| 1. |
- Bergdahl, Carl, et al.
(författare)
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Completeness in the Swedish Fracture Register and the Swedish National Patient Register: An Assessment of Humeral Fracture Registrations
- 2021
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Ingår i: Clinical Epidemiology. - 1179-1349. ; 13, s. 325-333
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Register-based clinical research is important. However, it is essential that the collected data are reliable for the registers to be a valuable source of information. This study evaluated the quality of humeral fracture data in the Swedish Fracture Register (SFR) and in the Swedish National Patient Register (NPR). Furthermore, a model for improved case ascertainment was developed for future validation processes. Materials and Methods: Data were obtained from the NPR and SFR for all individuals aged >= 16 years with an acute humeral fracture ICD-code treated at Sahlgrenska University Hospital. The true number of humeral fractures ("gold standard") was determined by crosslinkage between the two registers and a medical charts review. The completeness of registrations in each register was measured as the proportion of registrations compared with the gold standard, and accuracy was measured as positive predictive values (PPV). Results: The NPR demonstrated a high level of completeness (97%) and lower accuracy (PPV 70%) for acute humeral fractures, whereas the SFR had slightly lower completeness (88%) but perfect accuracy (PPV 100%). The most common systematic error was the registration of re-admissions as acute fractures in the NPR (84% of all erroneous registrations). With this knowledge, an adjustment model for NPR data was constructed to increase the accuracy of fracture registrations (PPV 92%) without excluding valid registrations. Conclusion: Data from the NPR tend to overestimate the true number of fractures, and proper case selection is needed in order for the data to function as a solid basis for epidemiological research and healthcare planning. In contrast, the SFR constitutes a complete, accurate and efficient source of information.
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| 2. |
- Bergvall, M., et al.
(författare)
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Validity of classification of distal radial fractures in the Swedish fracture register
- 2021
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Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDistal radial fractures (DRF) are one of the most common fractures with a small peak in incidence among young males and an increasing incidence with age among women. The reliable classification of fractures is important, as classification provides a framework for communicating effectively on clinical cases. Fracture classification is also a prerequisite for data collection in national quality registers and for clinical research. Since its inception in 2011, the Swedish Fracture Register (SFR) has collected data on more than 490,000 fractures. The attending physician classifies the fracture according to the AO/OTA classification upon registration in the SFR. Previous studies regarding the classification of distal radial fractures (DRF) have shown difficulties in inter- and intra-observer agreement. This study aims to assess the accuracy of the registration of DRF in adults in the SFR as it is carried out in clinical practice.MethodsA reference group of three experienced orthopaedic trauma surgeons classified 128 DRFs, randomly retrieved from the SFR, at two classification sessions 6 weeks apart. The classification the reference group agreed on was regarded as the gold standard classification for each fracture. The accuracy of the classification in the SFR was defined as the agreement between the gold standard classification and the classification in the SFR. Inter- and intra-observer agreement was evaluated and the degree of agreement was calculated as Cohen's kappa.ResultsThe accuracy of the classification of DRF in the SFR was kappa=0.41 (0.31-0.51) for the AO/OTA subgroup/group and kappa=0.48 (0.36-0.61) for the AO/OTA type. This corresponds to moderate agreement. Inter-observer agreement ranged from kappa 0.22-0.48 for the AO/OTA subgroup/group and kappa 0.48-0.76 for the AO/OTA type. Intra-observer agreement ranged from kappa 0.52-0.70 for the AO/OTA subgroup/group and kappa 0.71-0.76 for the AO/OTA type.ConclusionsThe study shows moderate accuracy in the classification of DRF in the SFR. Although the degree of accuracy for DRF appears to be lower than for other fracture locations, the accuracy shown in the current study is similar to that in previous studies of DRF.
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| 3. |
- Schmidt, Viktor, et al.
