Hand surgery makes up a large proportion of procedures, ranging from simple to complex. Increased complexity places greater demand on hand surgery competence. Furthermore, when surgical expertise is ...not matched to the procedure complexity, treatment injuries might occur. The purpose of this study was to assess patient-reported claims submitted to The Norwegian System of Patient Injury Compensation (NPE).
We examined all hand surgery claims submitted to NPE between 1 January 2007 and 30 June 2017. NPE records patient demography and variables, such as diagnosis, type of injury, injury location, the reason for the compensation claim, and whether a claim was accepted or rejected.
NPE received 1321 claims related to treatment injuries from hand surgery at a steady rate throughout the study period. A total of 532 claims were accepted (40.3%). The approval rate for trauma cases was significantly higher than for elective cases (45.5 vs. 34.2%, p < .05). The most common diagnoses were hand fractures, dislocations and ligament injuries, carpal tunnel syndrome and arthrosis of the first carpometacarpal joint. Tendon injuries had the highest percentage of accepted claims (52.6%). The most common reason for claims being accepted was 'failure of treatment'. 19.7% of these involved a disability percentage >15%. Elective surgery accounted for ⅔ of the approved disability cases.
This is the first national study of patient-reported injuries after hand surgery treatment in Norway. The proportion of accepted claims is similar to that seen for orthopaedics. Acceptance levels were, however, higher for hand trauma cases than for disorders treated electively.
NPE: Norwegian system of patient injury compensation; SD: standard deviation; CT: computed tomography; MRI: magnetic resonance imaging; UiT: University of Tromsø - Arctic University of Norway.
Spectral analysis of the laser Doppler flow (LDF) signal in the frequency interval from 0.0095–2.0 Hz reveals blood flow oscillations with frequencies around 1.0, 0.3, 0.1, 0.04 and 0.01 Hz. The ...heartbeat, the respiration, the intrinsic myogenic activity of vascular smooth muscle, the neurogenic activity of the vessel wall and the vascular endothelium influence these oscillations, respectively. The first aim of this study was to investigate if a slow oscillatory component could be detected in the frequency area below 0.0095 Hz of the human cutaneous blood perfusion signal. Unstimulated basal blood skin perfusion and enhanced perfusion during iontophoresis with the endothelium-dependent vasodilator acetylcholine (ACh) and the endothelium-independent vasodilator sodium nitroprusside (SNP) were measured in healthy male volunteers and the wavelet transform was computed. A low-frequency oscillation between 0.005 and 0.0095 Hz was found both during basal conditions and during iontophoresis with ACh and SNP. Iontophoresis with ACh increased the normalized amplitude to a greater extent than SNP (
P
=
0.001) indicating modulation by the vascular endothelium. To gain further insight into the mechanisms for this endothelium dependency, we inhibited nitric oxide (NO) synthesis with N
G-monomethyl-
l-arginine (
l-NMMA) and prostaglandin (PG) synthesis by aspirin.
l-NMMA did not affect the increased response to ACh vs. SNP iontophoresis in the 0.005–0.0095-Hz interval (
P
=
0.006) but abolished the difference in the 0.0095–0.021-Hz interval (
P
=
0.97). Aspirin did not affect the difference in response to ACh and SNP in either of the two frequency intervals. Thus, other endothelial mechanisms, such as endothelium-derived hyperpolarizing factor (EDHF), might be involved in the regulation of this sixth frequency interval (0.005–0.0095 Hz).
Nitric oxide (NO) and prostaglandines (PGs) are important in regulation of vascular tone and blood flow. Their contribution in human cutaneous circulation is still uncertain. We inhibited NO ...synthesis by infusing
N
G-monomethyl-
l-arginine (
l-NMMA) in the brachial artery (16 μmol/min for 5 min) and reversed it by intraarterial infusion of
l-arginine (40 μmol/min for 7.5 min). PG synthesis was inhibited by the cyclooxygenase inhibitor aspirin (600 mg over 5 min intravenously). Basal cutaneous perfusion and perfusion responses during iontophoresis with the endothelium-dependent vasodilator acetylcholine (ACh) and the endothelium-independent vasodilator sodium nitroprusside (SNP) were recorded by laser Doppler flowmetry (LDF). We performed wavelet transforms of the measured signals. Mean spectral amplitude within the frequency interval from 0.0095 to 1.6 Hz and mean and normalized amplitudes of five intervals around 1, 0.3, 0.1, 0.04, and 0.01 Hz were analysed. The oscillations with frequencies around 1, 0.3, 0.1, and 0.04 Hz are influenced by the heartbeat, the respiration, the intrinsic myogenic activity of vascular smooth muscle, and the neurogenic activity of the vessel wall, respectively. We have previously shown that the oscillation with a frequency around 0.01 Hz is modulated by the vascular endothelium.
l-NMMA reduced mean value of the LDF signal by ≈20% (
P = 0.0067). This reduction was reversed by
l-arginine. Mean value of the LDF signals during ACh and SNP iontophoresis did not change after infusion of
l-NMMA. Aspirin did not affect mean value of the LDF signal or the LDF signal during ACh or SNP iontophoresis. Before interventions the only significant difference between the effects of ACh and SNP was observed in the frequency around 0.01 Hz, where ACh increased normalized amplitude to a greater extent than SNP.
l-NMMA abolished this difference, whereas it reappeared after infusion of
l-arginine (
P = 0.0084). Aspirin did not affect this difference (
P = 0.006). We conclude that basal cutaneous blood flow and the endothelial dependency of the oscillation around 0.01 Hz are partly mediated by NO, but not by endogenous PGs. Other aspects of human cutaneous circulation studied are not regulated by NO or PGs.
