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Biomedical subjects

V Finsen

Publications and source records attributed to V Finsen.

At least 19 recordsLinked to original sources
PubMed2002

The position of the tourniquet on the upper limb.

Our aim was to determine if a tourniquet placed on the forearm has any advantage in clinical practice over the usual position on the upper arm. We randomised 50 patients who were undergoing an open operation for carpal tunnel syndrome under local anaesthesia into two groups. One had a tourniquet on the upper arm and the other on the forearm. The blood pressure, pulse, and level of pain were recorded at intervals of five minutes during the operation. The surgeons were also asked to evaluate the quality of the anaesthesia, the bloodless field, and the site of the tourniquet. The patients tolerated the tourniquet on the upper arm and forearm equally well. The surgeons had some difficulties when it was placed on the forearm. We therefore recommend placement of a tourniquet on the upper arm for operations on the hand and wrist which are carried out under local anaesthesia.

Adult↗
PubMed2001

[Injection therapy of trigger finger].

BACKGROUND: Since 1996 we have treated patients with trigger finger with corticosteroid injection as an alternative to surgery, on the basis of good results from this treatment reported in the literature. We wished to evaluate the results. MATERIAL AND METHODS: 27 patients with 32 trigger fingers were treated with corticosteroid injection. Two injections had been used in 17 fingers. The patients were contacted by mail or telephone median 4 years and 2 months (range 29-56 months) later, and patients with persistent pain were examined clinically. RESULTS: 12 fingers had been operated by the time of the follow-up. 14 fingers were reported to be quite normal, one gave slight discomfort, four were still painful, but less so than before injection, and one was still as bad as before injection. Two of these patients had painful carpometacarpal arthrosis. INTERPRETATION: We suggest that corticosteroid injection should be tried in patients with trigger finger.

Betamethasone↗
PubMed2001

[Corticosteroid injection for coccygodynia].

BACKGROUND: Severe coccygodynia is often treated with coccygectomy. In Norway, conservative treatment is usually restricted to avoiding pressure on the painful area. We have used local injection with a mixture of corticosteroid and lidocaine in this condition. MATERIAL AND METHODS: We present 11 patients with coccygodynia treated with local injection. All patients were contacted by telephone three or more years later. RESULTS: At follow-up, one patient was asymptomatic, five patients had improved so much that further treatment was unnecessary, and in one patient the condition was unchanged. Four patients had been operated during the follow-up period. INTERPRETATION: Local injection of corticosteroid and lidocaine is a simple therapeutic option that should be tried before operation.

Adrenal Cortex Hormones↗
PubMed2001

Neurophysiology not required before surgery for typical carpal tunnel syndrome.

Sixty-eight patients with typical carpal tunnel syndrome underwent neurophysiological investigations preoperatively, but these were not assessed until the end of the study. Open carpal tunnel release was performed and the clinical diagnosis of carpal tunnel syndrome was considered as confirmed when there was a prompt resolution of the preoperative symptoms. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. The neurophysiological tests were normal in these two patients, but were also normal in 14 of the 63 patients who improved with carpal tunnel surgery. Preoperative neurophysiology might therefore have led to up to 14 of the 63 cases of carpal tunnel syndrome being turned down for surgery. We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance.

Adult↗
PubMed2001

Duration of thrombosis prophylaxis in orthopaedic surgery.

BACKGROUND: We have given seven to 14 days thrombosis prophylaxis after orthopaedic surgery. Recently, six weeks prophylaxis has been recommended. We wished to evaluate the implications of prolonging prophylaxis. METHODS: We made a very thorough search of the hospital register of diagnoses and the registers of the departments of radiology and nuclear medicine and determined the number of detected thromboembolic complications during a five and a half-year period. RESULTS: We identified 91 cases (0.50%) with thromboembolism during the first six weeks after 18.368 orthopaedic operations: 1.4% after 836 total hip arthroplasties and 1.0% after 1.845 hip fractures. In these two groups 19 thromboembolic complications were registered after the second postoperative week. If it had been possible to prevent all of them by prolonging prophylaxis to six weeks, each avoided thromboembolism would have cost around US $ 23.700 in additional drug costs alone. One hip fracture patient died from probable thrombo-embolism during the second and one during the fourth postoperative week. No hip arthroplasty patients died from a probable thromboembolic complication during the third to sixth postoperative week. CONCLUSIONS: We conclude that the frequency of clinically detectable thrombo-embolism and fatal pulmonary embolus is so low during the third to sixth postoperative weeks that prophylaxis beyond two weeks is unwarranted.

Anticoagulants↗
PubMed2000

[Thrombosis prophylaxis in orthopedic surgery].

