| 1. |
- Juto, Hans, et al.
(författare)
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Epidemiology of Adult Ankle Fractures : 1756 cases identified in Norrbotten County during 2009–2013 and classified according to AO/OTA
- 2018
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Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: The ankle fracture is one of the most common fractures, increasing in an ageing population, but not generally seen as an osteoporotic fracture. The aim of this study was to examine the relationship between different AO/OTA classes of ankle fractures, age, sex and type of trauma.Methods: Ankle fractures, treated at any of the hospitals in Norrbotten County in Sweden between 2009 and 2013, were retrospectively identified and classified according to the AO/OTA-classification system. Information about the trauma mechanism was also obtained.Results: In Norrbotten County, 1756 ankle fractures in 1735 patients aged 20 years or older were identified. This gave an incidence in the county of 179 per 100,000 person-years. Of these patients, 34.6% were 65 years or older, 58.4% were women and 68.2% of the trauma leading to a fracture was defined as low-energy. In 1.5% of the cases the fractures were open. Incidences of type B fractures increased substantially with age, from 62 (95% CI 50–77) at 30–39 years of age to 158 (95% CI 131–190) in patients older than 80 years of age per 100,000 person-years. Type B fractures showed a slightly higher proportion of low-energy trauma while type C showed a lower mean age and proportion of women.Conclusions: This study shows an incidence of 179 adult ankle fractures annually per 100,000 persons. More than two thirds of the fractures were caused by a low-energy trauma and ankle fractures are more frequent among females. Females generally have an increased incidence during their life, mainly between the ages of 30 and 60. This is in contrast to men who have more of an even distribution throughout their life. Classification according to AO/OTA reveals some heterogeneity among the classes of ankle fractures in age and gender as well as the energy involved in the trauma.
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| 2. |
- Juto, Hans, et al.
(författare)
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Evaluating non-responders of a survey in the Swedish fracture register : no indication of different functional result
- 2017
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Swedish Fracture Register (SFR) currently contains information on more than 190,000 fractures. Patient Reported Outcome Measures (PROMs) are used for monitoring functional results after fracture treatment. One weakness, as in many surveys, is a low response rate. The aim of the current study was to examine if non-responders of a survey in the SFR differ in PROMs scores, how age and gender influence the response rate and reasons for not responding. Methods: Patients with fractures of radius, ulna or humerus between June and August 2013 and registered in the SFR were included in the study. The non-responders to both the pre-injury and the 1-year survey were contacted by phone and reminded to reply. A comparison of the results of both EQ-5D and Short Musculoskeletal Function Assessment (SMFA) could be made between the responders after a phone reminder and the initial responders. The response rate for the register as a whole was extracted in order to identify how age and gender affect the response rate. Results: Three hundred seventeen of the patients included in the study responded initially. After phone reminder another 94 patients answered the pre-injury survey. Two hundred sixty eight responded initially to the 1-year follow-up survey and 42 after phone reminder. No significant difference was identified in the score of the pre-injury survey between initial responders and responders after phone reminder neither in the EQ-5D nor in the Short Musculoskeletal Function Assessment (SMFA). Regarding the 1-year survey, responders after a phone reminder reported a significantly better outcome in crude data of SMFA score. This difference disappeared after controlling for confounding factors through case control matching. The highest response rate to PROMs in the SFR was among females in the age range 60-69 years. Conclusion: This study indicates that both in the preinjury survey as well as in the 1-year survey the non-responders in the SFR report similar function compared to the initial responders. Age and gender of patients affect the response rate of the survey which needs to be taken into consideration in analysis of data from the SFR.
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| 3. |
- Juto, Hans, et al.
(författare)
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Routine use of LMWH prophylaxis is associated with a lower incidence of venous thromboembolic events following an ankle fracture
- 2022
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Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 53:2, s. 732-738
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Tidskriftsartikel (refereegranskat)abstract
- Background: Venous thromboembolic events (VTE) are well-known and serious complications following a trauma to the lower extremities. There is an ongoing debate on the benefit of low-molecular-weight heparin (LMWH) as prophylaxis following ankle fracture treatment. We examined the association between the incidence of VTE and the use of LMWH-prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE.Methods: In this retrospective cohort study, data on ankle fractures and fracture treatment from the Swedish Fracture Register was linked to data from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Patients with VTE and patients who received LMWH prophylaxis were identified. The treating orthopedic departments were sent a questionnaire about their guidelines regarding the use of LMWH prophylaxis.Results: 222 cases of diagnosed VTE were identified among 14,954 ankle fractures. Orthopedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, CI 0.39–0.92). Among operatively treated patients, departments with a guideline for the routine use of LMWH prophylaxis also had lower incidence of VTE (OR 0.56, CI 0.37–0.86). A later onset of VTE was seen among patients prescribed LMWH prophylaxis, with a mean of 56 days to onset (CI 44–67), compared to 39 days (CI 33–45) in patients without prescribed prophylaxis. During the first two weeks following injury, there was only one case of VTE in patients with prescribed LMWH, compared to 39 cases of VTE among patients without prescribed prophylaxis.Conclusions: Routine use of LMWH in patients with operatively treated ankle fractures was associated with a lower incidence of VTE. A more frequent use of LMWH among patients with non-operatively treated ankle fractures were associated with a lower incidence of VTE. The onset occurred later among patients with LMWH-prophylaxis who still suffered a VTE.
