Operative versus non-operative treatment for non-displaced Lisfranc injuries: A two-center randomized clinical trial.

Background And Aims: There is no consensus on which Lisfranc injuries can be treated non-operatively. The aim of the study was to compare non-operative treatment and open reduction and internal fixation (ORIF) in the treatment of non-displaced Lisfranc injuries.

Materials And Methods: This study was a multicenter randomized controlled trial (RCT) conducted at two hospitals in Finland between 19 March 2012, and 20 December 2022, with a target sample size of 60 patients.

Open Reduction Internal Fixation vs Primary Arthrodesis for Displaced Lisfranc Injuries: A Multicenter Randomized Controlled Trial.

Background: There is no consensus whether the primary surgical method should be open reduction and internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries. The aim of our randomized controlled trial was to compare ORIF and PA for displaced Lisfranc injuries.

Methods: This study was a national multicenter randomized controlled trial.

Outcomes after nonoperatively treated non-displaced Lisfranc injury: a retrospective case series of 55 patients.

Background: Current knowledge of the role of the nonoperative treatment of Lisfranc injuries is based on a few retrospective case series. Hence, consensus on which patients can be treated nonoperatively does not exist. The aim of this study was to investigate outcomes after nonoperative treatment of Lisfranc injuries.

Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries.

Background: Injury of the tarsometatarsal (TMT) joint complex, known as Lisfranc injury, covers a wide range of injuries from subtle ligamentous injuries to severely displaced crush injuries. Although it is known that these injuries are commonly missed, the literature on the accuracy of the diagnostics is limited. The diagnostic accuracy of non-weight-bearing radiography (inter- or intraobserver reliability), however, has not previously been assessed among patients with Lisfranc injury.

Incidence of hallux valgus primary surgical treatment. Finnish nationwide data from 1997 to 2014.

Background: Many surgical procedures have been described for hallux valgus. Evidence provided by the current literature on the different procedures is, however, poor. The purpose of this study was to assess the incidence of HV surgery in Finland between 1997 and 2014 and to find out whether changes in operation techniques of HV have occurred during the study period.

Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial.

Objective: To determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks.

Design: Randomised, pragmatic, non-inferiority, clinical trial with blinded outcome assessment.

Setting: Two major trauma centres in Finland, 22 December 2012 to 6 June 2016.

Incidence and Characteristics of Midfoot Injuries.

Background:: The epidemiology of midfoot injuries is poorly known. It has been estimated that the incidence of Lisfranc injuries (intra-articular injury in the tarsometatarsal joint) is 1/55 000 person-years and the incidence of Chopart injuries (intra-articular injury in the talonavicular and calcaneocuboidal joint) 4/100 000 person-years. The purpose of our study was to assess the computed tomography (CT) imaging-based incidence (per 100 000 person-years) and trauma mechanisms of midfoot injuries.

Nonoperative, open reduction and internal fixation or primary arthrodesis in the treatment of Lisfranc injuries: a prospective, randomized, multicenter trial - study protocol.

Background: Lisfranc injuries are known to be rare and often overlooked injuries that can cause long-term disability and pain when missed or treated incorrectly. The wide variety of Lisfranc injuries ranges from subtle ligament distensions to open fracture dislocations. The treatment of Lisfranc joint injuries is still controversial and very little is known about what types of injury can be treated nonoperatively.

Treatment of acute Achilles tendon rupture with a standardised protocol.

Introduction: A treatment protocol favouring non-operative treatment and based on early weight-bearing and early range-of-motion exercises was implemented in standard clinical care of a level I trauma clinic.

Materials And Methods: All patients treated due to acute Achilles tendon rupture between 2008 and 2014 were included in the study (n = 411). The patient records were retrospectively evaluated.

Epidemiology of calcaneal fractures in Finland.

Background: The purpose of this study was to assess the nationwide incidence (per 100,000 person-years) of operative treatment and hospitalization due to calcaneal fractures (CF) in Finland.

Methods: The study was based on the Finnish National Hospital Discharge Register. All patients aged 18-years or older admitted to Finnish hospitals for primary treatment of CF in 1987-2012 were included.

Re-organizing inpatient care saves legs in patients with diabetic foot infections.

Aims: In this study, we evaluated the effects of the re-organization of inpatient care for patients with a diabetic foot infection, and the implementation of a specialized multi-disciplinary wound department at an academic tertiary hospital.

