| 1. |
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| 2. |
- Gustafsson, Johan, et al.
(författare)
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MRI of the knee after locked unreamed intramedullary nailing of tibia.
- 2008
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Ingår i: La Chirurgia degli organi di movimento. - : Springer Science and Business Media LLC. - 0009-4749 .- 1973-2538. ; 91:1, s. 45-50
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Tidskriftsartikel (refereegranskat)abstract
- We analysed the reason for knee pain after intramedullary (IM) nailing with standard MRI sequences at a mean of 27 months (range 2-45) after nail removal in eleven patients with a mean age of 30 years (range 15-52). Knee pain was assessed in four grades. All our patients had signal changes of fluid in the nail channel, areas of low signal intensity in Hoffa's fat pad and subcutaneous low signal nodes in front of a thickened patellar ligament. Ten patients had low signal adhesions from the nail insertion towards the patellar ligament. Six patients had severe knee pain and even marked adhesions. Two patients had no knee pain; one of these two had minimal adhesions and the other one no adhesions. Five of the patients had a meniscal tear and/or local cartilage reduction. The degree of adhesions from the nail insertion in the tibia towards the patellar ligament was proportional to the degree of knee pain. No sign of acute inflammation was found.
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| 3. |
- Hansson, Ulrik, et al.
(författare)
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A randomised RSA study of Peri-Apatitetrade mark HA coating of a total knee prosthesis.
- 2008
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Ingår i: Knee. - : Elsevier BV. - 1873-5800. ; 15, s. 211-216
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In total knee replacement, sound early fixation of the prosthesis is crucial for achieving a good long-term result and for minimising the risk of loosening. Various types of prosthetic material, different surface textures and shapes and the incorporation of screws or pegs have been used to achieve good fixation, particularly in the uncemented knee. Hydroxyapatite (HA) coating of prosthetic joint components is another technique used to enhance early stability and so to improve the longevity of the prosthesis-bone fixation. HA ceramic coatings are mostly plasma sprayed onto the fixation surface of the implant. Plasma spraying is largely a 'line of sight' technique and as such there are difficulties involved when covering three-dimensional planes, such as porous beaded fixation surfaces typically found on several knee prostheses. The objective of this study was to assess the clinical performance of the solution-deposited HA coating, Peri-Apatitetrade mark , with regard to its ability to stimulate an endurable and stable implant fixation. PATIENTS AND METHODS: We randomised 60 patients into two groups; one group received the porous coated prosthesis with solution-deposited HA, and the other group received a prosthesis without HA. Radiostereometric examination was used as the primary tool for measuring migration in the prosthetic components. RESULTS: There was a lower incidence of early subsidence in the Peri-Apatitetrade mark group. At 24 months there were no differences in clinical scorings or maximal total point motion. CONCLUSION: Addition of solution-deposited HA coating appears to provide better early stable fixation in a porous coated knee prosthesis.
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| 4. |
- Hansson, Ulrik, et al.
(författare)
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Mobile vs. fixed meniscal bearing in total knee replacement A randomised radiostereometric study.
- 2005
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Ingår i: Knee. - : Elsevier BV. - 1873-5800. ; 12:6, s. 414-418
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Tidskriftsartikel (refereegranskat)abstract
- 52 knees scheduled for a total knee arthroplasty were randomised to either a fixed or a mobile polyethylene bearing. The design was identical in all parts. The knee systems used were the Rotaglide Total Knee System (RTK) (R) and the Nuffield Total Knee System (NTK) (R), both from the same manufacturer (Corin Medical Ltd., UK). All knees implanted were uncemented. The patients were followed for 2 years clinically and with radiostereometric analyses to assess migration over time and inducible displacement of the tibial component. Separate analysis of the mobility of the tibial insert in the knees with a mobile bearing was also made. The migration measured with RSA between the I st and 2nd year expressed as maximum total point motion (MTPM) might predict the risk of loosening of the implant.
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| 5. |
- Hansson, Ulrik, et al.
