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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_4 | Pages 30 - 30
1 Jan 2013
Hartvigsen J Davidsen M Hestbaek L Søgaard K Roos E
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Background and purpose

Over the past decade, it has become apparent that more often than not musculoskeletal pain occurs in more than one site in an individual, and traditional approaches, where pain has been studied as a narrow site-specific problem, are often not feasible. The overall aim of this study is to describe clusters of pain using a large population-based sample. This presentation will focus specifically on musculoskeletal co-complaints in back pain sufferers.

Methods and results

The Danish National Institute of Public Health has since 1987 conducted national representative health interview surveys of the adult Danish population some of which have included questions on musculoskeletal complaints. We used latent class analysis to identify latent classes of musculoskeletal complaints that occurred alongside a primary complaint of back pain. In addition, probabilities that specific sites occurred as co-complaints were determined. Three latent classes were identified and they exhibited quite different patterns of musculoskeletal co-complaints. The most commonly occurring class had a low probability of any co-complaints, the second most commonly occurring class had a high probability of pain in the neck, shoulders and mid-back, while the least commonly occurring class had very high probabilities of pain at all other body sites.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 108 - 108
1 May 2011
Engell V Hvid I Moller-Madsen B Davidsen M
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Osteogenesis imperfecta is a heterogeneous group of collagen type 1 defects. The resulting fragile bone with increased risk of fractures and deformity is the primary orthopaedic challenge. Surgical treatment is aimed at reducing the risk of fracture, correcting deformity and improving ambulatory status.

Management of the growing child with extensible intramedullary device was introduced in the 1960’s by Bailey and Dubow. Since then a number of different nails have been used. The current report presents our experience with the Fassier-Duval intramedullary nail in the first ten patients.

Materials and Method: The first ten children who had been operated between 2005 and 2008 with the Fassier-Duval (FD) nail were reviewed. The indication for surgery in all patients was to stabilise the long bones of the lower extremity to promote mobility. Correction of the axis of the long bones was obtained with wedged osteotomies. There where 7 girls and 3 boys.

Median follow-up was 2 years and 3 months (Range 1 – 4 years and 3 month).

Results: 22 FD nails were inserted in 13 operations in 10 children. 8 FD nails (4 operations) were primary FD nail insertions. The mean age at insertion was 2 years. 14 FD nails (9 operations) were exchanges of other devices. In this group the mean age at insertion of the FD nail was 6 years. In both groups mean admission was 4,5 days.

5 operations were reoperations due to complications. All of these were in femora. 5 patients had a fracture despite the nail. 3 were reoperated due to bending or perforation of the nail. 2 were treated conservatively. All 5 healed uneventfully. 1 patient was reoperated 3 times. First due to migration of the nail, secondly failure of the nail to elongate and thirdly because of a fracture with bending of the nail. There were no infections, neurological- or vascular damage.

At follow-up 6 patients were walking without any aid. 2 were mobilised with aids. 2 were mobilised in wheelchair.

No radiographic evidence of growth arrest has been noted secondary to the crossing of the epiphysealplate by the nails.

Discussion: Our result supports the reported benefits of extensible intramedullary device in children suffering from osteogenesis imperfecta. Minimizing the crippeling effects of OI is aimed at reducing the risk of fracture, correcting deformity and improving ambulatory status. There are also complications with the Fassier-Duval nail. However these are less than reported with other extensible intramedullary nails. Indeed one could in some cases argue that a bended nail or a fracture after nail insertion is a consequence of the better mobility on the way to a better quality of life.