| 1. |
- Hernefalk, Björn, et al.
(författare)
-
Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery
- 2021
-
Ingår i: Scandinavian Journal of Surgery. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 110:1, s. 86-92
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Long-term prospective data on patient-reported outcome after surgical treatment of pelvic ring injuries are scarce. This study aimed at describing results at 5 years post-surgery using validated outcome measures.PATIENTS AND METHODS: Patients admitted for surgical treatment of pelvic ring injuries were prospectively included and asked to report their outcome at 1, 2 and 5 years post-surgery using two patient-reported outcome measures: the generic Short-Form 36 and the condition-specific pelvic discomfort index. Data were evaluated using mixed-effects linear models.RESULTS: There were 108 patients (68 males and 40 females), mean age 38 years. Injury type according to the AO/OTA-classification was B-type in 68 patients and C-type in 40 patients. No domain of the Short-Form 36 reached norm values at 5 years post-surgery. Females reported a worse outcome than males concerning general health (p < 0.01) at 5 years. Recovery of physical function (p < 0.01), mental health (p = 0.04), and pain (p = 0.01) was observed for males at 5 years compared to earlier assessments, while females on the contrary described more pain at this time-point (p = 0.03). Mean pelvic discomfort index at 5 years was 27, indicating moderate residual pelvic discomfort overall. Males reported less pelvic discomfort than females at 5 years (p = 0.02) and improved when compared to results at 2 years (p = 0.02), while females did not. Influence of age, fracture type, and presence of associated injuries on patient-reported outcome was limited.CONCLUSION: Surgically treated pelvic ring injuries are associated with long-standing negative effects on patient-reported outcome. Males report a better outcome than females at 5 years post-surgery.
|
|
| 2. |
- Hernefalk, Björn
(författare)
-
Surgical Treatment of Pelvic Ring Injuries and Acetabular Fractures : Aspects on Patient-reported Outcome
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis was to study the patient perspective on outcome following surgical treatment of pelvic ring injuries and acetabular fractures. All studies were based on patients treated for such injuries at the Department of Orthopaedics, Uppsala University Hospital, Sweden.In Study I, a patient-reported outcome measure to provide condition-specific information regarding outcome after surgical treatment of pelvic ring injuries was developed. Seventy-three patients were asked to complete a questionnaire at three time points during follow-up. Evaluation of data resulted in the Pelvic Discomfort Index (PDI). This instrument is comprised of six questions regarding residual problems from the pelvic region with respect to pain, walking, hip motion, leg numbness, sexual life and the operation scar.The influence of the time-point post-surgery at which patients with surgically treated pelvic ring injuries or acetabular fractures estimate their pre-traumatic state was examined in study II. Seventy-three patients assessed their pre-traumatic status at three time-points post-surgery. It was found that pre-traumatic quality of life was high and comparable to a reference population. Pre-existing discomfort from the pelvic region was uncommon. A tendency for patients to estimate a better pre-traumatic status when assessments were delayed was observed.The objective of Study III was to compare outcome after surgical treatment of complex acetabular fractures in the elderly using either the combined hip procedure, consisting of open reduction and internal fixation (ORIF) in conjunction with an acute total hip arthroplasty, or ORIF alone with respect to mortality, need for secondary surgery and patient-reported outcome. Thirteen patients treated with the CHP were compared to 14 patients with similar fracture patterns treated with ORIF alone. The CHP conferred a markedly reduced need for secondary surgical procedures while no differences in perioperative mortality or patient-reported outcome could be demonstrated.Patient-reported outcome at five years following surgical treatment of pelvic ring injury was evaluated in study IV. The consequences of these injuries were found to be substantial and long-standing. Females reported a worse outcome than males, while influence of variables age, injury type and presence of associated injuries was limited.In Study V, patient experiences of life following treatment for pelvic ring injury was explored. Semi-structured interviews were conducted with ten patients at a median of 11 years after injury and analyzed using inductive content analysis. Patients described a heterogenous outcome, with residual impairment ranging from virtually none to severe disability. A need for adequate patient information and individual assessments of patients was noted.
|
|
| 3. |
- Hulsart Billström, Gry, 1982-, et al.
(författare)
-
In vivo safety assessment of a bio-inspired bone adhesive
- 2020
-
Ingår i: Journal of materials science. Materials in medicine. - : SPRINGER. - 0957-4530 .- 1573-4838. ; 31:2
-
Tidskriftsartikel (refereegranskat)abstract
- A new class of materials, bone adhesives, could revolutionise the treatment of highly fragmented fractures. We present the first biological safety investigation of a bio-inspired bone adhesive. The formulation was based upon a modified calcium phosphate cement that included the amino acid phosphoserine. This material has recently been described as substantially stronger than other bioresorbable calcium phosphate cements. Four adhesive groups with the active substance (phosphoserine) and two control groups without phosphoserine were selected for in vitro and in vivo biocompatibility testing. The test groups were subject for cell viability assay and subcutaneous implantation in rats that was followed by gene expression analysis and histology assessment after 6 and 12 weeks. All adhesive groups supported the same rate of cell proliferation compared to the alpha-TCP control and had viability between 45-64% when compared to cell control. There was no evidence of an increased immune response or ectopic bone formation in vivo. To conclude, this bio-inspired bone adhesive has been proven to be safe, in the present study, without any harmful effects on the surrounding soft tissue.
|
|
| 4. |
- Pellegrini, Mariangela, et al.