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| 4. |
- Juto, Hans, 1975-
(författare)
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Studies of ankle fractures : classification, epidemiology, complications and results
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The ankle fracture is one of the most common fractures in adult patients and is a heterogeneous group of fractures. From the fully stable fracture on the most distal part of thefibula to severely unstable and even dislocated ankles. Patients with ankle fractures often report a good result after treatment, but a small group have persistent problems.The purpose of the dissertation is to investigate classification, epidemiology, complications, and results in order to improve knowledge and management of ankle fractures.This dissertation is mainly based on data from the Swedish Fracture Register (SFR).In Study I the accuracy of the AO/OTA classification, version 2007, of ankle fractures in the SFR was examined. Entry of data into the SFR is mainly performed by the attending doctors at the accident and emergency departments, often with varying experience of fracture classification. Classification of fractures can in some cases bedifficult even for experienced orthopaedic surgeons. This is because the fractures to be categorized can be seen being on a spectrum and there will always be cases which is on the border between different categories. We created a reference group that classified several randomly selected ankle fractures from the SFR based on X-rays from treatingorthopedic departments. The assessment that was then agreed upon was considered to be the gold standard classification and could in turn be compared to the classification found in the SFR. The agreement between the classification in the SFR and the classification of the reference group was 88% for AO/OTA type level and 74% for AO/OTAgroup level. This corresponded to a kappa value of 0.77 and 0.66 respectively. The findings were equivalent to or higher than in previous studies.In study II the aim was to examine the incidence of ankle fractures in Norrbotten county, as well as the relationship between AO/OTA-classes of ankle fractures with age, gender and low-energy trauma. Ankle fractures are increasing in an ageing population but are not generally seen as a fragility fracture. All ankle fractures treated at a hospital in the county were retrospectively identified, X-rays were inspected and classified, and the medical record reviewed. The study found 1,756 ankle fractures corresponding to an incidence of 179 per 100,000 person-years. Females had an increasing incidence with age while among males the incidence was more evenly distributed. The type B fractures showed a slightly higher proportion of low-energy trauma and increased substantially with age. In contrast were the A21-subgroup and type C ankle fractures which had a lower mean age and proportion of women.Study III investigated the association between the incidence of venous thromboembolic event (VTE) and the use of low-molecular-weight heparin (LMWH) prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE. VTE is a well-known complication after ankle fracture and especially after ankle fracture surgery. The use of LMWH prophylaxis is debated. Data on ankle fracture treatment from the Swedish Fracture Register was linked to data for VTE diagnosis and LMWH prescription from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Cases of diagnosed VTE were identified among 222 of 14,954 ankle fractures. Orthopaedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, 95% CI, 0.39-0.92). Among patients treated operatively at departments with guidelines for routine use of LMWH prophylaxis there was an incidence of VTE of 1.6%, compared to 2,7% at departments without routine use of LMWH prophylaxis (OR 0.56, 95% CI, 0.37-0.86). During the first two weeks following injury, there was only one case of VTE in 5,332 patients with prescribed LMWH, compared to 39 cases of VTE among 9,622 patients without prescription.Study IV examined the variations in the length of sick leave in ankle fracture patients. Even though most patients with an ankle fracture report a satisfactory outcome there are still a number of patients with persistent pain and functional impairment. The aim of the study was to analyse how treatment, different types of ankle fracture and patients-related factors were associated with the length of sick leave by combining data from the SFR and Swedish Social Insurance Agency (SSIA). Fifty-three per cent of patients registered with an ankle fracture in the SFR had a period of paid sick leave from the SSIA. There was an association between the length of the sick leave and the severity of the fracture. A correlation was also seen between the length of the sick leave and a worse patient-reported outcome.
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| 5. |
- Juto, Hans, et al.
