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- Flinck, M., et al.
(författare)
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Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model
- 2015
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Ingår i: Journal of Children's Orthopaedics. - : SAGE Publications. - 1863-2521 .- 1863-2548. ; 9:1, s. 77-84
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Tidskriftsartikel (refereegranskat)abstract
- Methods: Twenty-four femur models with an intramedullary canal diameter of 10.0 mm were used. Three groups with various combinations of titanium elastic nails (TEN) with end caps and one group with a PLN were tested. An oblique midshaft fracture was created, and the models underwent compression, rotation, flexion/extension, and a varus/valgus test, with 50 and 100 % of the forces generated during walking in corresponding planes. Results: We present the results [median (range)] from 100 % loading during walking. In axial compression, the PLN was less shortened than the combination with two 4.0-mm TEN [by 4.4 (3.4–5.4) mm vs. 5.2 (4.8–6.6) mm, respectively; p = 0.030]. No difference was found in shortening between the PLN and the four 3.0-mm TEN [by 7.0 (3.3–8.4) mm; p = 0.065]. The two 3.0-mm TEN did not withstand the maximum shortening of 10.0 mm. In external rotation, the PLN rotated 12.0° (7.0–16.4°) while the TEN models displaced more than the maximum of 20.0°. No model withstood a maximal rotation of 20.0° internal rotation. In the four-point bending test, in the coronal and the sagittal plane, all combinations except the two 3.0-mm TEN in extension withstood the maximum angulation of 20.0°. Conclusions: PLN provides the greatest stability in all planes compared to TEN models with end caps, even though the difference from the two 4.0-mm or four 3.0-mm TEN models was small. Background: The treatment for length-unstable diaphyseal femur fractures among school-age children is commonly intramedullary elastic nails, with or without end caps. Another possible treatment is the semi-rigid pediatric locking nail (PLN). The purpose of this biomechanical study was to assess the stability of a length-unstable oblique midshaft fracture in a synthetic femur model stabilized with different combinations of intramedullary elastic nails and with a PLN.
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- Broström, E W, et al.
(författare)
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Change in Gait Deviation Index after anti-tumour necrosis factor-α treatment in individuals with rheumatoid arthritis : a pilot study
- 2013
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa Healthcare. - 0300-9742 .- 1502-7732. ; 42:5, s. 356-361
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Anti-tumour necrosis factor-alpha (TNF-α) inhibitors provide fast, effective resolution of rheumatoid arthritis (RA) inflammation. In this study we aimed to quantify the impact of TNF-α treatment on gait dynamics.METHOD: The sample comprised 16 subjects [11 female, median age 56 (range 48-66) years, median disease duration 9.5 (range 4.6-20.6) years] with RA who met the American College of Rheumatology (ACR) criteria, had lower extremity involvement, did not use walking aids, and had started TNF-α treatment within 1 week of baseline gait analysis. Gait analysis focused on three-dimensional (3D) lower extremity joint kinematics, kinetics, time and distance parameters. The Gait Deviation Index (GDI) and GDI-Kinetic were calculated. Data on gait, disease activity, and physical disability were collected at baseline and at 3.5 months.RESULTS: Following treatment with TNF-α, statistically significant improvements were found in disease activity [using the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP); median difference (m(d)) = 2.3, p < 0.01], physical disability [Health Assessment Questionnaire (HAQ) m(d) = 0.4, p < 0.01], and pain during walking [visual analogue scale (VAS) m(d) = 11.0, p < 0.05]. Reductions in gait deviations were noted (GDI m(d) = 3.7, p = 0.04; GDI-Kinetic m(d) = 4.1, p = 0.05) along with reductions in dimensionless time and distance parameters. A moderate to good negative correlation existed between baseline GDI and GDI change scores (r(s) = -0.7, p < 0.01).CONCLUSIONS: Treatment with TNF-α improved gait dynamics in adults with RA. Significant gait deviations were, however, still present after treatment. In this study, GDI and GDI-Kinetic scores appeared to be useful outcome measures to quantify changes in gait deviations after this intervention.
