| 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. |
- MacIntosh, Bradley J., et al.
(författare)
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Radiological features of brain hemorrhage through automated segmentation from computed tomography in stroke and traumatic brain injury
- 2023
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Ingår i: Frontiers in Neurology. - 1664-2295. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Radiological assessment is necessary to diagnose spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury intracranial hemorrhage (TBI-bleed). Artificial intelligence (AI) deep learning tools provide a means for decision support. This study evaluates the hemorrhage segmentations produced from three-dimensional deep learning AI model that was developed using non-contrast computed tomography (CT) imaging data external to the current study. Methods: Non-contrast CT imaging data from 1263 patients were accessed across seven data sources (referred to as sites) in Norway and Sweden. Patients were included based on ICH, TBI-bleed, or mild TBI diagnosis. Initial non-contrast CT images were available for all participants. Hemorrhage location frequency maps were generated. The number of estimated haematoma clusters was correlated with the total haematoma volume. Ground truth expert annotations were available for one ICH site; hence, a comparison was made with the estimated haematoma volumes. Segmentation volume estimates were used in a receiver operator characteristics (ROC) analysis for all samples (i.e., bleed detected) and then specifically for one site with few TBI-bleed cases. Results: The hemorrhage frequency maps showed spatial patterns of estimated lesions consistent with ICH or TBI-bleed presentations. There was a positive correlation between the estimated number of clusters and total haematoma volume for each site (correlation range: 0.45–0.74; each p-value < 0.01) and evidence of ICH between-site differences. Relative to hand-drawn annotations for one ICH site, the VIOLA-AI segmentation mask achieved a median Dice Similarity Coefficient of 0.82 (interquartile range: 0.78 and 0.83), resulting in a small overestimate in the haematoma volume by a median of 0.47 mL (interquartile range: 0.04 and 1.75 mL). The bleed detection ROC analysis for the whole sample gave a high area-under-the-curve (AUC) of 0.92 (with sensitivity and specificity of 83.28% and 95.41%); however, when considering only the mild head injury site, the TBI-bleed detection gave an AUC of 0.70. Discussion: An open-source segmentation tool was used to visualize hemorrhage locations across multiple data sources and revealed quantitative hemorrhage site differences. The automated total hemorrhage volume estimate correlated with a per-participant hemorrhage cluster count. ROC results were moderate-to-high. The VIOLA-AI tool had promising results and might be useful for various types of intracranial hemorrhage.
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| 8. |
- Mellner, Carl, et al.
(författare)
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Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem
- 2021
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer. - 1863-9933 .- 1863-9941. ; 47, s. 803-809
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of this study was to compare the cumulative incidence of postoperative periprosthetic fracture (PPF) in a cohort of femoral neck fracture (FNF) patients treated with two commonly used cemented stems: either a collarless, polished, tapered Exeter stem or the anatomic Lubinus SP2 stem.METHODS: In this retrospective multicenter cohort study of a consecutive series of patients, we included 2528 patients of age 60 years and above with an FNF who were treated with either hemiarthroplasty or total hip arthroplasty using either a polished tapered Exeter stem or an anatomic Lubinus SP2 stem. The incidence of PPF was assessed at a minimum of 2 years postoperatively.RESULTS: The incidence of PPF was assessed at a median follow-up of 47 months postoperatively. Thirty nine patients (1.5%) sustained a PPF at a median of 27 months (range 0-96 months) postoperatively. Two of the operatively treated fractures were Vancouver A (5%), 7 were Vancouver B1 (18%), 10 were Vancouver B2 (26%), 7 were Vancouver B3 (18%), and 13 were Vancouver C (32%). The cumulative incidence of PPF was 2.3% in the Exeter group compared with 0.7% in the SP2 group (p < 0.001). The HR was 5.4 (95% CI 2.4-12.5, p < 0.001), using the SP2 group as the denominator.CONCLUSIONS: The Exeter stem was associated with a higher risk for PPF than the Lubinus SP2 stem. We suggest that the tapered Exeter stem should be used with caution in the treatment of FNF.TRIAL REGISTRATION: The study was registered at clinicaltrials.gov (identifier: NCT03326271).
