| 1. |
- Hedelin, Henrik, 1975
(författare)
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Bioabsorbable Screws for Pelvic Osteotomies in Children
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Multiple conditions, with developmental dysplasia of the hip being a prime example, affect the congruity of the pediatric hip joint. A Salter osteotomy (SO) or a triple pelvic osteotomy (TPO) can be used to address suboptimal biomechanical conditions in the hip joint by improving containment and load distribution. Traditionally these osteotomies use metal implants to stabilize the osteotomy of the ilium, necessitating a second surgery for implant removal. If Kirschner-wires are used there are also risks related to wire migration and lack of stability. The general aim of this thesis was to explore the novel use of poly lactic-co-glycolic acid (PLGA) screws for osteotomy fixation in SO and TPO. The feasibility of this concept was examined regarding the stability of fixation as well as the biocompatibility of the implants. Bioabsorbable screws negate the need for implant removal which would be a major benefit for children. Study I reported on a novel surgical method for SO using PLGA screws instead of metal implants. A case series of 21 patients was reported on and the stability of the osteotomy fixation was evaluated using the post-operative radiographs. Migration percentage, acetabular index and center-edge angle were used to decide if an osteotomy collapsed or remained stable. In all patients but one the osteotomy remained stable and healed with maintained perioperative correction. There were no local reactions to the bioabsorption of the screws. Study II presented a retrospective analysis of the bioabsorption of 4.5mm PLGA screws as interpreted on Magnetic Resonance Imaging (MRI). Twelve patients who had undergone a SO or TPO with PLGA screws as the method of fixation were included. Eighteen MRIs were performed 0.5-4.5 years postoperatively and were analyzed according to eight parameters. After 2-4.5 years all screw canals were replaced with >90% bone with one exception where most, but not 90%, was replaced with bone. The local reactions seen during the bioabsorption were minor. Study III described a modified surgical method for TPO utilizing PLGA screws for the ilium osteotomy. A case series of 11 patients was reported on and the postoperative stability of the osteotomy was evaluated using migration percentage, acetabular index, center-edge angle as well as Sharp’s angle. The osteotomy angle (OA) was, as an addendum, suggested as a parameter to evaluate the integrity of an osteotomy. All patients maintained the initial correction and there were no signs of implant failure nor any local reactions to the implants. In Study IV the finite element method was used to analyze how different screw configurations affect stability in a TPO. Relative flexibility for loads in all translational degrees of freedom was calculated for five different screw configurations in a standardized hemi-pelvis. In two of these configurations the entry points used are only viable options if bioabsorbable implants are used. The screw configurations with a more perpendicular angle to the osteotomy and with a greater spread in the osteotomy plane between the screws resulted in increased stability. The use of bioabsorbable implants enables entry points that can provide improved biomechanical stability in a TPO. In summary, the presented studies support that 4.5 mm PLGA screws provide sufficient stability in SO and TPO in children with no major local reactions to the implants. After bioabsorption the screw canals were mostly replaced by bone and the use of bioabsorbable implants enables fixation configurations that seems to improve stability of the osteotomy. The use of bioabsorbable screws for pelvic osteotomies can eliminate suffering associated with a second surgery and save resources.
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| 2. |
- Hedelin, Henrik, 1975, et al.
(författare)
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Innominate salter osteotomy using resorbable screws: A retrospective case series and presentation of a new concept for fixation
- 2019
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Ingår i: Journal of Children's Orthopaedics. - : SAGE Publications. - 1863-2521 .- 1863-2548. ; 13:3, s. 310-317
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Tidskriftsartikel (refereegranskat)abstract
- © 2019, British Editorial Society of Bone and Joint Surgery. All rights reserved. Purpose The Salter innominate osteotomy (SIO) in children is traditionally stabilized by Kirschner-wires, which have issues regarding stability, infection and the need to be extracted. To counter these disadvantages, we present a surgical method to stabilize SIO with modern resorbable poly lactic-co-glycolic acid screws. Using a case series of 21 patients treated with SIO for developmental dysplasia of the hip or Legg-Calvé- Perthes disease we evaluate the feasibility of the method. Methods The integrity of the osteotomy was interpreted by radiological measurements of acetabular index, centre-edge angle and Reimer’s index. Perioperative and postoperative complications were evaluated. Results Radiographic evaluation revealed a stable osteotomy and favourable development in all measured parameters with the exception of one patient who fell out of bed the first day postoperatively. No other perioperative surgical complications were observed and there were no local reactions to the resorbable screws. Conclusion Modern resorbable screws carry multiple benefits both for the patient and the surgeon. In our case series the implants provided sufficient stability and the implants caused no local reactions. The use of resorbable implants gave the surgeon a wider range of possible screw placements and avoided the need for implant removal.
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| 3. |
- Hedelin, Henrik, 1975, et al.