At Trondheim University Hospital, prophylaxis against thromboembolism after orthopaedic surgery was changed from dextran 70 to low molecular weight heparin in 1992. We wanted to assess whether the frequency of thromboembolic complications has fallen after this change of procedure and to search for any indication that prophylaxis should be prolonged from two to six weeks. Our register showed 97 cases (0.76%) with thromboembolism during the first 12 weeks after 12,711 operations during the dextran 70 period; 99 cases (0.54%) after 18,368 operations during the low molecular-weight heparin period (p < 0.05). A more thorough search identified 121 (0.66%) thromboembolic complications during the low molecular-weight heparin period; 2.2% among patients with total hip arthroplasty and 1.5% among patients with hip fractures. In these two groups, 19 (0.71%) thromboembolic complications were diagnosed during the third to sixth postoperative week. If all these complications had been avoided by prolonging prophylaxis to six weeks, each would have cost around NOK 200,000. Among patients with a diagnosed thromboembolic complication one hip fracture patient and no hip arthroplasty patients died during the third to sixth postoperative weeks. We conclude that there has been a significant fall in thromboembolism following the change from dextran 70 to low molecular-weight heparin. The frequency of thromboembolism and fatal lung embolus is so low during the third to sixth postoperative weeks that prophylaxis beyond two weeks is unwarranted.

Dalteparin↗
PubMed2000

Initial experience with the Forte plate for dorsally displaced distal radius fractures.

Open reduction and plate osteosynthesis is occasionally indicated for dorsally displaced distal radius fractures. We reviewed our medium term results with the Forte plate, one of the recently introduced purpose-made implants.Twenty-five patients operated on during the first year were reviewed 19 (12-24) months after surgery. Median age at operation was 53 (28-80) years. There were seven high energy and eighteen low energy injuries. Fourteen fractures extended into the radiocarpal joint.Three patients had a poor clinical result and were re-operated on before review with an arthrodesis, ulnar shortening, or Sauve-Kapandji operation. The remainder had six excellent, twelve good, and four fair results. Irritation of the extensor tendons was a minor problem. Initial radiological correction of deformity was satisfactory, but increased volar angulation of the distal radius was seen at follow up in twenty patients - by more than 10 degrees in nine. Seven patients had 20-30 degrees volar tilt at final review and tended to have a poorer clinical result than other patients. In our patients use of the Forte plate seems to have given satisfactory clinical results, but the increase in volar tilt after surgery is a cause for concern.

Accidental Falls↗
PubMed2000

AO tension-band osteosynthesis of displaced olecranon fractures.

This study reviewed 31 patients who underwent AO tension-band osteosynthesis of displaced olecranon fractures. Thirteen fractures were comminuted. Postoperative immobilization was short, and the median hospital stay was 3 days. In 2 patients, the stainless steel wire broke and required replacement. In 13 patients, the osteosynthesis material was removed after healing because of pain at the tip of the elbow; this did not influence the final result. Median time out of work was 12 weeks. There was no significant loss of elbow power. There was satisfactory mobility, function, and absence of pain. There were 29 good and 2 fair clinical results. Anatomic reduction was achieved in 24 elbows. Possible arthrosis was detected at follow-up in 5 elbows but these patients had a good clinical result. AO tension-band osteosynthesis of displaced olecranon fractures yields good clinical medium-term results with few serious complications.

Aged↗
PubMed1999

No advantage from splinting the wrist after open carpal tunnel release. A randomized study of 82 wrists.

To study the value of postoperative splinting after open carpal tunnel surgery, we randomly selected 82 wrists for 4 weeks of postoperative immobilization or no immobilization. The distributions of scar discomfort or pain and "pillar pain" were equal in the two groups both at 6 weeks and 6 months. Median sick leave was 6 weeks in both groups. Median VAS values for persistent discomfort and pain at 2 weeks, 6 weeks and 6 months were similar in the two groups. Grip strength was reduced compared to preoperative values by about 20% and keypinch strength by about 10% in both groups at 6 weeks and had returned to normal by 6 months. Pinch between the thumb and the tips of fingers 4 and 5 was considerably reduced postoperatively, but similar in both groups. We conclude that 4 weeks of postoperative immobilization confers no detectable benefit.

Absenteeism↗
PubMed1997

Tourniquets in forefoot surgery: less pain when placed at the ankle.