(författare)
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Epidemiology, treatment, and mortality of 3,983 scapula fractures from the Swedish fracture register
- 2024
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Ingår i: Journal of shoulder and elbow surgery. - : Elsevier. - 1058-2746 .- 1532-6500.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Scapula fractures are relatively uncommon, accounting for <1% of all fractures and approximately 3-5% of shoulder girdle fractures. This study comprehensively describes the epidemiology, fracture classification, treatment, and mortality associated with scapula fractures within a large adult Swedish population.METHODS: This observational study included all patients ≥18 years old at the time of injury with a scapula fracture (ICD S42.1) registered in the Swedish Fracture Register between March 2011 and June 2020. Variables studied were age, sex, and injury mechanism, including energy level, fracture classification, associated fractures, treatment, and mortality.RESULTS: We included 3,930 patients (mean age 58 years, SD 18, 64% men) with 3,973 scapula fractures. Some 22% of the fractures were caused by high-energy trauma and 21% had at least one associated fracture. High energy-injuries were most common in glenoid neck (44%) and scapular body (35%) fractures. However, same-level falls were the most common cause of glenoid rim (62%) and intra-articular glenoid (55%) fractures. Clavicle fractures (9%) and proximal humerus fractures (5%) were the most commonly associated fractures. The most common fracture types were the glenoid rim (n=1,289, 32%) and scapular body (n=1,098, 28%) fractures. Nonoperative treatment was performed in 81% of patients. Glenoid rim and intra-articular glenoid fractures were treated operatively in over 30% of cases. The mortality rate for the whole cohort was 4% at 1 year.CONCLUSIONS: Scapula fractures are predominately sustained by men. High energetic injuries and associated fractures are present in one in five patients. Nonoperative treatment is chosen in four of five patients, but for some fracture types one in three undergo surgery.
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| 4. |
- Agardh, Carl-David, et al.
(författare)
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Desensitisation as a means of preventing untoward reactions to ionic contrast media
- 1983
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Ingår i: Acta Radiologica Diagnosis. - 0567-8056. ; 24:3, s. 235-239
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Tidskriftsartikel (refereegranskat)abstract
- Patients with a previous history of anaphylactic reactions to ionic iodinated contrast media were desensitised before a second radiologic examination was performed. The tolerance to the contrast medium was raised by repeated intravenous injections in increasing doses and concentrations. No serious side effects were noted when the examinations with contrast medium was repeated within a few days after the desensitisation. The positive effect of the desensitisation may depend on a successive consumption of complement proteins, probably responsible for the allergic reactions. Therefore, the available amount of complement for some days may be too low for the occurrence of a complement reaction.
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| 5. |
- Andersson, Ronny, et al.
(författare)
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ICT och BIM i japanska byggindustrin
- 2010
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Ingår i: Samhällsbyggaren. - 2000-2408. ; :6, s. 46-51
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Den japanska byggsektorn är ofta ett föredöme för vår egen industris omvandling, t.ex. inom industrialisering och lean. Även när det gäller tillämpning och utveckling av Informations- och Kommunikations- Teknologi, ICT, t.ex. för BIM, ByggnadsInformationsModellering, har man mångårig avancerad erfarenhet som är intressant för oss att ta del av. Samtidig visar det sig att användningen och erfarenheterna av ICT och BIM delvis skiljer sig från motsvarande i Sverige. Detta kunde vi konstatera vid en nyligen genomförd studieresa till Japan som arrangerades av Centrum för Informationsteknik i Samhällsbyggnad, CITS, vid LTH, se även tidigare artikel i nr 3/2010 av Samhällsbyggaren.
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| 6. |
- Auffret, Alistair, et al.
(författare)
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Can field botany be effectively taught as a distance course? Experiences and reflections from the COVID-19 pandemic
- 2022
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Ingår i: AoB PLANTS. - : Oxford University Press (OUP). - 2041-2851. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 pandemic that started in 2020 forced a rapid change in university teaching, with large numbers of courses switching to distance learning with very little time for preparation. Courses involving many practical elements and field excursions required particular care if students were to fulfil planned learning outcomes. Here, we present our experiences in teaching field botany in 2020 and 2021. Using a range of methods and tools to introduce students to the subject, promote self-learning and reflection and give rapid and regular feedback, we were able to produce a course that allowed students to achieve the intended learning outcomes and that obtained similarly positive student evaluations to previous years. The course and its outcomes were further improved in 2021. We describe how we structured field botany as a distance course in order that we could give the best possible learning experience for the students. Finally, we reflect on how digital tools can aid teaching such subjects in the future, in a world where public knowledge of natural history is declining.In an era of large-scale biodiversity change and reductions in basic knowledge of natural history, it is important that practical courses in subjects like field botany continue to be taught effectively. Forced by the COVID-19 pandemic to teach plant identification with no direct contact with students, we used a range of methods and tools to promote self-learning and reflection in students, and to facilitate rapid feedback by teachers. Here, we present our method for producing a course that allowed students to achieve the intended learning outcomes and that obtained positive student evaluations.