(författare)
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Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound
- 2017
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Ingår i: Critical Ultrasound Journal. - : Springer Science and Business Media LLC. - 2036-3176 .- 2036-7902. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- Background: In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training. Methods: Physicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively. Results: One hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions. Conclusions: In the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group.
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| 4. |
- Hedelin, Henrik, 1975, et al.
(författare)
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MRI evaluation of resorbable poly lactic-co-glycolic acid (PLGA) screws used in pelvic osteotomies in children—a retrospective case series. : Hedelin H, Hebelka H, Brisby H, Laine T.
- 2020
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Ingår i: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The orthopaedic use of resorbable poly lactic-co-glycolic acid (PLGA) implants carries multiple potential benefits. To our knowledge, only one publication exists regarding the use of PLGA implants in pelvic osteotomies in children, and data regarding resorption and potential side effects are lacking for resorbable pelvic screws in children. The aim of this study is to present an MRI-based evaluation of the resorption pattern and local tissue reactions in a paediatric case series after pelvic osteotomies fixated with PLGA screws. Methods: Twelve children who had undergone a Salter or triple pelvic osteotomy fixated with 4.5 mm PLGA screws were included. A total of 18 MRIs was performed 0.5-4.5 years after surgery and were retrospectively analysed. Eight parameters relating to screw resorption, local reactions and re-formation of bone were interpreted. Results: The screw canals were > 90% replaced with solid bone after 2-4.5 years in all cases but one, where the canals were only partly replaced with bone. There were no major soft tissue reactions but small (< 12 mm) bone cysts were observed in 3 of the 18 MRIs and discrete fatty patches in the adjacent bone were common. Conclusion: PLGA screws in the paediatric pelvis appear to be resorbed and replaced with solid bone in most cases but this process takes at least 2 years. Minor reactions could be seen in the adjacent bone but were judged to be of no clinical significance.
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| 5. |
- Hedelin, Henrik, 1975, et al.
(författare)
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Postoperative stability following a triple pelvic osteotomy is affected by implant configuration: a finite element analysis
- 2022
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Ingår i: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The triple pelvic osteotomy is an established surgical method with multiple modifications regarding surgical technique and choice of implant. The stability of the osteotomy is affected by numerous factors, and among these, the three-dimensional implant configuration is a scientifically less explored aspect. Methods We used a finite element model of a hemi-pelvis with a standardized triple osteotomy to calculate relative flexibility for loads in all translational degrees of freedom for five different implant configurations. Two of the configurations used entry points only feasible when implant removal was not necessary. Results The stability of the osteotomy improved with an increased distance between the implants in the plane of the osteotomy as well as for a more perpendicular angle relative to the osteotomy plane. The implant configurations with more entry points available made this easier to adhere to. Conclusion The use of bioabsorbable implants may provide better opportunities for optimal implant constructs which can, to a certain degree, compensate for the lesser mechanical stiffness of bioabsorbable polymers as compared to metal implants.
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| 6. |
- Hedelin, Henrik, 1975, et al.
(författare)
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Stability in Pelvic Triple Osteotomies in Children Using Resorbable PLGA Screws for Fixation
- 2021
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Ingår i: Journal of Pediatric Orthopaedics. - : Ovid Technologies (Wolters Kluwer Health). - 0271-6798. ; 41:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: The triple pelvic osteotomy (TPO) is a major redirectional osteotomy used to improve the acetabular coverage of the femoral head in selected pediatric patients with hip disorders. Traditionally the iliac osteotomy is stabilized by metal screws that require a second surgery for removal. Despite favorable results for both adults and children in related pelvic osteotomies, resorbable implants have not previously been used for TPOs. This study aims to suggest a novel modified TPO surgical method in children using resorbable poly lactic-co-glycolic acid (PLGA) screws for fixation and to radiographically evaluate the postoperative stability achieved by these implants in a case series. Methods: All patients (n=11) with dysplasia of the hip (2), Perthe disease (5), or Down syndrome (4), who underwent primary TPO surgery during 2013 to 2019, using resorbable PLGA screws for fixation were included. The stability of the osteotomy was evaluated in the postoperative radiograph series using the acetabular index, migration percentage, Sharp's angle and the center-edge angle. The osteotomy angle was introduced as a parameter to confirm the postoperative integrity of the achieved correction. All cases were evaluated until radiographic healing of the iliac osteotomy. Hospital notes were analyzed for complications or local reactions in relation to the implants. Results: In all studied hips, the overall achieved correction was well maintained. The mean (SD) correction achieved, from the preoperative images to the last measurable postoperative image, was a 16.7 degrees decrease for Sharp angle, a 20.9 degrees decrease in acetabular index and a 24.7 degrees increase for the center-edge angle, respectively. There were no complications related to the bioabsorption of the implants. Conclusion: The present findings suggest that the modified TPO method, using resorbable PLGA screws, provides sufficient stability and appears to be a promising alternative to traditional TPO. Avoiding implant removal is a major benefit in a pediatric population. Resorbable screws enable the surgeon to place implants with more degrees of freedom since later implant removal is not a limiting factor.
