| 1. |
- Agarwal-Harding, Kiran J, et al.
(författare)
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Estimating the Global Incidence of Femoral Fracture from Road Traffic Collisions: A Literature Review.
- 2015
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 97A:6, s. 31-31
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Forskningsöversikt (refereegranskat)abstract
- Worldwide, road injuries cause over 1.3 million deaths and many more disabilities annually, disproportionately affecting the young and the poor. Approximately one in ten road injuries involves a femoral shaft fracture that is most effectively treated with surgery. Current femoral shaft fracture incidence according to country and age group is unknown and difficult to measure directly but is critical to designing and evaluating interventions.
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| 2. |
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| 3. |
- Akesson, Thomas, et al.
(författare)
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Primary nonoperative treatment of moderately displaced two-part fractures of the radial head
- 2006
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 88A:9, s. 1909-1914
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Tidskriftsartikel (refereegranskat)abstract
- Background: Moderately displaced two-fragment fractures of the radial head have been treated predominantly nonoperatively. Recently, however, open reduction and internal fixation has gradually gained interest, without clear evidence that initial nonoperative treatment leads to an unfavorable outcome. As a consequence, the purpose of the present study was to evaluate the long-term outcome after the initial nonoperative treatment of this type of fracture. Methods: Fifteen men and thirty-four women, with a mean age of forty-nine years at the time of the injury, were included in the study. All patients initially had been managed nonoperatively for a two-fragment fracture of the radial head that was displaced 2 to 5 mm and that included >= 30% of the joint surface (a Mason type-IIa fracture). Early mobilization had been used for twenty-seven patients, and cast immobilization for a mean of two weeks (range, one to four weeks) had been used for twenty-two. All patients were reevaluated with a questionnaire after a mean of nineteen years, and thirty-four also had a clinical and a radiographic evaluation. Six patients had had a delayed radial head excision because of an unsatisfactory primary outcome. Results: Forty of the forty-nine patients had no subjective complaints, eight were slightly impaired as the result of occasional elbow pain, and one had daily pain. Flexion was slightly impaired in the injured elbows as compared with the uninjured elbows (137 degrees +/- 8 degrees compared with 139 degrees +/- 7 degrees) as was extension (-3 degrees +/- 7 degrees compared with 1 degrees +/- 5 degrees) and supination (86 degrees +/- 7 degrees compared with 88 degrees +/- 4 degrees) (p < 0.05 for all comparisons). The prevalence of degenerative changes on radiographs was higher for the injured elbows than for the uninjured elbows (82% [twenty-eight of thirty-four] compared with 21% [seven of thirty-four]; p < 0.01). Conclusions: The initial nonoperative treatment of Mason type-IIa fractures of the radial head that are displaced by 2 to 5 mm is associated with a predominantly favorable outcome, especially if a delayed radial head excision is performed in the few cases in which the early outcome is unsatisfactory. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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| 4. |
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| 5. |
- Ali, Muhanned, et al.
(författare)
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Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations : A Long-Term Follow-up
- 2018
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : LIPPINCOTT WILLIAMS & WILKINS. - 0021-9355 .- 1535-1386. ; 100:8, s. 633-639
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Tidskriftsartikel (refereegranskat)abstract
- Background: The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. Methods: In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of >= 10 degrees, ulnar variance of >= 3 mm, and/or radial inclination of <= 15 degrees. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. Results: Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Mal union was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. Conclusions: Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain.
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| 6. |
- Anderson, Thomas, et al.
(författare)
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Uncemented STAR total ankle prostheses.
- 2004
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 86-A Suppl 1:Pt 2, s. 11-103
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Tidskriftsartikel (refereegranskat)
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| 7. |
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| 8. |
- Aspenberg, Per, et al.
