| 1. |
- Sundkvist, Jonas, et al.
(författare)
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Basicervical femoral neck fractures : an observational study derived from the Swedish fracture register
- 2024
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden. - 1745-3674 .- 1745-3682. ; 95, s. 250-255
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Limited research has been conducted on basicervical femoral neck fractures (bFNFs). The importance of displacement in clinical outcomes remains unclear. We aimed to characterize patient demographics, degree of displacement, treatment, treatment failures, and reoperations in a cohort of fractures from the Swedish Fracture Register (SFR).METHODS: 1,260 fractures in 1,185 individuals ≥ 60 years who had a bFNF registered in the SFR at 6 orthopedic departments from 2011 to 2020 were screened through radiographic review. The final sample included 291 patients with a confirmed bFNF. The medical records of these 291 patients were reviewed. We assessed baseline characteristics, initial fracture dislocation, treatment methods, tip-apex distance, failures, reoperations, and mortality.RESULTS: The mean age was 82 years (range 60-101, 55% women). 98 (34%) were undisplaced and 193 (66%) displaced. All patients underwent operative treatment. In the undisplaced group 95 (97%) patients received internal fixation (IF) and 3 (3%) had primary hip arthroplasty. In the displaced group 149 (77%) received IF and 41 (21%) had primary hip arthroplasty. 33 (11%) suffered treatment failure. When treating an undisplaced bFNF with IF, only 3 (3%) experienced treatment failure, in contrast to the 24 (16%) failure rate for a displaced bFNF.CONCLUSION: Undisplaced bFNFs have a low failure rate when treated with IF. For displaced bFNF treated with IF the failure rate is considerably higher. There is a need for further investigation of classification, treatment, and outcome of bFNF.
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| 2. |
- Lundqvist, Eva, 1985-
(författare)
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Distal radius fractures AO type C : A clinical and radiographic investigation
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The function of the hand is of substantial importance, and injuries have an impact on daily life. Distal radius fracture (DRF) is the most common fracture among adults. The annual incidence is 26 per 10,000 inhabitants, and the incidence is increasing because of an aging population. There has been a shift from conservative and other operative treatments, toward volar plate fixation to restore the anatomy and improve results. Operative treatment is often considered for displaced and unstable fractures. The optimal choice of treatment and fixation is still debated. The aim of this thesis was to study results after internal fixation of DRF AO type C.Study I (retrospective study, n=74) assessed outcomes after combined plating (CP) of DRFs AO type C, with 1-year follow-up. CP restored the anatomy and achieved a good functional outcome. The radiographic outcome did not correspond to the clinical or functional outcome.Study II (prospective study, n=97) assessed the prevalence of post-traumatic arthritis (PA) following CP of DRFs AO type C. CP yielded a good clinical outcome 7 years postoperatively and the prevalence of PA was low (29%). The presence of PA did not correlate with fracture group, radio-graphic, clinical, or functional outcome. Study III (randomized controlled trial, n=147) assessed the radiographic and clinical outcome following surgical treatment of DRFs AO type C, comparing volar plating (VP) with CP. Fixation with VP yieldedthe same radiographic and functional results as CP, but with a lower frequency of complications in the VP group.Study IV (prospective pilot study, n=10) assessed fragment migration with CTMA (CT-based micromotion analysis) after osteosynthesis with VP after DRF AO type C. The CTMA technique indicated that variable angle volar locking plate fixation can yield and maintain a stable reduction of the fracture fragments. CT volume registration could be a valuable tool in the detailed assessment of fracture fragment migration following VP fixation of DRFs.
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| 3. |
- Lundqvist, Eva, 1985-, et al.
(författare)
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Posttraumatic Arthritis After Combined Plating of Distal Radius Fractures AO Type C : A 7-Year Follow-up of 97 Cases
- 2022
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Ingår i: Hand (New York, N.Y.). - : Sage Publications. - 1558-9447 .- 1558-9455. ; :Sup. 1, s. 50S-59S
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Volar locking plate fixation is the most common method of operative fixation of distal radius fractures (DRFs). For more complex cases, combined plating is an option for stabilizing intra-articular fragments. The prevalence of posttraumatic arthritis (PA) after an intra-articular DRF, and its relation to patient-reported outcome measures (PROMs), remains unclear. The purpose of this study was to study the prevalence of PA and its correlation to clinical outcome measures.METHODS: We evaluated 97 consecutive patients with intra-articular DRF, operated with combined plating, 7 years postoperatively. The primary outcome measure was the prevalence of radiographic PA. Secondary outcome measures included visual analog scale (VAS) pain score, hand grip strength, wrist range of motion (ROM), Patient-Rated Wrist Evaluation (PRWE) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographic examination was performed between 1 and 7 years postoperatively.RESULTS: The prevalence of PA was 29% at the 7-year follow-up. No correlation was found between PA and ROM, hand grip strength, PRWE, QuickDASH, VAS pain scores, or radiographic reduction. Median wrist ROM and grip strength were significantly inferior compared with the uninjured side. Hardware removal was performed in 51.5% of cases. There were 2 cases of tendon ruptures.CONCLUSIONS: Combined plating can yield a good clinical outcome 7 years postoperatively and a low prevalence of PA. The presence of PA did not correlate to clinical outcome measures or to the accuracy of anatomical reduction 1 year postoperatively. The frequency of tendon ruptures was acceptable, but the high frequency of hardware removal is a concern.
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| 4. |
- Lundqvist, Eva, 1985-, et al.
(författare)
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Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures : A Randomized Controlled Study of 150 Cases
- 2022
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Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564. ; 47:9, s. 813-822
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating.METHODS: In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score.RESULTS: Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group.CONCLUSIONS: In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
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| 5. |
- Pandey, Gaurav Kumar, et al.