(författare)
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Substantial accuracy of fracture classification in the Swedish Fracture Register : evaluation of AO/OTA-classification in 152 ankle fractures
- 2016
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Ingår i: Injury. - : Elsevier BV. - 0020-1383 .- 1879-0267. ; 47:11, s. 2579-2583
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Since 2011 the Swedish Fracture Register (SFR) has collected information on fracture epidemiology, treatment and outcome. More than 112 000 fractures, including 11 600 ankle fractures, have been registered so far. The accuracy of the classification is crucial when using the register in future research and quality improvement of care. In this study we examine the degree of accuracy of the AO/ OTA-classification in which ankle fractures are recorded in the SFR.Methods: 152 randomly selected ankle fractures registered in the SFR were classified independently by a reference group of three orthopedic surgeons on two occasions. The agreed AO/OTA-classification of the reference group was regarded as the gold standard classification for each case. The originally recorded classification in the SFR was subsequently compared with the classification of the reference group and accuracy calculated.Results: The agreement between the classification in the SFR and of the reference group was 74%, corresponding to kappa 0.67, 95% CI (0.58-0.76) for AO/OTA group level. An agreement of 88% equivalent to kappa 0.77, 95% CI (0.67-0.87) was noted for AO/OTA type level. The agreement corresponds to substantial according to Landis and Koch. The kappa value of inter-and intraobserver agreement ranged from 0.67 to 0.93.Conclusions: The study results show substantial agreement between classifications made in the SFR and gold standard classification. The finding is equivalent to or higher than in previous studies. Consequently, we conclude that classifications of ankle fractures in the SFR are accurate and valid.
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| 6. |
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| 7. |
- Lagerqvist, Carina, et al.
(författare)
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Antigliadin immunoglobulin A best in finding celiac disease in children younger than 18 months of age
- 2008
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - 0277-2116 .- 1536-4801. ; 47:4, s. 428-35
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim was to investigate age-dependent serum levels and occurrence of elevated celiac disease (CD)-related antibodies in young children, to define the optimal serological procedure when selecting for small intestinal biopsy. PATIENTS AND METHODS: Included were 428 children with biopsy verified CD (median age 16 months; range 7.5 months-14 years) and 216 controls (median age 2.7 years; range 8.5 months-14.6 years). Immunoglobulin (Ig) A antibodies against gliadin (AGA-IgA), tissue transglutaminase (tTG-IgA), and endomysium (EMA-IgA) were analysed. RESULTS: Increased serum AGA-IgA levels were found in 411 of 428 CD cases, tTG-IgA in 385 of 428, and EMA-IgA in 383 of 428. In the control group, 11 of 216 had increased levels of AGA-IgA, 5 of 216 of tTG-IgA, and 8 of 216 of EMA-IgA. In CD children younger than 18 months, elevated AGA-IgA occurred in 97% and elevated tTG-IgA and EMA-IgA were found in 83% of the cases. Conversely, in CD children older than 18 months, elevated AGA-IgA occurred in 94%, and elevated tTG-IgA and EMA-IgA were found in 99% of the cases. CONCLUSIONS: In children older than 18 months, both tTG-IgA and EMA-IgA are sufficiently accurate to be used as a single antibody marker, whereas a large proportion of younger children with CD lack these antibodies. Therefore, when selecting children for small intestinal biopsy, the detection of a combination of AGA-IgA and tTG-IgA is optimal for identifying untreated CD in children younger than 18 months.
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| 8. |
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| 9. |
- 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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| 10. |
- Wennergren, David, et al.
(författare)
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Epidemiology and incidence of tibia fractures in the Swedish Fracture Register
- 2018
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Ingår i: Injury-International Journal of the Care of the Injured. - : Elsevier BV. - 0020-1383 .- 1879-0267. ; 49:11, s. 2068-2074
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: There is a lack of epidemiological studies of fractures in all segments of the tibia classified by orthopaedic surgeons according to the AO/OTA classification. Since 2011, the Swedish Fracture Register (SFR) has provided prospectively collected, population-based data on fractures of all types, treated both surgically and non-surgically. The aim of this study was to describe the epidemiology and incidence of fractures in all segments of the tibia in a cohort of consecutive tibia fractures over a period of five years at Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: Information on age, gender, date and mechanism of injury, fracture classification according to AO/OTA, affected side and high- or low-energy trauma was extracted from the SFR for all patients, aged 16 years and above, with tibia fractures treated at Sahlgrenska University Hospital, Gothenburg, during the five-year period 1 January 2011 to 31 December 2015. Results: 1325 patients sustained 1371 tibia fractures. There were 712 proximal tibia fractures, 417 tibial shaft fractures and 242 distal tibia fractures. Patients with proximal tibia fractures had a higher mean age (54.3) and 58% were women, whereas patients with shaft and distal fractures had a slightly lower mean age (47.0 and 48.7 respectively) and a dominance of men (59% and 54% respectively). The overall incidence of tibia fractures was 51.7 per 100,000 and year. The incidence of proximal, diaphyseal and distal tibia fractures was 26.9, 15.7 and 9.1 respectively per 100,000 and year. Among women, tibia fractures showed an increasing incidence with age in all segments, whereas men had a fairly flat incidence curve, except for tibial shaft fractures, which displayed a peak among young males. The incidence of tibia fractures and graphs for age-specific incidence for each segment of the tibia are presented. Conclusions: This study describes the epidemiology and incidence of fractures in the whole of the tibia classified by orthopaedic surgeons according to the AO/OTA classification. (C) 2018 Elsevier Ltd. All rights reserved.
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