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| 7. |
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| 8. |
- Bojan, Alicja J., 1980, et al.
(författare)
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Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures.
- 2013
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Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The most common mechanical failure in the internal fixation of trochanteric hip fractures is the cut-out of the sliding screw through the femoral head. Several factors that influence this complication have been suggested, but there is no consensus as to the relative importance of each factor.The purpose of this study was to analyse the cut-out complication with respect to the following variables: patients' age, fracture type, fracture reduction, implant positioning and implant design. METHODS: 3066 consecutive patients were treated for trochanteric fractures with Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l`Orthopedie (CTO), Strasbourg, France. Cut-out complications were identified by reviewing all available case notes and radiographs. Subsequently, the data were analysed by a single reviewer (AJB) with focus on the studied factors. RESULTS: Seventy-one cut-out complications were found (2.3%) of the 3066 trochanteric fractures. Cut-out failure associated with avascular head necrosis, pathologic fracture, deep infection or secondary to prior failure of other implants were excluded from the study (14 cases). The remaining 57 cases (1.85 %, median age 82.6, 79% females) were believed to have a biomechanical explanation for the cut-out failure. 41 patients had a basicervical or complex fracture type. A majority of cut-outs (43 hips, 75%) had a combination of the critical factors studied; non-anatomical reduction, non-optimal lag screw position and the characteristic fracture pattern found. CONCLUSIONS: The primary cut-out rate of 1.85% was low compared with the literature. A typical cut-out complication in our study is represented by an unstable fracture involving the trochanteric and cervical regions or the combination of both, non-anatomical reduction and non-optimal screw position. Surgeons confronted with proximal femoral fractures should carefully scrutinize preoperative radiographs to assess the primary fracture geometry and fracture classification. To reduce the risk of a cut-out it is important to achieve both anatomical reduction and optimal lag screw position as these are the only two factors that can be controlled by the surgeon.
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| 9. |
- Bojan, Alicja J., 1980, et al.
(författare)
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Three-dimensional bone-implant movements in trochanteric hip fractures. Precision and accuracy of radiostereometric analysis in a phantom model.
- 2015
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Ingår i: Journal of orthopaedic research : official publication of the Orthopaedic Research Society. - : Wiley. - 1554-527X. ; 33:5, s. 705-11
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Tidskriftsartikel (refereegranskat)abstract
- The accuracy and precision of RSA was evaluated in the experimental study of screw cut-out complication after fixation of trochanteric fractures. A plastic bone model of a two-part trochanteric fracture was constructed with a Gamma nail implant incorporating RSA markers. The femoral head fragment was attached to a separate rotational table and the femoral shaft was mounted on the micrometer. Three main motions were simulated: femoral head translation and rotation along the axis of the lag screw and fracture fragment translation along anatomical axes. Accuracy and precision were determined according to ISO 16087 and ASTM standard F2385-04. Translations along the lag screw axis were measured with a precision within±0.14mm and an accuracy within±0.03mm. With simultaneous translations along all three anatomical axes, lowest precision was measured for the x-axis (±0.29mm, 0.07mm respectively), but improved when analyzed as a vector (±0.08mm, 0.03mm). The precision and accuracy of femoral head rotations were within 0.5° and 0.18°, respectively. The resolution of the RSA method tested in this model was high, though it varied depending on the type of analyzed motion. This information is valuable when selecting and interpreting outcome parameters evaluating implant migration and osteosynthesis stability in future clinical RSA studies. This article is protected by copyright. All rights reserved.
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| 10. |
- Bojan, Alicja J., 1980, et al.
(författare)
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Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study
- 2018
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Ingår i: Injury-International Journal of the Care of the Injured. - : Elsevier BV. - 0020-1383. ; 49:3, s. 673-679
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Tidskriftsartikel (refereegranskat)abstract
- Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out. (C) 2018 Elsevier Ltd. All rights reserved.
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