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- Burgess, LC, et al.
(författare)
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The quality of intervention reporting in trials of therapeutic exercise for hip osteoarthritis: a secondary analysis of a systematic review
- 2021
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 22:1, s. 388-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTherapeutic exercise is recommended as a core treatment for hip osteoarthritis (HOA). Whilst it is widely accepted that exercise can improve pain and disability, optimal type and dose of exercise are yet to be agreed upon. This may, in part, be attributed to the wide variation and inadequate reporting of interventions within the literature. This study evaluates the quality of intervention reporting among trials of therapeutic exercise in HOA.MethodsRandomised controlled trials (RCTs) were sourced in a systematic review, completed in August 2020. Two raters independently used the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT) to evaluate intervention reporting. Correlations between quality assessment scores and CERT and TIDieR scores evaluated the relationship between internal validity and external applicability. The year of publication was compared to the quality of reporting scores.ResultsFourteen RCTs were included in the analysis. On average, studies were awarded 9.43 ± 1.95 out of 12 points for the TIDieR checklist (range 4–12) and 13.57 ± 4.01 out of 19 points for the CERT (range 5–19). Pearson’s correlation coefficient suggested that the quality of reporting had improved over time and that there was a fair, positive relationship between internal validity and external applicability.DiscussionWhilst the quality of intervention reporting is improving, many RCTs of therapeutic exercise in HOA lack the detail necessary to allow accurate evaluation and replication. Researchers are encouraged to utilise the standardised reporting guidelines to increase the translation of effective interventions into clinical practice.
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- Flinck, Marianne, et al.
(författare)
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Leg length discrepancy after skeletal maturity in patients treated with elastic intramedullary nails after femoral shaft fractures in childhood
- 2022
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Ingår i: Journal of Childrens Orthopaedics. - : SAGE Publications. - 1863-2521 .- 1863-2548. ; 16:4, s. 276-284
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose was to study radiographic and perceived leg length discrepancy after skeletal maturity in patients treated for femoral shaft fractures with elastic stable intramedullary nails in childhood. Methods: Thirty-five adults underwent standing radiographs and answered a questionnaire regarding perception of leg length discrepancy. Demographic data, fracture characteristics, angulation, stability of fixation, and callus formation, at time of fracture, were assessed. Results: Mean age at fracture was 10.2 (4.9-16.7) years, and mean follow-up time was 11.1 (3.8-16.8) years. In 8 of 35 participants, the fractured limb was 11-15 mm longer than the non-fractured, and in 16, 1-10 mm longer. In eight participants, the fractured limb was 1-10 mm shorter than the non-fractured, and in three participants, 12-23 mm shorter. The younger the child, the greater the lengthening (R-s = -0.49, p = 0.003). The greater the femoral angulation at time of fracture, the greater the shortening (R-s = 0.42, p = 0.013). There was no significant correlation between stability of fixation or callus formation 1 month postoperatively and radiographic leg length discrepancy after skeletal maturity. Fourteen (40%) had perception of leg length discrepancy at follow-up, of whom eight had a radiographic leg length discrepancy of 10-24 mm. Conclusion: Treatment with elastic stable intramedullary nail of femoral shaft fracture in childhood may result in radiographic leg length discrepancy. Younger children were more prone to lengthening and should possibly be assessed before skeletal maturity. The degree of fracture stability or callus formation at the time of fracture did not significantly affect leg length discrepancy. Perception of leg length discrepancy was not necessarily associated with a radiographic leg length discrepancy (>= 10 mm).
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- Gelink, Andrés, et al.