(författare)
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Effects of Teriparatide Compared with Risedronate on Recovery After Pertrochanteric Hip Fracture Results of a Randomized, Active-Controlled, Double-Blind Clinical Trial at 26 Weeks
- 2016
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : JOURNAL BONE JOINT SURGERY. - 0021-9355 .- 1535-1386. ; 98:22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Osteoporosis drugs might affect fracture-healing. We therefore studied the effects of teriparatide in comparison with risedronate on recovery after pertrochanteric hip fractures. Methods: The study was a randomized, multicenter, active-controlled, 78-week trial comparing teriparatide (20 mg/day) with risedronate (35 mg/week) initiated within 2 weeks after fixation of a low-trauma pertrochanteric hip fracture (AO/OTA 31-A1 or 31-A2). The main inclusion criteria were a bone mineral density T-score of amp;lt;=-22.0 and 25-OH-vitamin D of amp;gt;= 9.2 ng/mL. During the first 26 weeks, patients received study medication with oral or injectable placebo plus calcium and vitamin D in a double-blinded fashion. Secondary (Timed Up-and-Go [TUG] test, hip pain, Short Form [SF]-36 health status, and safety) and exploratory (radiographic outcomes and ability to walk) 26-week end points are reported. Results: Of the 224 patients who were randomized, 171 (86 teriparatide, 85 risedronate) were included in the analysis. The mean age was 77 +/- 8 years, 77% were female, and 26% had a prior history of low-trauma fracture. The teriparatide group completed the TUG test in a shorter time at 6, 12, 18, and 26 weeks (differences of 25.7, -4.4, -3.1, and -3.1 seconds, respectively; p = 0.021 for the overall difference). They also reported less pain on a visual analog scale immediately after the TUG test at 12 and 18 weeks (adjusted absolute differences of 10.6 and 11.9 mm, respectively; p amp;lt; 0.05). There were no significant between-group differences in the SF-36 score, Charnley hip pain score, ability to walk, or use of walking aids during follow-up. Radiographic healing at 6, 12, and 26 weeks, mechanical failure of the implant (teriparatide, 7; risedronate, 8), loss of reduction (teriparatide, 2; risedronate, 4), and nonunion (0 cases) were not significantly different. Mild hypercalcemia and hyperuricemia were more frequent with teriparatide. Conclusions: Teriparatide was associated with less pain and a shorter time to complete the TUG test between 6 and 26 weeks compared with risedronate. Other fracture-recovery outcomes were similar. The results should be interpreted with caution as these were secondary end points.
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| 9. |
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| 10. |
- Bajammal, Sohail S., et al.
(författare)
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The use of calcium phosphate bone cement in fracture treatment : A meta-analysis of randomized trials
- 2008
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Ingår i: Journal of Bone and Joint Surgery. American volume. - 0021-9355 .- 1535-1386. ; 90:6, s. 1186-96
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Available options to fill fracture voids include autogenous bone, allograft bone, and synthetic bone materials. The objective of this meta-analysis was to determine whether the use of calcium phosphate bone cement improves clinical and radiographic outcomes and reduces fracture complications as compared with conventional treatment (with or without autogenous bone graft) for the treatment of fractures of the appendicular skeleton in adult patients. METHODS: Multiple databases, online registers of randomized controlled trials, and the proceedings of the meetings of major national orthopaedic associations were searched. Published and unpublished randomized controlled trials were included, and data on methodological quality, population, intervention, and outcomes were abstracted in duplicate. Data were pooled across studies, and relative risks for categorical outcomes and weighted mean differences for continuous outcomes, weighted according to study sample size, were calculated. Heterogeneity across studies was determined, and sensitivity analyses were conducted. RESULTS: We identified eleven published and three unpublished randomized controlled trials. Of the fourteen studies, six involved distal radial fractures, two involved femoral neck fractures, two involved intertrochanteric femoral fractures, two involved tibial plateau fractures, one involved calcaneal fractures, and one involved multiple types of metaphyseal fractures. All of the studies evaluated the use of calcium phosphate cement for the treatment of metaphyseal fractures occurring primarily through trabecular, cancellous bone. Autogenous bone graft was used in the control group in three studies, and no graft material was used in the remaining studies. Patients managed with calcium phosphate had a significantly lower prevalence of loss of fracture reduction in comparison with patients managed with autograft (relative risk reduction, 68%; 95% confidence interval, 29% to 86%) and had less pain at the fracture site in comparison with controls managed with no graft (relative risk reduction, 56%; 95% confidence interval, 14% to 77%). We were unable to compare pain at the bone-graft donor site between the studies because of methodological reasons. Three studies independently demonstrated improved functional outcomes when the use of calcium phosphate was compared with the use of no grafting material. CONCLUSIONS: The use of calcium phosphate bone cement for the treatment of fractures in adult patients is associated with a lower prevalence of pain at the fracture site in comparison with the rate in controls (patients managed with no graft material). Loss of fracture reduction is also decreased in comparison with that in patients managed with autogenous bone graft.
