1987

Limb lengthening by epiphyseal distraction. An experimental study in the caprine femur.

Epiphyseal distraction of the left distal femur was accomplished in 10 goats (aged 3-4.5 months). A modified Hoffmann external fixation device was used as a unilateral distraction frame. A distraction rate of 1.5 mm/day was applied for 5.5 weeks. Epiphysiolysis occurred after 3-7 days of distraction. After the lengthening procedure, the growth plate had reduced in height in eight animals on radiographic examination. In two animals the growth plate was fused. Three animals were killed at 4 (Group 1) and 8 (Group 2) weeks and four animals at 16 (Group 3) weeks after the end of the distraction period. The gain in leg length obtained by distraction was reduced owing to growth retardation in the distal femur of the operated limb. The average final lengthening was 24.9, 19.4, and 13.4% in Groups 1, 2, and 3, respectively. Femur and tibia from both sides were tested mechanically in torsion. Only one femur fractured in the elongation area. All but one elongated femur fractured in the area of the diaphysis subjected to distractional force. The torsional strength of the elongated femur compared with control was reduced to approximately 50% in all groups. The corresponding torsional strength of the tibia on the elongated extremity compared with control was reduced to approximately 75% in all groups. The difference in relative strength of femur compared with that of tibia was statistically significant. This finding can be explained by a stress-protective effect on the femur in the distraction area caused by the external device.

Animals↗
PubMed1987

Late diagnosed congenital dislocation of the hip.

During the years 1975 to 1979, 82,574 children from five counties in southeast Norway were live-born, 197 of whom were treated for late detected CDH, for an incidence of 2.4 per 1,000 live births, i.e., 0.4 promille dislocation, 0.6 promille subluxation, and 1.4 promille dysplasia of the acetabulum without dislocation. All the hips had been found stable at birth. Eighty-six percent were girls, and the left hip was affected in 48 percent, the right hip in 31 perent, and both hips in 21 percent. Only 6.5 percent were delivered in the breech position. This and the stability found neonatally may indicate an etiologic difference between neonatally and late diagnosed CDH.

Breech Presentation↗