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| 7. |
- Hedelin, Henrik, 1975, et al.
(författare)
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The Ambiguity of Names and Landmarks in Radiographs of the Pediatric Pelvis: Variations and a Historical Perspective
- 2023
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Ingår i: Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews. - 2474-7661. ; 7:9
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Forskningsöversikt (refereegranskat)abstract
- For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular index, the center-edge angle, and the migration percentage, have stood the test of time and remain the default tools for any pediatric orthopaedic surgeons. However, in contemporary research, the terminology regarding these measurements has become markedly inconsistent. A substantial number of synonyms, acronyms, and similar, but not identical, terms are used to label measurements. This is perhaps unsurprising, considering decades of use and numerous suggested modifications. The results of treatment cannot be reliably compared if the measured parameters are not identical, and scientific analysis of disease requires consistent terminology. In this review, we aim both to provide historical definitions and identification of radiographic landmarks commonly used in three parameters of interest on pediatric AP radiographs and to examine the variability of landmarks and definitions in contemporary research.
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| 8. |
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| 9. |
- Identeg, Fredrik, 1990, et al.
(författare)
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Low occurrence of MRI spinal changes in elite climbing athletes; a cross-sectional study.
- 2023
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Ingår i: BMC sports science, medicine & rehabilitation. - : Springer Science and Business Media LLC. - 2052-1847. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- To examine the occurrence of magnetic resonance imaging (MRI) changes in the thoracolumbar spine among elite climbing athletes.All climbers of the Swedish national sport climbing team (n=8), and individuals having trained for selection to the national team (n=11), were prospectively included. A control group, matched in age and sex, were recruited. All participants underwent a thoracolumbar MRI (1.5T, T1- and T2-weighted imaging), evaluated according to Pfirrmann classification, modified Endplate defect score, Modic changes, apophyseal injuries and spondylolisthesis. Pfirrmann≥3, Endplate defect score≥2 and Modic≥1 was defined as degenerative findings.Fifteen individuals, 8 women, participated in both the climbing group (mean age 23.1, SD 3.2years) and the control group respectively (mean age 24.3, SD 1.5years). In the climbing group, 6.1% of the thoracic and 10.6% of the lumbar intervertebral discs showed signs of degeneration according to Pfirrmann. One disc with a grade above 3 was present. Modic changes in the thoracic/lumbar spine were prevalent in 1.7%/1.3% of the vertebrae. Degenerative endplate changes according to the Endplate defect score were found in 8.9% and 6.6% of the thoracic and lumbar spinal segments of the climbing group, respectively. Two apophyseal injuries were found, while no participants displayed signs of spondylolisthesis. There was no difference in point-prevalence of radiographic spinal changes between climbers and controls (0.07
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| 10. |
- Identeg, Fredrik, 1990, et al.
(författare)
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Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers - the CLIMB study.
- 2024
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Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central (BMC). - 2052-1847. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls.METHODS: A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire.RESULTS: A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%).CONCLUSION: The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.
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| 11. |
- Identeg, Fredrik, 1990, et al.
(författare)
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Patterns of traumatic outdoor rock-climbing injuries in Sweden between 2008 and 2019
- 2021
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Ingår i: Journal of Experimental Orthopaedics. - : Springer Science and Business Media LLC. - 2197-1153. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Injury prevalence patterns for climbers have been presented in several papers but results are heterogenous largely due to a mix of included climbing disciplines and injury mechanisms. This study describes the distribution and pattern of acute traumatic climbing injuries sustained during outdoor climbing in Sweden. Methods Patients that experienced a climbing related traumatic injury during outdoor climbing between 2008 and 2019 and who submitted a self-reported questionnaire to the Swedish Climbing Association were included in the study. Medical records were retrieved, and the International Climbing and Mountaineering Federation injury classification system was used for injury presentation. Results Thirty-eight patients were included in the study. Seven (18%) injuries occurred during traditional climbing, 13 (34%) during sport climbing and 9 (24%) during bouldering. Varying with climbing discipline, 84-100% injuries were caused by falls. Injuries of the foot and ankle accounted for 72-100% of the injuries. Fractures were the most common injury (60%) followed by sprains (17%) and contusions (10%). Conclusions Traumatic injuries sustained during outdoor climbing in Sweden were predominantly caused by falls and affected the lower extremities in all major outdoor climbing disciplines. Rope management errors as a cause of injury were common in sport climbing and in activity surrounding the climbing, indicating there is room for injury-preventing measures.
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