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| 11. |
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| 12. |
- Bergkvist, Dan, et al.
(författare)
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Acute Achilles Tendon Rupture A Questionnaire Follow-up of 487 Patients
- 2012
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 94:13, s. 1229-1233
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present study, the outcomes of surgical and nonsurgical treatment in a large number of patients were compared on the basis of patient age and sex. METHODS: The records of all 487 patients with an acute total Achilles tendon rupture that had occurred between 2002 and 2006 and had been treated at one of two university hospitals in Sweden were manually reviewed. Surgical treatment was primarily used at Hospital 1, whereas nonoperative functional treatment was primarily used at Hospital 2. At one to seven years after the rupture, the majority of the patients were evaluated for complications, the Achilles Tendon Total Rupture Score was calculated, a heel-raise test was performed, and calf circumference was measured. The outcomes of surgical and nonsurgical treatment were compared on the basis of patient age and sex. RESULTS: The mean age at the time of the injury was forty-five years. In the surgical treatment group at Hospital 1, six (3%) of 201 patients had a re-rupture and three (1.5%) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6% (fifteen of 227). When the results for the surgical treatment group at Hospital 1 were compared with those for the nonsurgical treatment group at Hospital 2, there was no significant difference in terms of the mean Achilles Tendon Total Rupture Score (81.7 compared with 78.9; p = 0.1), but both the difference in the heel-raise test (p = 0.01) and the difference in calf circumference (1.4 compared with 2.0 cm; p = 0.01) reached significance in favor of surgery. Nonsurgically managed female patients showed significant worsening of the Achilles Tendon Total Rupture Score and heel-raise test with increasing age at the time of injury. CONCLUSIONS: The good Achilles Tendon Total Rupture Score in the nonsurgically managed group, together with the relatively low rate of re-ruptures and other complications in these patients, makes this treatment a preferable option for most patients. However, the tendency for a lower re-rupture rate and better performance on the heel-raise test in surgically treated patients suggest surgery may be beneficial in selected patients. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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| 13. |
- Brüggemann, Anders, et al.
(författare)
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Safety of Use of Tantalum in Total Hip Arthroplasty
- 2020
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Ingår i: Journal of Bone and Joint Surgery. American volume. - 0021-9355 .- 1535-1386. ; 102:5, s. 368-374
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Tidskriftsartikel (refereegranskat)abstract
- Background:Tantalum implants have been used in >500,000 orthopaedic patients. Although the risks of metallosis and aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) after total hip arthroplasty (THA) are being debated, we are not aware of any studies investigating the liberation of tantalum ions and their potential effects on the immune system. We evaluated whether tantalum concentrations are elevated after THA with acetabular tantalum implants and assessed potential alterations in T-cell subpopulations.Methods:After a mean follow-up of 4 years (range, 0.5 to 8.9 years) of 144 patients who had undergone THA, blood samples were analyzed regarding blood tantalum concentrations, total white blood-cell counts, and lymphocyte subsets in 3 groups of patients: those treated with non-tantalum primary THA (“primary non-tantalum,” n = 30), those treated with primary THA with a tantalum cup (“primary tantalum,” n = 30), and those who underwent revision surgery with a tantalum shell (“revision tantalum,” n = 84). Blood donors served as controls for immunological parameters (n = 59). Correlations between tantalum concentrations and human leukocyte antigen (HLA)-DR+ T cells were calculated, radiographic signs of implant loosening were assessed, and the Harris hip score (HHS) was used to evaluate hip function.Results:The median tantalum concentration was similar to the detection limit both in the primary non-tantalum group (0.05 µg/L, 95% confidence interval [CI] = 0.05 to 0.05 µg/L) and in the primary tantalum group (0.051 µg/L, 95% CI = 0.050 to 0.055 µg/L), and it was 0.091 µg/L (95% CI = 0.083 to 0.112 µg/L) in the revision tantalum group (p < 0.0001 in the group-wise comparison with both primary non-tantalum and primary tantalum). We found a weak negative correlation of higher tantalum concentration with the concentration of HLA-DR+/CD8+ T cells (r = −0.22, 95% CI = −0.35 to −0.05, p = 0.01) but no correlation of tantalum concentration with the concentration of HLA-DR+/CD4+ T cells (r = −0.11, 95% CI = −0.27 to 0.06, p = 0.24). The values for all lymphocyte subgroups were within normal ranges. No implants were deemed loose. The median HHS was good to excellent.Conclusions:Exposure to stable tantalum cups is associated with low blood concentrations of tantalum. Signs of T-cell activation typical of ALVAL seem to be lacking.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence
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| 14. |
- Buijze, Geert A., et al.