(författare)
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Once-weekly oral medication with alendronate does not prevent migration of knee prostheses : A double-blind randomized RSA study
- 2009
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Ingår i: Acta Orthopaedica. - : Informa Healthcare. - 1745-3674 .- 1745-3682. ; 80:1, s. 41-45
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Tidskriftsartikel (refereegranskat)abstract
- Background and purposeEarly migration of joint replacements is an effect of poor fixation and can predict late loosening. By reducing the bone resorption after implantation of a joint replacement, it should be possible to enhance the initial fixation of the implant. We studied the effect of once-weekly treatment with alendronate after knee replacement.Patients and methodsWe recruited 60 patients (60 knees) with gonarthrosis who were scheduled for a total knee replacement. They were operated on with identical implants and uncemented fixation. 30 patients were treated with a bisphosphonate (alendronate) and 30 patients underwent placebo treatment. The treatment started postoperatively and continued on a weekly basis for 6 months. The fixation of the implants was measured with repeated radiostereometry for 2 years.ResultsThere was no difference in migration of implants between the two groups.ConclusionWith uncemented fixation of knee implants, no benefit of once-weekly treatment with alendronate, starting postoperatively, could be seen during a 2-year follow-up period.
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| 6. |
- Hansson, Ulrik, et al.
(författare)
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Once-weekly oral medication with alendronate does not prevent migration of knee prostheses
- 2009
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 80:1, s. 41-45
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Early migration of joint replacements is an effect of poor fixation and can predict late loosening. By reducing the bone resorption after implantation of a joint replacement, it should be possible to enhance the initial fixation of the implant. We studied the effect of once-weekly treatment with alendronate after knee replacement. Patients and methods We recruited 60 patients (60 knees) with gonarthrosis who were scheduled for a total knee replacement. They were operated on with identical implants and uncemented fixation. 30 patients were treated with a bisphosphonate (alendronate) and 30 patients underwent placebo treatment. The treatment started postoperatively and continued on a weekly basis for 6 months. The fixation of the implants was measured with repeated radiostereometry for 2 years. Results There was no difference in migration of implants between the two groups. Conclusion With uncemented fixation of knee implants, no benefit of once-weekly treatment with alendronate, starting postoperatively, could be seen during a 2-year follow-up period.
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| 7. |
- Henricson, Anders, 1944-
(författare)
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Total knee arthroplasty : aspects on improved fixation in the younger patient
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The results of total knee arthroplasty are inferior in younger patients. The challenge today is therefore to develop designs and concepts that will last at least 25 years. This thesis has evaluated the fixation to bone of modern designs of knee prostheses uring RSA analysis. Coating implant surfaces with hydroxy-apatite have proven to enhance fixation to bone. Addition of screws for fixation of the tibial component enhances the fixation, but has negative side effects such as osteolysis around the screws, in turn leading to a higher risk of component loosening. The magnitude and pattern of migration was studied in a randomized study of uncemented tibial implants coated with hydroxy-apatite with and without additional screw fixation in patients younger than 65 years. The uncemented implants migrated initially more than the cemented implants that constituted the control group. Both uncemented groups stabilized at 3 monthes with no further migration, while the cemented implants showed a continuous migration up to the 2 year follow-up, indicating continuous bone resorption at the implant-bone interface, a fact that might lead to an increased risk of late implant loosening. This may not be a problem in older patients, but may have consequences for long-term fixation in younger patients. There was no difference between the two uncemented groups indicating that screws do not improve fixation. Hydroxy-apatite coated knee implants might be well suited for younger patients. Mobile bearing total knee arthroplasty theoretically uncouples the forces at the implant-bone interface, thus improving fixation of the implant to bone. The magnitude and pattern of migration of a cemented mobile bearing knee arthroplasty and a fixed bearing total knee arthroplasty was compared in a randomized study. The results showed that mobile bearings did not improve fixation. Trabecular metal, a new material recently introduced for total knee arthroplasty, has several theoretical advantages. Trabecular metal tibial implants were evaluated in a randomized study in patients younger than 60 years. The implants displayed the typical migration pattern for uncemented implants with greater migration initially followed by early stabilization. The majority of the trabecular metal implants subsided into the bone with no lift-off. Lift-off has the potential of exposing the interface to joint fluid with the potential risk of bone resorption and late loosening, and is commonly seen in metal-backed implants. The finding of absence of lift-off is regarded beneficial for uncemented fixation. Trabecular metal tibial implants might be suited for younger patients. The optimal mode of fixation of the femoral component is yet to be established. Comparing cemented femoral components with uncemented femoral components in a randomized study in patients younger than 60 years revealed no differences of the magnitude or the pattern of migration. Uncemented femoral component seems equally as good as cemented components in younger patients.