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| 9. |
- Mellner, Carl, 1987-
(författare)
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Studies on the complications and prediction of mortality after hip fracture surgery
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An elderly patient who sustains a hip fracture has increased morbidity and mortality. Scandinavia presents the highest incidence annually of hip fractures worldwide. Femoral neck fracture (FNF) of the hip accounts for 50% of all hip fractures in geriatric patients. Intertrochanteric and subtrochanteric femoral fracture accounts for the other 50%. Hip fracture patients are plagued with a high 1-year mortality rate ranging from 8% to 36%. Complications of hip fracture surgery after arthroplasty generally include periprosthetic fracture (PPF), periprosthetic joint infection (PJI), and dislocation. Treatent regarding FNF has improved in the last decade. Arthroplasties are currently the standard treatment for displaced FNFs in the elderly. The surgical treatment of PPF can be technically demanding, with a high frequency of complications due to deep infection, dislocation and intraoperative fractures. Some prosthetic designs have been reported.PJIs are associated with prolonged antibiotic treatment, multiple revision surgeries, prolonged hospital stays, late aseptic loosening and poor functional outcome for the patients. A widely accepted treatment of choice for acute deep PJIs comprises debridement, antibiotics and implant retention (DAIR).There are currently several models for predicting mortality with the aim of identifying and optimizing patients at risk. The Sernbo score was initially developed as a guidance tool for the orthopedic surgeon in decision making in hip fracture surgery.Study I: This was a prospective cohort study of patients with FNFs treated with hemiarthroplasty or total arthroplasty. The aim of this study was to compare the risk for PPF between the straight, highly, polished, tapered (CPT) stem and the matte anatomic SPII stem. It was found that the CPT stem imposed a higher risk of postoperative PPF.Study II: This was a retrospective multicenter cohort study of patients with FNFs treated with total or hemiarthroplasty. The aim of this study was to compare the risk for PPF between the straight, highly polished, tapered Exeter stem and the matte anatomic SPII stem. It was found that Exeter stem imposed a higher risk of sustaining a PPF.Study III: This was a retrospective cohort study of patients treated with a primary hip arthroplasty (hemi- or total hip) for a displaced FNF. The primary aim of this study was to identify the frequency of PJI and to evaluate the success rate of DAIR. The secondary aim was to analyze the risk factors for developing PJI. It was found that DAIR had a high short- term success rate and that the need for repeated bandage changes indicates an increased risk of PJI and should prompt early surgical intervention.Study IV: This was a retrospective study with the aim of validating the Sernbo score for predicting mortality after hip replacement for a displaced FNF in elderly patients. The Sernbo score (based on age, habitat, walking aids and mental state) can be used to stratify patients into groups with different one-year mortality rates. The score can be calculated using information obtained during routine orthopedic patient assessments.The Sernbo score was found to identify patients at high risk of dying in the first postoperative year.Study V: This was a retrospective registry study. All patients who sustained a hip fracture and registered in “Rikshöft” (a Swedish database for hip fracture) were included. The aim of this study was to validate the Sernbo score for predicting mortality after hip fracture in elderly patients on a registry-based level. It was found that the Sernbo score can be used to stratify patients into groups with different one-year mortality rates.
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| 10. |
- Mellner, Carl, et al.
(författare)
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The Sernbo score predicts 1-year mortality after displaced femoral neck fractures treated with a hip arthroplasty
- 2017
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 88:4, s. 402-406
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Displaced femoral neck fractures (FNFs) are associated with high rates of mortality during the first postoperative year. The Sernbo score (based on age, habitat, mobility, and mental state) can be used to stratify patients into groups with different 1-year mortality. We assessed this predictive ability in patients with a displaced FNF treated with a hemiarthroplasty or a total hip arthroplasty. Patients and methods - 292 patients (median age 83 (65-99) years, 68% female) with a displaced FNF were included in this prospective cohort study. To predict 1-year mortality, we used a multivariate logistic regression analysis including comorbidities and perioperative management. A receiver operating characteristic (ROC) analysis was used to evaluate the predictive ability of the Sernbo score, which was subsequently divided in a new manner into a low, intermediate, or high risk of death during the first year. Results - At 1-year follow-up, the overall mortality rate was 24%, and in Sernbo's low-, intermediate-, and high-risk groups it was 5%, 22%, and 51%, respectively. The Sernbo score was the only statistically significant predictor of 1-year mortality: odds ratio for the intermediate-risk group was 4.2 (95% Cl: 1.5-12) and for the high-risk group it was 15 (95% CI: 5-40). The ROC analysis showed a fair predictive ability of the Sernbo score, with an area under the curve (AUC) of 0.79 (95% CI: 0.73-0.83). Using a cutoff of less than 11 points on the score gave a sensitivity of 61% and a specificity of 83%. Interpretation - The Sernbo score identifies patients who are at high risk of dying in the first postoperative year. This scoring system could be used to better tailor perioperative care and treatment in patients with displaced FNF.
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| 11. |
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| 12. |
- Mukka, Sebastian, et al.