(författare)
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Diagnostic Performance of Radiographs and Computed Tomography for Displacement and Instability of Acute Scaphoid Waist Fractures
- 2012
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 94A:21, s. 1967-1974
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fracture displacement is the most important factor associated with nonunion of a scaphoid waist fracture. We evaluated the performance characteristics of radiographs and computed tomography (CT) in the diagnosis of intraoperative displacement and instability of scaphoid waist fractures using wrist arthroscopy as the reference standard. Methods: During a six-year period (2004 to 2010) at two institutions, forty-four adult patients with a scaphoid waist fracture underwent arthroscopy-assisted operative fracture treatment at a mean of nine days (range, two to twenty-two days) after injury. Subjects included all of those with a displaced scaphoid fracture seen on radiographs and a selection of patients with a nondisplaced scaphoid fracture. All patients had preoperative radiographs and CT. Arthroscopy with up to 5 kg of traction was the reference standard for fracture displacement and instability. Results: The reference standard (arthroscopy) led to a diagnosis of twenty-two displaced fractures (all unstable) and twenty-two nondisplaced fractures (seven unstable). Displacement was diagnosed in eleven patients (25%) with the use of radiographs and in twenty (45%) with CT. The sensitivity, specificity, and accuracy for diagnosing intraoperative displacement were 45%, 95%, and 70%, respectively, with the use of radiographs and 77%, 86%, and 82%, respectively, with CT. The sensitivity, specificity, and accuracy for diagnosing intraoperative instability were 34%, 93%, and 55%, respectively, with the use of radiographs and 62%, 87%, and 70%, respectively, with CT. Assuming a 10% prevalence of fracture displacement and instability among all scaphoid waist fractures, the positive and negative predictive values for displacement were 53% and 94%, respectively, with the use of radiographs and 39% and 97% with CT whereas the positive and negative predictive values for instability were 36% and 93%, respectively, with radiographs and 34% and 95% with CT. Conclusions: Radiographs and CT scans cannot be relied on to accurately diagnose intraoperative scaphoid fracture displacement or instability compared with arthroscopic examination. The influence, with regard to the risk of nonunion, of intraoperative instability of a scaphoid fracture that is seen to be nondisplaced on radiographs or CT is currently unknown.
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| 15. |
- Buijze, G. A., et al.
(författare)
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Three-Dimensional Compared with Two-Dimensional Preoperative Planning of Corrective Osteotomy for Extra-Articular Distal Radial Malunion
- 2018
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Ingår i: Journal of Bone and Joint Surgery-American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 100:14, s. 1191-1202
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Tidskriftsartikel (refereegranskat)abstract
- Background: Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. Methods: From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. Results: From baseline to 12 months of follow-up, the reduction in the mean DASH score was 230.7 +/- 18.7 points for the 3D planning group compared with220.1 +/- 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of 234.4 +/- 22.9 points for the 3D planning group compared with -26.6 +/- 18.3 points for the 2D planning group (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3 degrees; p = 0.04) and radial inclination (by 2.7 degrees; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. Conclusions: Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology.
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| 16. |
- Bögl, Hans Peter, et al.