(författare)
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The risk-associated long noncoding RNA NBAT-1 controls neuroblastoma progression by regulating cell proliferation and neuronal differentiation.
- 2014
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Ingår i: Cancer Cell. - : Elsevier BV. - 1535-6108 .- 1878-3686. ; 26:5, s. 722-737
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Tidskriftsartikel (refereegranskat)abstract
- Neuroblastoma is an embryonal tumor of the sympathetic nervous system and the most common extracranial tumor of childhood. By sequencing transcriptomes of low- and high-risk neuroblastomas, we detected differentially expressed annotated and nonannotated long noncoding RNAs (lncRNAs). We identified a lncRNA neuroblastoma associated transcript-1 (NBAT-1) as a biomarker significantly predicting clinical outcome of neuroblastoma. CpG methylation and a high-risk neuroblastoma associated SNP on chromosome 6p22 functionally contribute to NBAT-1 differential expression. Loss of NBAT-1 increases cellular proliferation and invasion. It controls these processes via epigenetic silencing of target genes. NBAT-1 loss affects neuronal differentiation through activation of the neuronal-specific transcription factor NRSF/REST. Thus, loss of NBAT-1 contributes to aggressive neuroblastoma by increasing proliferation and impairing differentiation of neuronal precursors.
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| 6. |
- Bjorling, Patrik, et al.
(författare)
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Ten Year Follow-up After Total Wrist Arthroplasty
- 2017
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Konferensbidrag (refereegranskat)abstract
- Hypothesis Total wrist arthroplasty (TWA) is an option in the management of wrist arthritis. The aim of the study was to evaluate the long-term results of TWA.Methods In this cohort study, we followed 56 cases that underwent TWA (Avanta, Biax, Universal 2 and Maestro) between 2005 and 2006 at a single-center. Data was collected preoperatively and 10 years postoperatively. Patient-related outcome measures, grip strength, range of motion (ROM), VAS pain scores were analyzed.Results VAS pain scores and patient-related measures were significantly improved at the 10-year follow-up. Jamar grip strength was also significantly improved. ROM remained largely unchanged, except for extension which improved significantly at the 10-year follow-up. Five of 56 TWAs were revised. Five patients died of unrelated causes and 10 were lost to follow-up.Summary Points This study shows good long-term results after TWA with a high level of patient satisfaction. The revision rate was acceptable.
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| 7. |
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| 8. |
- Fischer, Per, 1981-, et al.
(författare)
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Functional and kinematic analysis of a wrist radial hemiarthroplasty design
- 2017
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Konferensbidrag (refereegranskat)abstract
- Hypothesis A radial hemiarthroplasty could obviate difficulties related to distal component loosening of the total wrist arthroplasty. The aim of this study is to investigate kinematically, the feasibility of a new design for radial wrist hemiarthroplasty.Methods Six, fresh-frozen cadaveric wrist specimens were used. Testing was performed on the native wrist, after insertion of a radial hemi-arthroplasty with intact proximal carpal row (Hemi) and with proximal row carpectomy (Hemi+PRC). Each wrist was fixed to an experimental table with the tendons of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and abductor pollicis longus (APL) attached to the apparatus. Range of motion, axis of rotation, and muscle moment arms were recorded in manually controlled movements in wrist flexion/extension, radial/ulnar deviation, dart throwers motion, and circumduction.Results A statistically significant decrease in flexion range of motion occurred between the intact and Hemi conditions and between the intact and Hemi+PRC conditions with no significant differences in flexion range of motion occurring between the Hemi and Hemi+PRC conditions. No statistically significant changes in range of motion occurred in extension, radial deviation, ulnar deviation, flexion/ulnar deviation component of the dart throw, extension/radial deviation component of the dart throw, or circumduction functional tests.Summary Points This study indicates that the new wrist radial hemiarthroplasty can produce a stable wrist with range of motion similar to the native wrist. Overall, wrist kinematics appears to be equally acceptable in hemiarthroplasty with and without resection of the proximal row.
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| 9. |
- Fischer, Per, 1981-
(författare)
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Hemi and total wrist arthroplasty
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To study implant survival and implant loosening following primary total wrist arthroplasty (TWA) using four different implants. To report outcome following wrist revision arthroplasty. To evaluate a new radial wrist hemi arthroplasty (RWHA) design clinically and biomechanically.Method: The studies included 136 primary TWAs and 16 revision TWAs, both studies with prospectively collected data. Six fresh frozen cadaveric wrist specimen were used for biomechanical analysis. The RHWA was evaluated clinically in a pilot series of 20 cases.Results: Total implant survival was 92% but with high frequency of implant loosening of surviving Re-Motion implants. None of the surviving Maestro implants were considered radiographically loose. Implant survival following revision arthroplasty was 75%, considerably lower than following primary TWAs. However, none of the patients with surviving revision implants had pain at rest and little or no pain in activity. The surgical procedure and placement of the RHWA was feasible. Overall, the kinematic and functional changes appeared acceptable compared to the native wrist. None of the patients underwent revision following RHWA but reoperation was performed in 7 patients on the indication of persistent pain. However, patients reported relief of pain and improvement of patient-reported outcome measures.Conclusion: High long-term implant survival and no signs of radiographic loosening was found for the Maestro implant. However, the Maestro implant is no longer available on the market and we believe there is a need for new TWA designs. Revision arthroplasty is a valid option in the management of failed TWA. However, implant survival is lower than for primary TWAs and as many as 25% require additional surgery. Promising results were found using the new RHWA design but the implant needs modification before further testing.
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| 10. |
- Fischer, Per, 1981-, et al.
(författare)
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Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years
- 2018
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Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564. ; 43:5, s. 489.e1-489.e7
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).RESULTS: Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.CONCLUSIONS: Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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