(författare)
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A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly : a pilot study for a clinical trial
- 2020
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Ingår i: Pilot and Feasibility Studies. - : Springer Nature. - 2055-5784. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The literature regarding undisplaced femoral neck fractures (FNF) is sparse. The aim of this prospective feasibility study is to compare the clinical outcome after undisplaced FNF treated with internal fixation (IF) and displaced FNF treated with hip arthroplasty. We hypothesized that hip arthroplasty would give a lower incidence of reoperations.Methods: A total of 235 patients were included with a median age of 84 years (range 65-99). A consecutive series of 65 patients with undisplaced FNF were treated with IF, and 170 patients with displaced FNF were treated with either a total hip arthroplasty or a hemiarthroplasty. Follow-up interviews were conducted at 1 year using the Harris Hip Score (HHS), WOMAC, and pain numeric rating scale (PNRS). The minimum follow-up time was 22 months. There was no difference in baseline data between the groups.Results: Nineteen (8%) hips required reoperation at least once at a mean of 6 months (range 0-35). The rate of reoperation was higher in the IF group compared to the hip arthroplasty group (13.8% vs. 5.9%, 95% CI 0.9-6.4). The overall 1-year and 2-year mortality was 28% and 40%, respectively, with no difference between the groups. The most common reasons for reoperations in the IF group were non-union and avascular necrosis, and 6 patients were treated with hip or excision arthroplasty. In the arthroplasty group, the most common indications were deep infection and dislocation. We did not find any differences between the groups in terms of HHS, WOMAC, and PNRS.Conclusions: In this feasibility study, we found no differences in patient-reported outcomes between the groups although IF required a higher rate of reoperations. Further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly.Trial registration: ClinicalTrial.org, NCT03392285. Retrospectively registered on 5 February 2018.
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| 13. |
- Parr, William C.H., et al.
(författare)
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Fatigue implications for bending orthopaedic plates
- 2021
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Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 52:10, s. 2896-2902
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: - We aimed to investigate how pre-bending affects the mechanical properties, specifically fatigue, of stainless-steel plates.Methods: - 3.5mm LCP 10-hole plates were pre-bent in 1, 2 and 3 locations to the same overall degree and fatigue testing performed. Finite Element Analysis (FEA) was performed in Strand7 (version 2.4.6) to better understand the failure point of the plates in four-point bending.Results: - Six different plate pre-bending conditions were tested for resistance to fatigue failure. Increasing the number of pre-bends improved the fatigue resistance with two pre-bends having a mean 509,304 cycles to failure and three pre-bends 491,378 cycles to failure. The region of highest stress and the point of fatigue failure were at the plate's minimum cross-sectional area, which was predicted by the FEA and confirmed with mechanical testing. For plates pre-bent in two locations, the fatigue failure always occurred in the screw hole not in between the positions of the two pre-bends. Non-linear FEA simulation confirmed that work hardening occurs around pre-bend locations, conferring increased fatigue resistance to the holes next to, or between, pre-bend locations.Conclusions: We found that contrary to orthopaedic folklore, pre-bending of plates is not detrimental to fatigue resistance of the stainless-steel plates we tested. Pre-bending plates in a single plane increased the fatigue properties of the 10-hole stainless-steel plate tested.
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| 14. |
- Röding, Fredrik, 1969-
(författare)
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Injuries are not accidents! : an emergency-department population-based epidemiological study of injuries with special reference to trauma recidivism hip fractures and geriatric falls
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Injury is a major public health problem. In rich countries fall injures now kill more people than all other injury mechanisms together, because of global ageing and large-scale sustainable injury prevention programs for all other injury mechanisms but falls. Injuries from falls in the young are often trivial, but in old people falls may have devastating consequences.We used the Umeå Injury Database, 1993 – 2014, 220,014 injury events attended to by the emergency department: e.g., type of injury, localization, mechanism, activity and severity. Logistic regression was used to evaluate injury trends, Cox regression for associations between injury type, severity and recidivism.Fractures were responsible for 1⁄4 of all injuries and for 3⁄4 of trauma inpatient days. Fractures and contusions became more common with increasing age while sprains and wounds decreased with age. Injuries due to fall increased during the study period.Recurrent injuries accounted for some 40%, mostly in young men and in old women. Prior fractures and sprains were strongest predictors for recurrent serious injuries.The hip fracture incidence fell for the most important age/sex groups during the 22-year period, but the total number increased with 3,5%, due to an increasing elderly population. 40% of all hip fracture patients had sustained a previous injury. Multiple previous injuries also increase the risk of future hip fracture. No less than 12% hip fracture patients suffered a new one. With age, injury pattern changed, with more lower extremity fractures that also were more proximally located. Soft tissue injuries to the head/face also increased, also indicating that the ability to reduce and spread the impact of the kinetic energy is a key factor in geriatric trauma, in addition to tissue strengthThe most common, expensive and devastating injury mechanism, falls, are still outrageously neglected, especially concerning injury prevention, which has been so successful in reducing road traffic- and workplace-related deaths. Why? A common misconception is the primitive belief is that fall injuries are fated and therefore inevitable. There are also few economic and legal drivers to prevent falls, especially recurrent ones. Another reason is that GDPR has prohibited the injury database. Statistics on fall injuries are necessary for targeting preventive interventions. Without spying, no clue. On-line feedback of official statistics should be used to monitor the results. There are no technical, just legal hurdles. The Swedish parliament has since 1997 flagged a zero vision for road traffic injuries; in 2015 the government also launched a more modest goal for a 50% reduction of falls in the elderly. So far, nothing has happened...
