The disabilities of arm, shoulder, and hand (DASH) questionnaire is a 30-item region-specific questionnaire that is used to measure the effect of treatment of the upper extremity. The purpose of this study was to assess the reliability of, and validate, the Danish version of the DASH score in patients with fractured wrists. Sixty patients were studied. We investigated internal consistency and test-retest reliability, convergent validity, content validity and responsiveness. Time to complete questionnaire was 11 minutes and two questionnaires were not usable. The internal consistency was sufficient (Cronbach's alpha 0.96 and intraclass correlation coefficient 0.89). The difference in the mean was 4.6 (CI: 0.48 to 8.72, p = 0.03). Convergent validity at first and last control was high for both pain, 0.46 and 0.40 respectively, and for physical mobility, 0.64 and 0.65 respectively, indicating that results confirmed other similar scores. We conclude that the Danish version of the 30-item DASH questionnaire is valid and practical for patients with fractured wrists.

The need for validated outcome measures is increasing. The purpose is to translate and validate the Patient Rated Wrist Evaluation (PRWE) in Danish. Translation was done by an expert panel followed by evaluation of a lay panel and a field test on 10 patients. Sixty patients with wrist fractures were included. Both lay panel comments and field test revealed issues not dealt with by the expert panel, and a final version of the Danish PRWE was made. The validation process then continued and reliability results. were presented as Cronbach's alpha = 0.94, describing the homogeneity and the intraclass correlation coefficient = 0.88 and difference of mean = 5.7 (CI = 1.12-10.37, p = 0.017), describing the concordance of the results. Convergent validity at first and last control was for pain, 0.51 and 0.46, and physical mobility, 0.56 and 0.64, respectively, describing the correlation with a gold standard questionnaire. A minor floor effect was noticed, but not enough to indicate a lack of sensitivity of the PRWE. Effect size, the ability to measure sensitivity to change, was 0.62, also described as responsiveness. The translation resulted in a questionnaire that represents correct easy-understandable Danish. It is concluded that the modified Danish version is a valid questionnaire for patients with wrist fractures.

BackgroundRandomized controlled trials have demonstrated that a restrictive red blood cell (RBC) transfusion strategy lowers transfusion frequency without affecting mortality. However, the external validity of these trials has not been tested in a large cohort. The purpose was to estimate the effect of introducing a National Clinical Guideline (NCG) for a restrictive hemoglobin transfusion threshold on transfusion frequency and mortality in hip fracture patients > 65 years old.MethodsA consecutive cohort study of hip fracture patients > 65 years old residing in the southern region of Denmark was conducted using prospectively gathered data from registers during two separate 1-year time periods. The first period from October 1, 2012, to September 30, 2013, included 1494 patients and used a liberal transfusion threshold, whereas the second period from October 1, 2015, to September 30, 2016, including 1414 participants used a restrictive threshold from the NCG. Participant data for age, sex, body mass index, Charlson Comorbidity Index, time to surgery, and death were retrieved from the Danish Interdisciplinary Registry of Hip Fractures and were merged with RBC transfusion and medication data extracted from the Danish Transfusion and Odense Pharmacoepidemiological Databases, respectively. Cox proportional hazards models were used to test relative mortality risk for the restrictive group compared with the liberal group at 30 and 90 days.ResultsOverall RBC transfusions decreased from 42 to 30% (p < 0.001). The 30-day mortality rate (95% CI) was 9% (8;11) in the restrictive group and 13% (11;14) in the liberal group (p < 0.008), whereas the adjusted relative mortality risk was 0.72 (0.57;0.91). The 90-day mortality rate was 15% (13;17) in the restrictive group and 19% (17;21) in the liberal group, whereas the adjusted relative mortality risk was 0.78 (0.65;0.94).ConclusionThese data suggest that the introduction of an NCG on restrictive blood transfusion leads to lower transfusion frequency in hip fracture patients > 65 years old. Even though this reduction is associated with decreased mortality at both 30 and 90 days, it may be explained by other issues than restrictive transfusion strategy. There has been an improvement in the mortality of hip fracture patients in Denmark, and we suggest that a restrictive transfusion strategy does not lead to increased mortality.

This is a randomised study to compare two types of osteosynthesis to mobilise wrists after distal fractures of the radius. Inclusion criteria were Older type 2 and 3 fractures. External fixation was managed with Hoffmann II compact non-bridging. Internal fixation was managed with Micronail. Patients were followed up for 12 weeks. The primary outcome was the results of the disabilities of arm, shoulder and hand (DASH) questionnaire. The secondary outcomes were answers to the patient-rated wrist evaluation (PRWE), grip strength, satisfaction, radial length, and volar tilt. Thirty patients were randomised to have external fixation and 31 to have internal fixation.There were no significant differences in DASH score. Internal fixation gave significantly better grip strength at five (p = 0.00) and 12 weeks (p = 0.03). The operating time was significantly shorter (p = 0.00) when non-bridging external fixation was used, and there were minor radiological differences. An activity-based costing analysis showed that external fixation cost three times more overall.

The aim of study is to examine the frequency of reoperation and difference in failures for short cephalomedullary nail (SN) and long cephalomedullary nail (LN).We included patients with an intertrochanteric fracture treated with Gamma nail (Stryker®). All radiographs were reviewed, TAD and diastasis were measured, and type of failure registered.216 patients were included, 95 short nails and 121 long nails. We found 12 reoperations, 5 in the SN group and 7 in the LN group. Most common failure was cut out. Our study showed no difference in frequency of reoperations or type of failures.