(författare)
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Reduced Risk of Reoperation Using Intramedullary Nailing with Femoral Neck Protection in Low-Energy Femoral Shaft Fractures
- 2020
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : LIPPINCOTT WILLIAMS & WILKINS. - 0021-9355 .- 1535-1386. ; 102:17, s. 1486-1494
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, approximately 1 in 4 women who are >= 50 years of age will sustain a hip fracture. Patients treated for a femoral shaft fracture are likely to have an even higher risk. We hypothesized that intramedullary nails protecting the femoral neck reduce the risk of subsequent hip fracture and allow the patient to avoid a challenging reoperation.Methods: Between 2008 and 2010, 5,475 fractures of the femoral shaft, in patients who were >= 55 years of age, were registered in a national registry in Sweden. Of these patients, 897 fulfilled the inclusion criteria. We used radiographs and register data to identify the reasons for and the types of reoperation that occurred between the index surgical procedure and December 31, 2014. The categories of implants were determined through a review of radiographs as intramedullary nails with and without femoral neck protection. Reoperations related to peri-implant fractures (including hip fractures) were analyzed as a subgroup of all major reoperations. Multivariable-adjusted, cause-specific hazard ratios (HRs) were calculated to compare the risk of reoperation between cases with nails with and without femoral neck protection.Results: Among the 897 patients, a total of 82 reoperations were performed. In 640 patients who were treated with intramedullary nails with femoral neck protection, there were 7 peri-implant fractures (no hip fractures) and 27 major reoperations. Among the 257 patients who were treated with intramedullary nails without femoral neck protection, 14 peri-implant hip fractures and 24 major reoperations were identified. Patients who received nails with femoral neck protection had a lower hazard for any peri-implant fracture (multivariable-adjusted cause-specific HR, 0.19 [95% confidence interval (CI), 0.07 to 0.5]) and major reoperation (multivariable-adjusted cause-specific HR, 0.51 [95% CI, 0.28 to 0.92]).Conclusions: Intramedullary nails with femoral neck protection in the treatment of low-energy femoral shaft fractures prevent secondary hip fractures and decrease the overall risk of reoperation for 4 to 6 years postoperatively.
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| 17. |
- Chammout, Ghazi Khalil, et al.
(författare)
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Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures : a randomized long-term follow-up study
- 2012
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : Journal of Bone and Joint Surgery. - 0021-9355 .- 1535-1386. ; 94:21, s. 1921-1928
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of seventeen years.Methods: We enrolled 100 patients who had sustained a femoral neck fracture in a single-center, randomized controlled trial; all patients had had a healthy hip before the injury. The study group included seventy-nine women and twenty-one men with a mean age of seventy-eight years (range, sixty-five to ninety years). The subjects were randomly assigned to either total hip replacement (the arthroplasty group) (n = 43) or internal fixation (the control group) (n = 57). The primary end point was hip function, evaluated with use of the Harris hip score. Secondary end points included mortality, reoperations, gait speed, and activities of daily life. Follow-up evaluations were performed at threemonths and at one, two, four, eleven, and seventeen years.Results: The Harris hip score was higher in the total hip arthroplasty group, with a mean difference of 14.7 points (95% confidence interval, 9.2 to 20.1 points; p < 0.001 [analysis of covariance]) during the study period. We found no difference in mortality between the two groups. Four patients (9%) in the total hip replacement group and twenty-two patients (39%) in the internal fixation group had undergone a major reoperation (relative risk, 0.24; 95% confidence interval, 0.09 to 0.64). The overall reoperation rate was 23% (ten of forty-three) in the total hip replacement group and 53% (thirty of fifty-seven) in the internal fixation group (relative risk, 0.44; 95% confidence interval, 0.24 to 0.80). The results related to gait speed and activities of daily living favored the arthroplasty group during the first year.Conclusions: Over a period of seventeen years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality.
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| 18. |
- Chemnitz, Anette, et al.
(författare)
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Functional outcome thirty years after median and ulnar nerve repair in childhood and adolescence.
- 2013
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 95:4, s. 329-337
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Tidskriftsartikel (refereegranskat)abstract
- Age at injury is believed to be a factor that strongly influences functional outcome after nerve injury. However, there have been few long-term evaluations of the results of nerve repair and reconstruction in children. Our aim was to evaluate the long-term functional outcome of nerve repair or reconstruction at the forearm level in patients with a complete median and/or ulnar nerve injury at a young age.
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| 19. |
- Clementson, Martin, et al.