(författare)
-
Inspiratory Efforts, Positive End-Expiratory Pressure, and External Resistances Influence Intraparenchymal Gas Redistribution in Mechanically Ventilated Injured Lungs
- 2021
-
Ingår i: Frontiers in Physiology. - : Frontiers Media S.A.. - 1664-042X. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Potentially harmful lung overstretch can follow intraparenchymal gas redistribution during mechanical ventilation. We hypothesized that inspiratory efforts characterizing spontaneous breathing, positive end-expiratory pressure (PEEP), and high inspiratory resistances influence inspiratory intraparenchymal gas redistribution.Methods: This was an experimental study conducted on a swine model of mild acute respiratory distress syndrome. Dynamic computed tomography and respiratory mechanics were simultaneously acquired at different PEEP levels and external resistances, during both spontaneous breathing and controlled mechanical ventilation. Images were collected at two cranial-caudal levels. Delta-volume images (ΔVOLs) were obtained subtracting pairs of consecutive inspiratory images. The first three ΔVOLs, acquired for each analyzed breath, were used for the analysis of inspiratory pendelluft defined as intraparenchymal gas redistribution before the start of inspiratory flow at the airway opening. The following ΔVOLs were used for the analysis of gas redistribution during ongoing inspiratory flow at the airway opening.Results: During the first flow-independent phase of inspiration, the pendelluft of gas was observed only during spontaneous breathing and along the cranial-to-caudal and nondependent-to-dependent directions. The pendelluft was reduced by high PEEP (p < 0.04 comparing PEEP 15 and PEEP 0 cm H2O) and low external resistances (p < 0.04 comparing high and low external resistance). During the flow-dependent phase of inspiration, two patterns were identified: (1) gas displacing characterized by large gas redistribution areas; (2) gas scattering characterized by small, numerous areas of gas redistribution. Gas displacing was observed at low PEEP, high external resistances, and it characterized controlled mechanical ventilation (p < 0.01, comparing high and low PEEP during controlled mechanical ventilation).Conclusions: Low PEEP and high external resistances favored inspiratory pendelluft. During the flow-dependent phase of the inspiration, controlled mechanical ventilation and low PEEP and high external resistances favored larger phenomena of intraparenchymal gas redistribution (gas displacing) endangering lung stability.
|
|
| 5. |
- Procter, Philip, et al.
(författare)
-
Gluing Living Bone Using a Biomimetic Bioadhesive : From Initial Cut to Final Healing
- 2021
-
Ingår i: Frontiers in Bioengineering and Biotechnology. - : Frontiers Media S.A.. - 2296-4185. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- Osteoporotic fractures are a growing issue due to the increasing incidence of osteoporosis worldwide. High reoperation rates in osteoporotic fractures call for investigation into new methods in improving fixation of osteoporotic bones. In the present study, the strength of a recently developed bone bioadhesive, OsStictm, was evaluated in vivo using a novel bone core assay in a murine animal model at 0, 3, 7, 14, 28, and 42 days. Histology and micro-CT were obtained at all time points, and the mean peak pull-out force was assessed on days 0–28. The adhesive provided immediate fixation to the bone core. The mean peak bone core pull-out force gradually decreased from 6.09 N (σ 1.77 N) at day 0 to a minimum of 3.09 N (σ 1.08 N) at day 7, recovering to 6.37 N (σ 4.18 N) by day 28. The corresponding fibrin (Tisseel) control mean peak bone core pull-out characteristic was 0.27 N (σ 0.27 N) at day 0, with an abrupt increase from 0.37 N (σ 0.28) at day 3, 6.39 N (σ 5.09 N) at day 7, and continuing to increase to 11.34 N (σ 6.5 N) by day 28. The bone cores failed either through core pull-out or by the cancellous part of the core fracturing. Overall, the adhesive does not interrupt healing with pathological changes or rapid resorption. Initially, the adhesive bonded the bone core to the femur, and over time, the adhesive was replaced by a vascularised bone of equivalent quality and quantity to the original bone. At the 42 day time point, 70% of the adhesive in the cancellous compartment and 50% in the cortical compartment had been replaced. The adhesive outwith the bone shell was metabolized by cells that are only removing the material excess with no ectopic bone formation. It is concluded that the adhesive is not a physical and biochemical barrier as the bone heals through the adhesive and is replaced by a normal bone tissue. This adhesive composition meets many of the clinical unmet needs expressed in the literature, and may, after further preclinical assessments, have potential in the repair of bone and osteochondral fragments.
|
|
