| 1. |
- 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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| 2. |
- 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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| 3. |
- Björk, Marie, et al.
(författare)
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Self-efficacy corresponds to wrist function after combined plating of distal radius fractures
- 2020
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Ingår i: Journal of Hand Therapy. - : Elsevier. - 0894-1130 .- 1545-004X. ; 33:3, s. 314-319
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A prospective cohort single-center study.INTRODUCTION: Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability will more likely reach a good outcome.PURPOSE OF THE STUDY: The aim of this study was to examine if SE has an effect to physical functioning, pain and patient-rated wrist function three months postoperatively in patients undergoing plating due to a distal radius fracture.METHODS: Sixty-seven patients undergoing plating for a distal radius fracture rated SE at the first appointment with the physiotherapist. At the three-month follow-up, the following assessments were administered: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip strength, and range of motion.RESULTS: The group with a high SE showed significantly better range of motion for flexion (P = .046) and supination (P = .045), hand grip strength (P = .001) and PRWE scores (P = .04). The NRS pain during activity was lower, although not significantly lower (P = .09). Using Spearman's rank correlation coefficient, there was a moderate correlation between SE and pain during activity, wrist flexion, and PRWE score.DISCUSSION: SE corresponds to wrist function after combined plating of distal radius fractures.CONCLUSION: Measurement of SE could possibly be useful to identify patients in special need of support during the postoperative rehabilitation.
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| 4. |
- Björk, Marie, et al.
(författare)
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Self-efficacy corresponds to wrist function after combined plating of distal radius fractures
- 2019
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Ingår i: Abstract book IFSHT. - Freiburg : Intercongress GmbH. - 9783000635854
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Konferensbidrag (refereegranskat)abstract
- Clinical issue/s: Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability willmore likely reach a good outcome. The distal radius fracture (DRF) is the most common fracture in adults constituting 18% of all fractures in an orthopedic trauma unit. To our knowledge there are no reports investigating the role of patient-reported self-efficacy in the rehabilitation of surgically treated DRFs. A tool that could identify patients in need of increased postoperative rehabilitation could potentially improve the allocation of rehabilitation resources.Clinical reasoning: The aim of this study was to examine if SE has an effect on physical functioning, pain and patient-rated wrist function three months postoperatively in patients who underwent combined plating with a volar and dorsal plate due to a distal radius fracture (DRF).innovative, analytical or new approach: Methods: This prospective study involved 67 patients. Follow-up results were available for 55 of them. The patients rated SE at the first appointment with the physiotherapist. The three months follow-up contained the outcome values: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip-strength and range of motion. Thestudy was approved by the regional ethical committee.Results: Three months after surgery the average wrist motion was 62-93 percent and hand grip-strength was 58 percent compared to the uninjured hand. Patients who rated high SE showed significantly better ROM for flexion and supination, handgrip-strength and PRWE-scores.Contribution to advancing HT practice: Discussion: Patients with a high SE are more likely to have a better wrist functionthree months postoperatively compared to patients with a low SE. Conclusion: SE can be a tool to assist the hand therapist in the allocation of rehabilitation resources.
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| 5. |
- 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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| 6. |
- Fischer, Per, 1981-, et al.
(författare)
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Total Wrist Arthroplasty : A 10-Year Follow-Up
- 2020
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Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564. ; 45:8, s. 780.e1-780.e10
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess long-term implant survival in total wrist arthroplasty (TWA), comparing 4 different implants.Methods: In a prospective cohort of 124 patients, 136 TWAs were evaluated 5 years and 10 years after surgery. The TWAs were implanted between 2005 and 2009. The primary outcome was implant survival. Survival analysis was performed with revision and radiographic loosening as the final end point. Revision was defined as exchange of whole or parts of the prosthesis. Implant loosening was assessed using radiographic examination at the 5-year and 10-year follow-up. Secondary outcome measures included wrist range of motion, hand grip strength, visual analog scale (VAS) pain scores, and patient-related outcome measures, including Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and Canadian Occupational Performance Measure (COPM).Results: Total cumulative implant survival was 92% with revision as the primary end point. When including a nonrevised radiographic loose implant as a failure, total implant survival was 75%. Radiographic loosening differed significantly between the implants with a range in frequency from 0% to 37.5%. At the 10-year follow-up, assessing the nonrevised TWAs, range of motion was preserved compared with preoperative values. Significant improvement was recorded for hand grip strength, VAS pain scores, and patient-related outcome measures at the 10-year follow-up compared with preovperative values.Conclusions: High 10-year implant survival was found when defining the primary end point as revision of any cause. When including radiographic loosening of the implant in the survival analysis, implant survival was considerably lower. However, radiographic loosening does not seem to correlate with changes in secondary outcome measures, questioning the need for revision surgery in these cases.
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| 7. |
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| 8. |
- Jakobsson, Hugo, 1990-, et al.
(författare)
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Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome
- 2023
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Ingår i: Archives of physiotherapy. - : BioMed Central (BMC). - 2057-0082. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF. MATERIALS &METHODS: This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength.RESULTS: Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse.CONCLUSIONS: Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.
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| 9. |
- Karlsson, Emma, et al.