(författare)
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Clinical and Patient-Reported Outcomes After Total Wrist Arthroplasty and Total Wrist Fusion : A Prospective Cohort Study with 2-Year Follow-up
- 2024
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Ingår i: Journal of Bone and Joint Surgery. - 1535-1386. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The functional benefits of total wrist arthroplasty (TWA) over total wrist fusion (TWF) are unknown. The purpose of this prospective cohort study was to compare TWA and TWF with respect to functional outcomes and activitylimitations at up to 2 years postoperatively.Methods: Between 2015 and 2020, we enrolled all adult patients undergoing TWA or TWF for the management of symptomatic end-stage wrist arthritis at 1 hand surgery department. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE). The secondary outcomes were the visual analog scale (VAS) for pain at rest, on motion, and on loading; grip strength; Disabilities of the Arm, Shoulder and Hand (DASH); and range of motion. Patients completed questionnairesand were examined by the same physiotherapist at baseline and at 3, 6, 12, and 24 months postoperatively. Mixed-model analyses adjusting for age, diagnosis, the preoperative value of the dependent variable, and time since surgery wereperformed to compare differences in PRWE scores, VAS pain scores, and grip strength between TWA and TWF.Results: Of the 51 patients who had been included at baseline, 47 (18 in the TWA group and 29 in the TWF group) responded to questionnaires and underwent examinations at up to 2 years postoperatively. At baseline, the 2 groups did not differ in terms of age, sex, diagnosis (inflammatory or noninflammatory arthritis), PRWE score, VAS pain score, grip strength, DASH score, or range of motion. No differences between the groups were found for the PRWE (b, 20.1; 95% confidence interval [CI], 214 to 13; p = 0.99), VAS pain at rest (b, 23.3; 95% CI, 215 to 9; p = 0.58), VAS pain on loading (b, 25.3; 95% CI, 222 to 11; p = 0.52), or grip strength (b, 20.02; 95% CI, 20.18 to 0.14; p = 0.80) on the adjusted mixed-model analyses.Conclusions: Among patients with symptomatic end-stage wrist arthritis, those who underwent TWA did not demonstrate short-term outcomes, including patient-reported disability, pain, and grip strength, superior to those of patients who underwent TWF. These findings call into question the widespread use of TWA.Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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| 20. |
- Comfort, Thomas, et al.
(författare)
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International comparative evaluation of fixed-bearing non-posterior-stabilized and posterior-stabilized total knee replacements.
- 2014
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 96A, s. 65-72
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Tidskriftsartikel (refereegranskat)abstract
- Differences in survivorship of non-posterior-stabilized compared with posterior-stabilized knee designs carry substantial economic consequences, especially with limited health-care resources. However, these comparisons have often been made between relatively small groups of patients, often with short-term follow-up, with only small differences demonstrated between the groups. The goal of this study is to compare the outcomes of non-posterior-stabilized and posterior-stabilized total knee arthroplasties with use of a unique collaboration of multiple established knee arthroplasty registries.
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| 21. |
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| 22. |
- Diarbakerli, E., et al.
(författare)
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Health-Related Quality of Life in Adulthood in Untreated and Treated Individuals with Adolescent or Juvenile Idiopathic Scoliosis
- 2018
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Ingår i: Journal of Bone and Joint Surgery-American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 100:10, s. 811-817
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health-related quality of life in adults with idiopathic scoliosis diagnosed before maturity has been reported to be similar between brace-treated and surgically treated individuals. The aim of this study was to compare health-related quality of life in untreated, brace-treated, and surgically treated adults with idiopathic scoliosis diagnosed before skeletal maturity. Subgroup analyses were performed on the basis of age at the time of the study, age of onset, surgical characteristics, and curve magnitude. Methods: We included 1,187 adults with juvenile or adolescent idiopathic scoliosis with a mean age (and standard deviation) of 38.8 +/- 12.7 years. Of these, 347 were untreated, 459 had been brace-treated, and 381 had been surgically treated. The Scoliosis Research Society-22r (SRS-22r) and EuroQol 5-Dimensions (EQ-5D) were used. Statistical analyses were performed using analysis of covariance. Results: The mean SRS-22r subscore was 4.15 +/- 0.59 points for the untreated group, 4.10 +/- 0.57 points for the previously braced group, and 4.01 +/- 0.64 points for the surgically treated group (p = 0.007 adjusted for age and sex). The EQ-5D index was 0.82 +/- 0.20 for the untreated group, 0.82 +/- 0.20 for the previously brace-treated group, and 0.79 +/- 0.24 for the surgically treated group (p = 0.026, adjusted for age and sex). Brace cessation was at the mean age of 16.2 +/- 1.5 years, and the surgical procedure had been performed at the mean age of 15.3 +/- 2.1 years. A more caudal fusion was associated with a lower SRS-22r subscore and EQ-5D index. No differences were observed when comparing individuals with juvenile or adolescent onset scoliosis (all p > 0.05). Conclusions: Untreated adults with idiopathic scoliosis had similar health-related quality of life to previously brace-treated individuals, and they had marginally higher health-related quality of life compared with surgically treated individuals. Therefore, both surgical and brace treatments for idiopathic scoliosis could be considered successful from a health-related quality-of-life point of view in adulthood. The age of onset of idiopathic scoliosis does not seem to influence quality of life in adulthood.