Methods: This was a retrospective cohort study, comprising 272 patients treated for diabetic foot infections in 2006-2007 (Group 1, n=124) and 2013-2014 (Group 2, n=148). In 2012, inpatient care of all chronic wounds was centralized at a single wound department with a multi-disciplinary team.

The Elimination of Transfer Distances Is an Important Part of Hospital Design.

Objective: The objective of the present study was to describe how a specific patient flow analysis with from-to charts can be used in hospital design and layout planning.

Background: As part of a large renewal project at a university hospital, a detailed patient flow analysis was applied to planning the musculoskeletal surgery unit (orthopedics and traumatology, hand surgery, and plastic surgery).

Method: First, the main activities of the unit were determined.

[Optimization of working in the operating room by minimizing losses and improving flow].

The need for development of practices within the Finnish healthcare system is immense. Economic threats will force the system to streamline treatment processes without sacrificing quality. Surgical operations bind resources and represent one of the most expensive units in the hospital.

Hypertrophy of the flexor hallucis longus muscle after tendon transfer in patients with chronic Achilles tendon rupture.

Background: Flexor hallucis longus tendon (FHLT) transfer has become a popular method for reconstructing a chronic Achilles tendon rupture (ATR). The purpose of this study was to evaluate the clinical outcomes and possible hypertrophy of the FHL muscle after FHLT transfer in patients with chronic ATR.

Methods: Seven patients with chronic ATR underwent an FHLT transfer to heel through single incision.

Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: a prospective randomized trial.

Background: Bisphosphonates are commonly used as an adjuvant in the management of acute Charcot neuroarthropathy (CNA), although the clinical efficacy of the treatment is controversial. The aim of the present study is to investigate the effect of immobilization and zoledronic acid on bone mineral density (BMD) changes during the treatment of acute CNA.

Methods: Thirty-five patients with acute midfoot CNA were randomly assigned to treatment with either zolendronic acid or placebo.

Lisfranc injury in adolescents.

Background: There are only few studies of Lisfranc injuries in children and adolescents. The aim of this study was to evaluate the mid-term results of the operatively treated injuries.

Methods: Seven Lisfranc injuries of adolescents were treated operatively in the Tampere University Hospital between 2004 and 2009.

[When is ankle fracture treatable without surgery?].

Stability of a fractured ankle is the most important factor when considering the choice between operative and non-operative treatment. Depending on the mechanism of injury, the most common type of ankle fracture, spiral fracture of the lateral malleolus (Weber B) may be stable or unstable. It can be treated conservatively, provided that the shape of the ankle joint has remained intact in both projections and there is neither significant injury of deep deltoid ligament nor another fracture within the ankle region.

[Ankle ligament injury: diagnosis and functional therapy].

Primary treatment of acute ankle ligament injury is almost always conservative. The more severe injury is, the more careful initial treatment, rehabilitation and follow-up is required. If the rupture of ligaments is suspected, the ankle must be supported with an air splint or ankle support.

The effect of zoledronic acid on the clinical resolution of Charcot neuroarthropathy: a pilot randomized controlled trial.

Objective: To investigate the clinical efficacy of zoledronic acid in patients with diabetes and acute Charcot neuroarthropathy.

Research Design And Methods: Thirty-nine consecutive patients were randomly assigned to placebo or three intravenous infusions of 4 mg zoledronic acid. The primary outcome was clinical resolution of acute Charcot neuroarthropathy determined by total immobilization time (casting plus orthosis).

Orthotic insoles do not prevent physical stress-induced low back pain.

Orthotic insoles are suggested to prevent low back pain. This randomized controlled study assessed if customised orthotic insoles prevent low back pain. Healthy military conscripts (n = 228; mean age 19 years, range 18-29) were randomly assigned to use either customised orthotic insoles (treatment group, n = 73) or nothing (control group, n = 147).

Long-term outcome and quality of life in patients with Charcot foot.

Background: There is only sparse scientific data about the long-term effects of the Charcot foot on patients' lives and the clinical outcome. This study evaluates the long-term effects of diabetic Charcot foot.

Methods: A cross-sectional follow-up study of consecutive series of patients with Charcot foot referred to the University Hospital Diabetic Foot and Ankle Clinic between 1991 and 2002.