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| 15. |
- Svehla, M., et al.
(författare)
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No effect of a type I collagen gel coating in uncemented implant fixation
- 2005
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Ingår i: J Biomed Mater Res B Appl Biomater. - 1552-4973. ; 74:1, s. 423-8
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Tidskriftsartikel (refereegranskat)abstract
- Uncemented joint replacement with a variety of substrate materials, structures, and coatings are commonplace in arthroplasty. Even with specialized surgical preparation of bone, intimate contact between the implant and host bone may not always be achieved. This study evaluated the in vivo effect of fibrillar atelopeptide and PEG crosslinked collagens coatings placed directly into porous sintered bead structures on bone ingrowth using a skeletally mature bicortical, bilateral ovine tibia model. Bone ingrowth into the implants increased with time, although differences were not significant. At 4 weeks woven bone was present within the pores that remodeled with time. Significantly lower levels of ingrowth were observed in the intramedullary region of the implants when compared with the cortical region. Implant metal type did not affect ingrowth in both regions analyzed. Both fibrillar and crosslinked forms of dermal type I collagen did not significantly alter bone ingrowth.
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| 16. |
- Walsh, William Robert, et al.
(författare)
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Bone ongrowth and mechanical fixation of implants in cortical and cancellous bone
- 2020
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Ingår i: Journal of Orthopaedic Surgery and Research. - : BioMed Central (BMC). - 1749-799X. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: What is the right surface for an implant to achieve biological fixation? Surface technologies can play important roles in encouraging interactions between the implant surface and the host bone to achieve osseointegration. Preclinical animal models provide important insight into in vivo performance related to bone ongrowth and implant fixation.Methods: A large animal model was used to compare the in vivo response of HA and plasma-sprayed titanium coatings in a well-reported adult ovine model to evaluate bone ongrowth in terms of mechanical properties in cortical sites, and histology and histomorphometry in cortical and cancellous sites at 4 and 12weeks.Results: Titanium plasma-sprayed surfaces outperformed the HA-coated samples in push-out testing in cortical sites while both surfaces supported new bone ongrowth and remodeling in cortical and cancellous sites.Conclusions: While both HA and Ti plasma provided an osteoconductive surface for bone ongrowth, the Ti plasma provided a more robust bone-implant interface that ideally would be required for load transfer and implant stability in the longer term.
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| 17. |
- Walsh, William R., et al.
(författare)
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Does implantation site influence bone ingrowth into 3D-printed porous implants?
- 2019
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Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 19:11, s. 1885-1898
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND CONTEXT: The potential for osseointegration to provide biological fixation for implants may be related to anatomical site and loading conditions.PURPOSE: To evaluate the influence of anatomical site on osseointegration of 3D-printed implants.STUDY DESIGN: A comparative preclinical study was performed evaluating bone ingrowth in cortical and cancellous sites in long bones as well as lumbar interbody fusion with posterior pedicle screw stabilization using the same 3D-printed titanium alloy design.METHODS: 3D-printed dowels were implanted in cortical bone and cancellous bone in adult sheep and evaluated at 4 and 12 weeks for bone ingrowth using radiography, mechanical testing, and histology/histomorphometry. In addition, a single-level lumbar interbody fusion using cages based on the same 3D-printed design was performed. The aperture was filled with autograft or ovine allograft processed with supercritical carbon dioxide. Interbody fusions were assessed at 12 weeks via radiography, mechanical testing, and histology/histomorphometry.RESULTS: Bone ingrowth in long bone cortical and cancellous sites did not translate directly to interbody fusion cages. While bone ingrowth was robust and improved with time in cortical sites with a line-to-line implantation condition, the same response was not found in cancellous sites even when the implants were placed in a press fit manner. Osseointegration into the porous walls with 3D porous interbody cages was similar to the cancellous implantation sites rather than the cortical sites. The porous domains of the 3D-printed device, in general, were filled with fibrovascular tissue while some bone integration into the porous cages was found at 12 weeks when fusion within the aperture was present.CONCLUSION: Anatomical site, surgical preparation, biomechanical loading, and graft material play an important role in in vivo response. Bone ingrowth in long bone cortical and cancellous sites does not translate directly to interbody fusions.
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