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| 8. |
- Lohmander, Stefan, et al.
(författare)
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Surgical treatment of osteoarthritis
- 2006
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Ingår i: Osteoarthritis Handbook. - 9781841842851 - 1841842850 ; , s. 161-161
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Nilsdotter, Anna, et al.
(författare)
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A 5 year prospective study of patient-relevant outcomes after total knee replacement.
- 2009
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 17, s. 601-606
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF). METHODS: 102 consecutive patients with knee OA, 63 women and 39 men, mean age 71 (51-86) assigned for TKR at the Department of Orthopaedics at Lund University Hospital were included in the study. The self-administered questionnaires Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-36 were mailed preoperatively and 6 months, 12 months and at 5 years postoperatively. RESULTS: Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P<0.001). The percentage of patients performing more demanding functions related to sports and recreation increased postoperatively. The best postoperative result was reported at the 1 year follow-up. Compared to the 1 year follow-up, a significant (P
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| 10. |
- Nilsdotter, Anna, et al.
(författare)
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Knee arthroplasty: are patients' expectations fulfilled?
- 2009
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 80:1, s. 55-61
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose With an aging population expecting an active life after retirement, patients' expectations of improvement after surgery are also increasing. We analyzed the relationship between preoperative expectations and postoperative satisfaction and self-reported outcomes with regard to pain and physical function after knee arthroplasty. Patients and methods 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51-86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations, satisfaction, and relevance of the outcome to the patient. These investigations took place preoperatively and postoperatively after 6 months, 1 year, and 5 years of follow-up. Results Response rate at 5 years was 86%. In general, the patients' preoperative expectations were higher than their postoperative ability. For example, 41% expected to be able to perform activities such as golfing and dancing while only 14% were capable of these activities at 5 years. Having high or low preoperative expectations with regard to walking ability or leisure-time activities had no influence on the KOOS scores postoperatively. 93% of the patients were generally satisfied 5 years postoperatively, while 87% were satisfied with the relief of pain and 80% with their improvement in physical function at that time. Interpretation With an expanding population of mentally alert elderly, we can expect that great demands will be put on joint replacements. This study shows that patients have high preoperative expectations concerning reduction of pain. To a considerable extent, these expectations are fulfilled after one year. Expectations concerning demanding physical activities are not fulfilled to the same degree; however, most patients reported general satisfaction with the outcome indicating that satisfaction is not equivalent to fulfilled expectations. Preoperative counseling should include realistic information on outcomes concerning physical function and pain relief.
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| 11. |
- Toksvig-Larsen, Sören, et al.
(författare)
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Inferior fixation with a new pin design for external fixation: A randomized study in 50 patients operated on by the hemicallotasis technique.