The wavelet transform technique, a time-frequency method with logarithmic frequency resolution, was used to analyze oscillations in human peripheral blood flow measured by laser Doppler flowmetry. ...The oscillations extended over a wide frequency state and their periods varied in time. Within the frequency range studied, 0.0095-1.6 Hz, five characteristic oscillations were revealed, arising from both local and central regulatory mechanisms. After the insertion of endothelium-dependent and endothelium-independent vasodilators the spectra of blood how markedly differed in the frequency interval 0.0095-0.02 Hz. In this way it was demonstrated that endothelial activity is a rhythmic process that contributes to oscillations in blood flow with a characteristic frequency of around 0.01 Hz. The study illustrates the potential of laser Doppler flowmetry combined with dynamical systems analysis for studies of both the micro- and macroscopic mechanisms of blood flow regulation in vivo.
The purpose of the present study was to compare the effects of endothelium-dependent acetylcholine (ACh) and endothelium-independent sodium nitroprusside (SNP) vasodilators on the oscillatory ...components of the cutaneous blood perfusion signals in humans. The unstimulated basal blood perfusion and the blood perfusion during iontophoretically delivered ACh and SNP were measured using laser Doppler flowmetry (LDF). The wavelet transform was calculated before spectral analysis of the measured signals. In the frequency interval from 0.0095 to 1.6 Hz the LDF signal consists of oscillations with five different characteristic frequencies. In addition to the cardiac (1 Hz) and respiratory (0.3 Hz) rhythms, three other oscillations in the regions around 0.1, 0.04, and 0.01 Hz were detected. The oscillations with the different frequencies were observed in unstimulated blood flow and also during stimulation with ACh and SNP. Compared to the unstimulated blood flow, both ACh and SNP increased the mean amplitude of the total spectrum (P< 0.005 for both substances). The only significant difference between the effects of ACh and SNP was observed in the amplitude of oscillations with the frequency of around 0.01 Hz. ACh increased the absolute amplitude of this frequency to a greater extent than SNP in athletes (P= 0.03), whereas only a trend was observed in controls (P= 0.2). The relative amplitude, defined as the ratio between the absolute amplitude of a particular frequency interval and the mean amplitude of the total spectrum, was also higher for ACh compared to SNP both in controls (P= 0.008) and in athletes (P= 0.004), only for oscillations with the frequency of around 0.01 Hz. We conclude that ACh selectively influences the oscillatory component of around 0.01 Hz in the cutaneous blood perfusion signal to a greater extent than SNP. This finding indicates that endothelium-mediated vasodilatation is manifested as oscillations with a repetition time of approximately 1 min. The mechanisms for the endothelial dependency of this frequency remain to be elucidated. Our data indicate that spectral analysis based on wavelet transform of the cutaneous perfusion signal can be used clinically to investigate endothelial function. The described noninvasive method might be used to evaluate endothelial function for research, for diagnostic purposes, and maybe also to assess effects of therapy in cardiovascular diseases.
Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims ...due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation were "operative treatment should have been performed" (14/34) and "wrong operative method applied" (13/34). The mean amount per compensation was €14,927 (€0-€52,995). Stonger focus on quality of care, updated guidelines and shared decission-making may reduce the number og complains and compensations.
Treatment of distal radius fractures Kvernmo, Hebe Désirée; Krukhaug, Yngvar
Tidsskrift for den Norske Lægeforening,
2013-Feb-19, Volume:
133, Issue:
4
Journal Article
Peer reviewed
In light of the Norwegian Orthopaedic Association's wish to prepare guidelines for treatment of distal radius fractures, we have reviewed the knowledge base for the provision of such treatment.
The ...paper is based on systematic reviews of treatment of distal radius fractures from literature search in the following databases: the Cochrane Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE Cochrane), the Health Technology Assessment (HTA) database, PreMedline, Medline and Embase.
There is evidence for recommending percutaneous pinning of unstable, dorsally displaced distal radius fractures rather than conservative treatment, but which pinning method is best remains uncertain. There is also documentation to support the use of external fixation rather than conservative treatment. There is insufficient documentation available to draw conclusions regarding the relative efficacy of the various methods of external fixation, but external fixation in combination with adjuvant pinning of the fracture fragment enhances the result compared to external fixation alone. The evidence indicates that plates may enhance functional short-term results for unstable distal radius fractures compared to external fixation.
There is evidence in support of differentiated treatment of distal radius fractures. However, many questions remain unanswered, and good prospective, randomised multi-centre trials are needed.
Nerve tumour of the wrist Kjærvik, Christer; Kvernmo, Hebe Désirée; Bågenholm, Anna ...
Tidsskrift for den Norske Lægeforening
136, Issue:
22
Journal Article
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