(författare)
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Combined volar and dorsal plating vs. volar plating of distal radius fractures : A single-center study of 105 cases
- 2020
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Ingår i: Hand surgery & rehabilitation. - : Elsevier. - 2468-1229 .- 2468-1210. ; 39:6, s. 516-521
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Tidskriftsartikel (refereegranskat)abstract
- Despite recent advances in the surgical management of distal radius fractures (DRFs), the optimal treatment remains controversial as different fixation methods often have similar clinical functional and radiographic outcomes. The objective of this study was to assess the differences in outcomes 1 year postoperatively between volar plating and combined plating for DRFs. In a retrospective cohort study, we evaluated 105 consecutive patients operated with either a volar locking plate or combined dorsal and volar plating. The primary outcome was wrist range of motion (ROM). Secondary outcome measures included hand grip strength, visual analog scale (VAS) pain scores, radiographic examination and patient-related outcome measures. Patients treated with combined plating had significantly inferior wrist flexion, extension and ulnar deviation. The radiographic Batra score 1 year postoperatively was similar for both groups. The PRWE (patient-rated wrist evaluation) score was 16 for the volar plating group and 14 for the combined plating group. The QuickDASH (Quick disabilities of the hand arm and shoulder) score was 9 for the volar plating group and 16 for the combined plating group. VAS pain scores were 0 at rest and 2 during activity for both groups. Grip strength was similar between the two groups. Hardware removal was done in 18/78 patients for the combined plating group and 1/27 for the volar plate group. Two patients operated with combined plating had tendon ruptures. Our findings indicate that both methods can yield satisfactory clinical and radiographic outcomes. However, combined plating resulted in inferior wrist ROM and substantially higher frequency of hardware removal. The potential advantages of combined plating in stabilizing a comminuted DRF must be balanced by the potential drawbacks such as inferior wrist ROM and higher frequency of hardware removal.
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| 10. |
- Larsson, Sune, et al.
(författare)
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Augmentation of Tibial Plateau Fractures with Calcium Phosphate Cement : A Randomized Study Using Radiostereometry
- 2004
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Konferensbidrag (refereegranskat)abstract
- Purpose: One problem with tibial plateau fractures that involve a depressed articular fragment is the difficulty of maintaining reduction until healing. The conventional method is to fill the subchondral void with autologous bone transplant followed by restricted weightbearing for 8 to 12 weeks. Recently, biomaterials have been introduced that might overcome several problems associated with bone transplant. The purpose of this study was to evaluate an injectible calcium-phosphate cement when used as a bone graft substitute in lateral tibial plateau fractures, with special emphasis on the stability of the elevated articular fragment.Methods: Twenty-four patients with a lateral tibial plateau fracture type 41-B2 or 41-B3 (OTA classification) were included. The authors operated on all patients. Conventional metal fixation was used to fix the fracture following elevation of the articular fragment. The subchondral void was filled with injectable calcium-phosphate cement (Norian SRS, Synthes) or conventional iliac bone graft according to randomization during surgery. There were 12 patients in each group with an average age of 50 and 52 years, respectively. During surgery, tantalum markers were inserted for subsequent radio stereometry (RSA) (RSA Biomedical Innovation, Umeå, Sweden), a radiologic technique that enables measurement of movement along and around three orthogonal axes with a precision of less than 0.5 mm and 0.7°. Continuous passive motion was begun immediately after surgery. Weightbearing was restricted to 20 kg for 6 weeks in the SRS group and for 12 weeks in the control group. Radio stereometry was performed before weightbearing and at 1, 6, and 12 weeks and at 6 and 12 months. Conventional radiographs were used for assessment of reduction and healing. Clinical evaluation (Lysholm score and a visual analog scale score of 0 to 10 for pain) was conducted by a physiotherapist. For assessment of compliance with regard to weightbearing, patients were examined with F Scan (Tecscan, Inc., Boston, Massachusetts, USA) at each time point.Results: No patients were lost but two were excluded from the RSA evaluation due to technical problems. All fractures healed. There was one deep infection (SRS). At 6 weeks, average weightbearing was 22 kg in the SRS group and 19 kg among the controls (NS); at 12 weeks, 66 kg vs. 28 kg (P <0.001); and at 6 and 12 months, on average, between 66 and 72 kg with no difference between groups. Pain during activity was lower in the SRS group at 1 week (P <0.01), 6 weeks (P <0.004), 3 months (P <0.005), and at 6 months (P <0.02), with no difference at 1 year. The Lysholm knee score was better at 6 weeks (P <0.01), 12 weeks (P <0.002), and 6 months (P <0.02) in the SRS group, and there was no significant difference at 1 year. Radio stereometry revealed movement of the articular fragment in all patients. The total translation was, on average, 1.41 mm in the SRS group and 3.88 mm in the controls (P <0.001). In both groups the most significant movement occurred during the first 6 weeks, and there was no significant movement of the articular fragment from 6 to 12 months, indicating stable healing. The most typical pattern of movement was subsidence along the vertical axis or rotation in the transversal axis (forward tilt) or both, and as toe-out rotation around the vertical axis. One patient from the SRS group had a migration exceeding 3 mm, and two controls had a migration exceeding 5 mm.Conclusion/Significance: Injectable calcium-phosphate cement provided a more stable fixation of the elevated articular fragment in lateral tibial plateau fractures when compared with conventional bone graft, despite the fact that cement-augmented patients were allowed earlier weightbearing. Patients treated with cement also had less pain during the entire course of healing when compared with controls. Bone graft substitutes can offer new perspectives for treatment of fractures involving metaphyseal defects, without the side effects associated with bone grafting.
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