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| 23. |
- Düppe, Henrik, et al.
(författare)
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Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years
- 1994
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 76:2, s. 249-252
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Tidskriftsartikel (refereegranskat)abstract
- Fifty-six patients who had had a fracture of the scaphoid from January 1950 through December 1959 were interviewed, re-examined, and had radiographs made of both hands an average of thirty-six years (range, thirty-one to forty years) later. The average age at the time of the treatment was twenty-eight years (range, fifteen to forty-five years). Fifty-two of the fifty-six patients were treated at the time of the fracture; the other four had a non-union when first seen. The rate of non-union for the fresh fractures at the most recent follow-up examination was 10 per cent (five of fifty-two). Dorsal intercalated-segment instability was found in three of the fifty-six patients; all three had a pseudarthrosis and manifest radiocarpal osteoarthrosis. Marked radiocarpal osteoarthrosis developed in only one (2 per cent) of the forty-seven patients who had a healed fracture; it was far more common in the group that had a pseudarthrosis, in which the prevalence was five of nine patients. Manifest osteoarthrosis also seemed to be associated with pain or weakness: it had developed in only three (6 per cent) of the forty-nine patients who did not have any symptoms at the re-examination, compared with three of the seven who had symptoms.
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| 24. |
- Ekblom, Anna Gerber, et al.
(författare)
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Hand Function in Adults with Radial Longitudinal Deficiency.
- 2014
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386 .- 0021-9355. ; 96:14, s. 1178-1184
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Tidskriftsartikel (refereegranskat)abstract
- Functional impairment in individuals with radial longitudinal deficiency can be influenced by several factors, including a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited finger motion, and impaired grip strength, but their relationship with activity and participation in adults with radial deficiency is not known.METHODS: Twenty individuals, eighteen to sixty years of age, who had Bayne type-II to V radial longitudinal deficiency, were examined in the context of the International Classification of Functioning, Disability and Health. Body function and structure were evaluated by measures of range of motion, grip strength, key pinch, sensibility, and radiographic parameters. Activity was evaluated by the Box and Block Test and the Sollerman test, and participation was evaluated by QuickDASH (the short form of the Disabilities of Arm, Shoulder and Hand outcome measure) and by the Medical Outcomes Study 12-Item Short Form Health Survey. Statistical correlations among assessments of body function and structure, activity, and participation were examined.RESULTS: The mean total active motion of the wrist (43°) and mean total active motion of the digits (377°) were less than the norms. The mean radial deviation of the wrist was 31°. The mean grip strength (4.0 kg), key pinch (1.4 kg), and scores for the Box and Block Test (55 blocks per minute) and the Sollerman test on hand function (56 points) were considerably lower than the norms. The mean scores were 18 points for QuickDASH, 51 points for Short Form-12 physical component summary, and 53 points for Short Form-12 mental component summary. Significant relationships were found between the Box and Block Test and grip strength (p = 0.012), key pinch (p < 0.001), and total active motion of digits (p < 0.001); between the Sollerman test and the total active motion of elbow (p < 0.001) and the total active motion of digits (p < 0.001); between the QuickDASH and forearm length (p < 0.001), the total active motion of elbow (p = 0.001), and the total active motion of digits (p < 0.001); between the Short Form-12 physical component summary and grip strength (p = 0.016), forearm length (p < 0.001), total active elbow motion (p < 0.001), and total active digit motion (p < 0.001); and between the Short-Form-12 mental component summary and radial deviation of the wrist (p = 0.019). No significant correlations were found between the radiographic measurement of the radial deviation of the wrist (total forearm angle) and the Box and Block Test (p = 0.244), the Sollerman test (p = 0.775), QuickDASH (p = 0.156), Short Form-12 physical component summary (p = 0.107), or Short Form-12 mental component summary (p = 0.129).CONCLUSIONS: In individuals with radial longitudinal deficiency, grip strength, key pinch, forearm length, and elbow and digital motion seem to be more important for the individual's activity and participation than the radial angulation of the wrist.LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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| 25. |
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