- 2008
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 79:1, s. 48-52
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Tibial osteotomy by the hemicallotasis technique (HCO) requires strong pin fixation. We compared pin fixation in HCO using a new self-drilling XCaliber pin (Orthofix) with optimized thread and tip design, with the commonly used standard pin (Orthofix). Patients and methods 50 patients, mean age 51 (35-66) years, to be treated by HCO were randomized to standard pins or XCaliber pins. In the metaphyseal bone, hydroxyapatite-coated (HA-coated) pins were used in both types of pins. In the diaphyseal bone, non-coated pins were used. The torque forces for insertion and extraction (in Nm) were measured. Results The insertion torque was higher for both the proximal and distal standard pins (2.1 Nm (SD 0.9) and 7.0 Nm (1.3), respectively) than for the XCaliber pins (1.3 Nm (0.8) and 3.6 Nm (1.4)). The extraction torque force was higher for the proximal standard pins (4.3 Nm (3.1)) than for the proximal XCaliber pins (1.5 Nm (1.7)) (p < 0.001). The extraction torque for the distal standard pins was 1.9 Nm (2.0) and for the distal XCaliber pins it was 1.4 Nm (1.1). Interpretation The commonly used standard pin gives stronger fixation during the treatment of HCO.
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| 12. |
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| 13. |
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| 14. |
- W-Dahl, Annette, et al.
(författare)
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A 2-year prospective study of patient-relevant outcomes in patients operated on for knee osteoarthritis with tibial osteotomy
- 2005
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Tibial osteotomy is a treatment for younger and/or physically active patients suffering from uni-compartmental knee osteoarthritis. The open wedge osteotomy by the hemicallotasis technique includes the use of external fixation. The use of external fixation has several advantages, as early mobilization and the opportunity for optimal correction. However, the hemicallotasis technique has also been described as a cumbersome procedure for the patient. The aim of this study was to prospectively evaluate patient-relevant outcomes during the first 2 postoperative years. Especially the treatment period, during which external fixation was used, was closely monitored. Methods: In an uncontrolled study, fifty-eight consecutive patients, 30 men and 28 women ( mean age 54 years) were operated on by the hemicallotasis technique were evaluated with the patient-relevant outcome measure Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively, during the treatment with external fixation, one week after removal of the external fixation, at 6 months, and at one and two years postoperatively. Results: At the 2-year postoperative follow-up, all subscales of the KOOS were improved ( p < 0.001), mostly in pain ( 41 - 80 on a 0 - 100 worst to best scale) and knee-related quality of life ( 21 61 on a 0 - 100 worst to best scale), compared to the preoperative status. Significant improvements in pain and other symptoms, function of daily life and quality of life were seen already during the treatment period ( mean 98 +/- 18 days) with the external fixation. More demanding functions such as kneeling, squatting, jumping and running, were improved first after extraction of the external fixation device and the pins. Conclusion: Tibial osteotomy by the hemicallotasis technique yields large improvement in self-rated pain, function and quality of life, which persists over two years. Surprisingly, large improvements occurred already during the immediate post-operative period when the external fixation was still used.
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| 15. |
- W-Dahl, Annette, et al.
(författare)
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Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study.
- 2009
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 10:Dec 8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The association between knee alignment and knee pain in knee osteoarthritis (OA) is unclear. High tibial osteotomy, a treatment option in knee OA, alters load from the affected to the unaffected compartment of the knee by correcting malalignment. This surgical procedure thus offers the possibility to study the cross-sectional and longitudinal association of alignment to pain. The aims were to study 1) the preoperative association of knee alignment to preoperative knee pain and 2) the association of change in knee alignment with surgery to change in knee pain over time in patients operated on for knee OA by high tibial osteotomy. METHODS: 182 patients (68% men) mean age 53 years (34 - 69) with varus alignment having tibial osteotomy by the hemicallotasis technique for medial knee OA were consecutively included. Knee alignment was assessed by the Hip-Knee-Ankle (HKA) angle from radiographs including the hip and ankle joints. Knee pain was measured by the subscale pain (0 - 100, worst to best scale) of the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at one year follow-up. To estimate the association between knee alignment and knee pain multivariate regression analyses were used. RESULTS: Mean preoperative varus alignment was 170 degrees (153 - 178) and mean preoperative KOOS pain was 42 points (3 - 86). There was no association between preoperative varus alignment and preoperative KOOS pain, crude analysis 0.02 points (95% CI -0.6 - 0.7) change in pain with every degree of HKA angle, adjusted analysis 0.3 points (95% CI -1.3 - 0.6).The mean postoperative knee alignment was 184 degrees (171 - 185). The mean change in knee alignment was 13 degrees (0 - 30). The mean change in KOOS pain was 32 (-16 - 83). There was neither any association between change in knee alignment and change in KOOS pain over time, crude analysis 0.3 point (95% CI -0.6 - 1.2), adjusted analysis 0.4 points (95% CI 0.6 - 1.4). CONCLUSION: We found no association between knee alignment and knee pain in patients with knee OA indicating that alignment and pain are separate entities, and that the degree of preoperative malalignment is not a predictor of knee pain after high tibial osteotomy.
