Stalins skygge over Agder : Jakob Friis, Olav Scheflo og innvirkningen av sovjetisk politikk på Kristiansand Arbeiderparti, 1936 –1939

Master's thesis in History (HI500

Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years

Abstract Background Fixation of proximal humeral fractures (PHF) with locking plates has gained popularity over conservative treatment, but surgery may be complicated with infection, non-union, avascular necrosis (AVN) of the humeral head and fixation failure. Failure to achieve structural support of the medial column has been suggested to be an important risk factor for fixation failure. The aims of this study were to examine the effect of calcar screws and fracture reduction on the risk of fixation failure and to assess long-term shoulder pain and function. Methods This was a single-centre retrospective study of 190 adult PHF patients treated with a locking plate between 2011 and 2014. Reoperations due to fixation failure were the primary outcome. Risk factors for fixation failure were assessed using the Cox regression analysis. Postoperative shoulder pain and function were assessed by the Oxford Shoulder Score (OSS). Results Thirty-one of 190 (16%) patients underwent a reoperation: 14 (7%) due to fixation failure, 10 (5%) due to deep infection and 2 (1%) due to AVN. The absence of calcar screws and fixation with residual varus malalignment (head-shaft angle < 120°) both increased the risk of fixation failure with an adjusted hazard ratio (95% CI) of 8.6 (1.9–39.3; p = 0.005) and 4.9 (1.3–17.9; p = 0.02), respectively. The median (interquartile range) OSS was 40 (27–46). Conclusion The use of calcar screws, as well as the absence of postoperative varus malalignment, significantly reduced the risk of fixation failure. We, therefore, recommend the use of calcar screws and to avoid residual varus malalignment to improve the medial support of proximal humeral fractures treated with a locking plate

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function

Fifty-two consecutive adult patients with syndesmotic diastasis (SD) were treated with closed anatomical reduction and stable fixation by a trans-syndesmotic cancellous screw. A short leg splint was prescribed for a six week postoperative period. Treatment outcomes of syndesmotic screw removal at various time points were studied and compared (group 1 at six weeks, group 2 at three months and group 3 at an average of nine months). Recurrence of SD, incidence of syndesmotic screw breakage and ankle function were compared among the three groups. Recurrence of SD occurred in 15.8% (3/19) of patients in group 1, 15.0% (3/20) in group 2 and 0% (0/13) in group 3 (p = 0.054). Breakage of the syndesmotic screw occurred in three patients within three months (group 2, 15.0%) and in two patients beyond three months (group 3, each at six and 12 months, 15.4%). None of the group 1 patients experienced screw breakage (p = 0.034). Forty-three patients (82.7%) were classified as having satisfactory outcomes. Ankle function did not significantly differ among the three groups (p = 0.191), with or without syndesmotic screw breakage (p = 0.343) and with or without SD recurrence (p = 0.218). In conclusion, restriction of daily activity for at least three months is required to prevent recurrence. Removal of the syndesmotic screw at six weeks may prevent its breakage but increases the risk of recurrence. Over an average follow-up of 19 months, SD recurrence does not lead to deterioration in ankle function