(författare)
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Valgus slipped capital femoral epiphysis : Presentation, treatment, and clinical outcomes using patient-reported measurements
- 2021
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Ingår i: Journal of Pediatric Orthopaedics Part B. - 1060-152X .- 1473-5865. ; 30:2, s. 111-115
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Tidskriftsartikel (refereegranskat)abstract
- Valgus slipped capital femoral epiphysis (SCFE), is rare. This study describes the diagnosis, treatment and outcome of valgus SCFE in Uruguay. The medical records and radiographs were reviewed in eight consecutive children [mean age 11.9 years (range 9-13; six female)] with valgus SCFE between 1997-2017. In 2018-2019, all patients were reexamined clinically, new radiographs obtained, and patient-reported outcomes completed using the international tool of hip results (iHOT-12). The prevalence of clinical femoroacetabular impingement (FAI), avascular necrosis, and surgical complications were also studied. There were 11 valgus SCFEs in eight patients; two had primary bilateral SCFEs, and one child later developed a valgus SCFE in the contralateral hip. Seven out of eight patients were overweight. All were stable idiopathic SCFEs. The mean femoral head shaft angle on the anteroposterior radiographs for the 11 SCFEs was 145° (range 140-168) and 141° (range 139-145) for the six healthy contralateral hips. Slip severity measured on the Lauenstein projection was mild (<30°) in eight hips and moderate (30°-60°) in three hips. At a mean follow-up of 87 months (range 24-252), there were no cases of avascular necrosis. The mean iHOT12 was 74 (range 13-97). Significant remodeling was detected in both head shaft angle (8°) and alpha angle (10°) in the affected hips. Nine hips (81%) demonstrated clinical signs of FAI. Our study is the first to describe long-term results using both clinical and patient outcome measures (iHOT-12). A majority of patients have residual symptoms, likely associated with FAI.
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- von Heideken, J, et al.
(författare)
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Acute injuries to the posterolateral corner of the knee in children: a case series of 6 patients
- 2011
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 39:10, s. 2199-2205
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Tidskriftsartikel (refereegranskat)abstract
- Background: Isolated avulsion fractures of the posterolateral structures (the popliteus tendon, the lateral collateral ligament, and the popliteofibular ligament) of the knee are rare.Purpose: To describe the outcome after an isolated avulsion fracture at the femoral attachment of the posterolateral structures in skeletally immature patients and to communicate our clinical experience concerning diagnosis and treatment.Study Design: Case series; Level of evidence, 4.Methods: Six skeletally immature patients (mean age, 13.3 years; range, 12.6-13.7 years; 5 boys, 1 girl) with an avulsion fracture of the femoral attachment of the posterolateral structures were evaluated on average 5.1 years (range, 2.7-8.3 years) after the injury. Five patients were treated with open reduction and fixation of the fragment. The sixth patient was treated nonoperatively with cast immobilization. The evaluation was based on reassessment of radiographs and magnetic resonance imaging (MRI scans), registration of activity level, and examination of objective and subjective knee function.Results: The injury involved both the popliteus tendon and the lateral collateral ligament in 5 of the 6 cases. In the operated patients, the mean Lysholm knee score was 98 (range, 94-100) (0-100, with higher scores indicating a better outcome). The mean Knee injury and Osteoarthritis Outcome Score (KOOS) quality of life (QOL) was 80 (range, 50-100) (0-100, with higher scores indicating a better outcome). The range of motion and the KT-1000 arthrometer anterior laxity measurements were normal. The nonoperatively treated patient with involvement of both the popliteus tendon and the lateral collateral ligament suffered a bone bridge in the periphery of the femoral physis, causing a valgus deformity of the knee. An open wedge femoral osteotomy was performed. The Lysholm knee score was 80, and KOOS QOL was 25 at follow-up. The patient also had an extension deficit of 5° and a flexion deficit of 10°.Conclusion: An avulsion of the femoral attachment of the posterolateral structures in skeletally immature patients may involve both the popliteus tendon and the lateral collateral ligament. Open reduction and fixation of the fragment gave a satisfactory outcome.
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| 26. |
- von Heideken, J, et al.
(författare)
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Rapidly increasing incidence in scoliosis surgery over 14 years in a nationwide sample
- 2018
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Ingår i: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. - : Springer Science and Business Media LLC. - 1432-0932. ; 27:2, s. 286-292
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Tidskriftsartikel (refereegranskat)
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