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| 16. |
- W-Dahl, Annette, et al.
(författare)
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Infection prophylaxis: a prospective study in 106 patients operated on by tibial osteotomy using the hemicallotasis technique.
- 2006
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer Science and Business Media LLC. - 1434-3916 .- 0936-8051. ; 126:7, s. 441-447
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Tibial osteotomy by the hemicallotasis technique is a clean elective operation. With external fixation pins inserted, close to the knee joint, the infection prophylaxis should be considered. The primary aim was to investigate the differences in the postoperative use of antibiotics during the time in external fixation between administrating prophylactic antibiotics for 3 days or as a single dose in patients operated on by the hemicallotasis technique for knee deformities. Secondary aims were to study the differences in pin-site infection rate and grade and complications. Material and methods A total of 106 consecutive patients of mean age 52 years (range 18-69) operated on by the hemicallotasis technique for knee deformities were included in this prospective study. Sixty patients were prescribed prophylactic antibiotics for 3 days and 46 patients as a single dose. Chlorhexidine (5 mg/ml) in alcohol (70% ethanol) was used as cleansing agent in the pin-site care. The power of the study was calculated to 80% to detect a difference in the postoperative use of antibiotics for 7 days during the treatment in external fixation. Results There were no differences in postoperative use of antibiotics between 3 days administration or a single dose of prophylactic antibiotics. This was the case with infection rate and grade, positive bacterial cultures, presence of Staphylococcus aureus, nor positive culturing from the tip of the pins at removal. Neither were there any differences in numbers of loose pins and complications. Conclusion There were no differences between 3 days of administration of prophylactic antibiotics and one single dose. One single dose of prophylactic antibiotics is appropriate together with a pin-site concept preventing pin-site infection in patients operated on by hemicallotasis osteotomy.
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| 17. |
- W-Dahl, Annette, et al.
(författare)
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No clinical benefits using a new design of pins for external fixation: a randomized study in 50 patients operated on by the hemicallotasis technique.
- 2008
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer Science and Business Media LLC. - 1434-3916 .- 0936-8051. ; 128:7, s. 661-667
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pin-site infection and pin loosening are complications that can cause discomfort to the patients. The purpose of present study was to evaluate pin-site infection, pain, and the use of medications using the XCaliber pin (Orthofix) with optimized thread and tip design, and the commonly used standard pin (Orthofix) during the procedure of hemicallotasis osteotomy (HCO). MATERIAL AND METHODS: Fifty patients of mean age 51 (35-66) years treated with HCO were randomized to standard pins (Orthofix) or XCaliber pins (Orthofix). Hydroxyapatite-coated pins were used in the metaphyseal bone and non-coated pins in the diaphyseal bone in both groups. Pin sites, pain, and the use of medications were evaluated weekly during the HCO. RESULTS: At week 7 the patients in the XCaliber group had more pain at rest [19 (22) vs. 5 (5) mm, P = 0.01] and during activity [32 (32) vs. 12 (13) mm, P = 0.02] and used more paracetamol (2,100 vs. 925 mg, P = 0.04) than those in the standard group, with similar differences, until the extraction of the pins. There was no difference in the use of antibiotics [10.5 (14.5) days (XCaliber) vs. 7 (7.5) days (standard) (P = 0.16)]. CONCLUSION: The commonly used standard pin has important clinical- and patient-related benefits.