We studied perioperative pain and postoperative neurological changes after surgery for hallux valgus in 50 patients operated on under local ankle block. Patients were randomised to have the pneumatic tourniquet either at calf level or just above the ankle. The cuffs were inflated to 100 mmHg above systolic blood pressure. One patient was withdrawn from the study after randomisation. Areas of pain, paraesthesia and numbness were marked by patients on a diagram of the foot before operation and at six and ten weeks after operation. Both positions of the tourniquet gave an excellent bloodless field. The proximal tourniquet gave significantly greater discomfort (p < 0.01) during the operation, after 10, 20 and 30 minutes. Application of the cuff at the ankle gave no relative increase in areas of numbness and paraesthesia at six and ten weeks. An ankle tourniquet gives less discomfort with no increase in the incidence of nerve injury.

Adolescent↗
PubMed1996

Tendon interposition arthroplasty for basal joint arthrosis. 38 thumbs followed for 4 years.

We reviewed 38 thumbs (35 patients) operated with a modified Burton procedure for basal joint arthrosis. There were 3 pintrack infections and 9 patients reported severe discomfort during the postoperative period in a plaster of Paris. After a follow-up of 4 (1-7) years, 28 patients rated the overall result as excellent, while 1 would not have consented to the operation if she had known the result in advance. Activities of daily living were markedly improved. Compared to the nonoperated hand, the key pinch was moderately reduced and grip strength was almost the same. The postoperative scaphometacarpal gap was 6 mm.

Activities of Daily Living↗
PubMed1996

Metacarpal lengthening after traumatic amputation of the thumb.

In nine patients of median age 34 years who had sustained an amputation of the thumb at a median 24 (5 to 131) months previously, we lengthened the first metacarpal by 30 (17 to 36) mm. Seven amputations had been through the proximal phalanx and two through the metacarpal. The first two patients had autogenous grafting at a second stage, but the other seven had callotasis alone. In these patients the external fixators were removed at a median 189 (115 to 271) days after osteotomy. In six cases the adductor pollicis tendon was transferred proximally and the first web deepened. There was late fracture or palmar flexion of the callus in five patients, but this required further surgery in only one. Treatment was complete at 326 (140 to 489) days after osteotomy. The extended thumb retained its sensitivity; both grasp and key-pinch strength were satisfactory and only one patient felt that the result did not warrant the long course of treatment. Metacarpal lengthening by this method is a prolonged procedure, but provides a valuable alternative to more complex reconstructions.

Adult↗
PubMed1995

The effect of cerclage wires on the strength of diaphyseal bone.

In ten mature rabbits two cerclage wires were placed 9 mm apart on one femur. The contralateral femora were sham-operated and served as controls. The animals were killed after 99 days and the femora subjected to four-point bending tests. All wires were embedded in callus. Strength slightly increased and stiffness was unchanged in the wired femur compared with the contralateral femur. Provided they give sufficient stability, cerclage wires may be used without fear of reducing bone strength.

Animals↗
PubMed1995

Hip fractures in Nordic cities: difference in incidence.

All new hip fractures referred to hospital in 1989 were recorded in seven urban populations from Denmark, Finland, Norway and Sweden. The total population at risk (50 years and older) was 588,427, and 4075 fractures were observed (76.5% women). In all cities an age-dependent increase in incidence was found, and the female incidence was highest. When comparing the incidence rates after direct standardization, significant differences in hip fracture incidence were found between the cities for both women and men. The standardized relative rates seemed to decrease when moving south and east with the lowest rates found in Tampere, Finland. This indicates that factors which differ even between urban populations within a restricted geographical region may have an important impact on hip fracture incidence.

Aging↗
PubMed1995

Mobility, survival and nursing-home requirements after hip fracture.

A consecutive series of 117 patients treated for hip fracture were followed up prospectively for three years. The mortality was highest during the first year. The proportion living in nursing-homes was increased by 50% at one year and 25% at three years compared with before injury, but the absolute numbers were reduced because of mortality. Reduced pre-injury mobility greatly increased the risk of becoming institutionalized. The proportion of the survivors who walked without aids was reduced by more than half at one and three years. The proportion of those bedridden increased six fold. Among patients who walked without aids before fracture 31% needed two sticks or more and 7% were bedridden after one year. Among those who before fracture walked with one stick or more, the percentages were 91 and 43.

Aged↗
PubMed1994

Poor results after resection for Haglund's heel. Analysis of 35 heels in 23 patients after 3 years.

We reviewed 23 patients 3 (1-6) years after resection of the calcaneus for 35 Haglund's heels. 19 heels had been treated with a small resection and 16 with a large resection. The effect on the heel pain was independent of the size of the resection, but stiffness and ankle pain were more frequently associated with large than small resections. At follow-up persistent heel pain was found in 12 heels and additional various late complaints in 22. The overall clinical outcome was good in 20 heels, satisfactory in 10 and poor in 5 heels.

Achilles Tendon↗