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| 18. |
- W-Dahl, Annette, et al.
(författare)
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No delayed bone healing in Swedish male oral snuffers operated on by the hemicallotasis technique: A cohort study of 175 patients.
- 2007
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 78:6, s. 791-794
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose The effect of oral snuff on bone healing is virtually unknown. In vitro data have indicated that delay in bone healing in smokers may be the result of components of smoke other than nicotine. We compared the time for bone healing after high tibial osteotomy in snuffers, smokers, and in control subjects who did not use snuff or cigarettes. Patients and methods 175 male patients comprising 41 smokers, 21 oral snuff users, and 113 non-smokers/ non-snuffers, all of whom were operated on for knee deformity by tibial osteotomy using the hemicallotasis technique (HCO) between 2000 and 2005, were included in a consecutive manner. Preoperative tobacco use, postoperative complications, and treatment time in external fixation were documented. Results There was no delayed healing in the oral snuff users. The mean time in external fixation for all patients was 94 days (SD 20). Oral snuff users had the shortest time in external fixation (87 days (SD11)) compared to smokers (100 days (SD 25)) (p = 0.03) and non-smokers/non-snuffers (93 days (SD 14)). The risk ratio for smokers developing complications was 6.1 (95% CI: 1.2-36.4) compared with oral snuff users. Interpretation Our findings indicate that the use of oral snuff does not delay bone healing or increase the risk of postoperative complications, which cigarette smoking does, in patients operated on by the hemicallotasis technique.
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| 19. |
- W-Dahl, Annette, et al.
(författare)
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Undisturbed theatre dressing during the first postoperative week. A benefit in the treatment by external fixation: a cohort study.
- 2009
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Ingår i: Strategies in Trauma and Limb Reconstruction. - : Jaypee Brothers Medical Publishing. - 1828-8936 .- 1828-8928.
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Tidskriftsartikel (refereegranskat)abstract
- In the literature, there are several different suggestions as to when the first postoperative pin-site care should be carried out to best prevent pin-site infections during the treatment by external fixation. In a cohort study, we compared the use of antibiotics and complications in patients where the theatre dressing was changed during the first postoperative week with patients where the theatre dressings were left undisturbed for the first postoperative week. Sterile compresses moistened with chlorhexidine 5 mg/ml in alcohol (70%), draped around each pin site and fixed by a bandage, were used as theatre dressing. In all patients, cultures were taken 1 week postoperatively from each pin site; use of antibiotics and complications during the treatment was documented. In 101 consecutive patients (118 knees) (73% men, mean age 50, mean BMI 27.5 kg/m(2)) operated on by high tibial osteotomy for knee deformity using the hemicallotasis technique, during 2005-2006, the theatre dressings were left undisturbed during the first postoperative week in 90 patients (104 knees) of group 1, and in 11 patients (14 knees) of group 2, the theatre dressings were changed during the first postoperative week. Eight of 11 patients in group 2 were treated with antibiotics compared to 32 of 90 patients in group 1 (RR 2.0, 95% CI 1.6-2.7, p = 0.02) during the treatment period by external fixation. Patients with a disturbed theatre dressing during the first postoperative week had an increased use of antibiotics by 18.6 days (95% CI 10.6-26.5, p < 0.0001, adjusted analysis). Four of 11 patients in group 2 had complications and 11 of 90 in group 1, adjusted analysis (RR 2.7, 95% CI 0.4-16.2, p = 0.3). Bilateral surgery simultaneously showed increased use of antibiotics by 10.4 days (4.4, 16.4, p = 0.0009) and increased risk of complications (RR 5.8, 95% CI 1.2-27.5, p = 0.03). In conclusion, the increased use of antibiotics indicates that leaving the theatre dressing undisturbed during the first postoperative week is beneficial to the treatment by external fixation and is probably of importance in the prophylactic pin-site care.
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