| 1. |
- Ali, Muhanned, et al.
(författare)
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Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations : A Long-Term Follow-up
- 2018
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : LIPPINCOTT WILLIAMS & WILKINS. - 0021-9355 .- 1535-1386. ; 100:8, s. 633-639
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Tidskriftsartikel (refereegranskat)abstract
- Background: The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. Methods: In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of >= 10 degrees, ulnar variance of >= 3 mm, and/or radial inclination of <= 15 degrees. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. Results: Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Mal union was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. Conclusions: Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain.
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| 2. |
- Aspenberg, Per, et al.
(författare)
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Effects of Teriparatide Compared with Risedronate on Recovery After Pertrochanteric Hip Fracture Results of a Randomized, Active-Controlled, Double-Blind Clinical Trial at 26 Weeks
- 2016
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : JOURNAL BONE JOINT SURGERY. - 0021-9355 .- 1535-1386. ; 98:22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Osteoporosis drugs might affect fracture-healing. We therefore studied the effects of teriparatide in comparison with risedronate on recovery after pertrochanteric hip fractures. Methods: The study was a randomized, multicenter, active-controlled, 78-week trial comparing teriparatide (20 mg/day) with risedronate (35 mg/week) initiated within 2 weeks after fixation of a low-trauma pertrochanteric hip fracture (AO/OTA 31-A1 or 31-A2). The main inclusion criteria were a bone mineral density T-score of amp;lt;=-22.0 and 25-OH-vitamin D of amp;gt;= 9.2 ng/mL. During the first 26 weeks, patients received study medication with oral or injectable placebo plus calcium and vitamin D in a double-blinded fashion. Secondary (Timed Up-and-Go [TUG] test, hip pain, Short Form [SF]-36 health status, and safety) and exploratory (radiographic outcomes and ability to walk) 26-week end points are reported. Results: Of the 224 patients who were randomized, 171 (86 teriparatide, 85 risedronate) were included in the analysis. The mean age was 77 +/- 8 years, 77% were female, and 26% had a prior history of low-trauma fracture. The teriparatide group completed the TUG test in a shorter time at 6, 12, 18, and 26 weeks (differences of 25.7, -4.4, -3.1, and -3.1 seconds, respectively; p = 0.021 for the overall difference). They also reported less pain on a visual analog scale immediately after the TUG test at 12 and 18 weeks (adjusted absolute differences of 10.6 and 11.9 mm, respectively; p amp;lt; 0.05). There were no significant between-group differences in the SF-36 score, Charnley hip pain score, ability to walk, or use of walking aids during follow-up. Radiographic healing at 6, 12, and 26 weeks, mechanical failure of the implant (teriparatide, 7; risedronate, 8), loss of reduction (teriparatide, 2; risedronate, 4), and nonunion (0 cases) were not significantly different. Mild hypercalcemia and hyperuricemia were more frequent with teriparatide. Conclusions: Teriparatide was associated with less pain and a shorter time to complete the TUG test between 6 and 26 weeks compared with risedronate. Other fracture-recovery outcomes were similar. The results should be interpreted with caution as these were secondary end points.
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| 3. |
- Buijze, G. A., et al.
(författare)
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Three-Dimensional Compared with Two-Dimensional Preoperative Planning of Corrective Osteotomy for Extra-Articular Distal Radial Malunion
- 2018
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Ingår i: Journal of Bone and Joint Surgery-American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 100:14, s. 1191-1202
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Tidskriftsartikel (refereegranskat)abstract
- Background: Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. Methods: From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. Results: From baseline to 12 months of follow-up, the reduction in the mean DASH score was 230.7 +/- 18.7 points for the 3D planning group compared with220.1 +/- 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of 234.4 +/- 22.9 points for the 3D planning group compared with -26.6 +/- 18.3 points for the 2D planning group (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3 degrees; p = 0.04) and radial inclination (by 2.7 degrees; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. Conclusions: Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology.
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| 4. |
- Diarbakerli, E., et al.
(författare)
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Health-Related Quality of Life in Adulthood in Untreated and Treated Individuals with Adolescent or Juvenile Idiopathic Scoliosis
- 2018
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Ingår i: Journal of Bone and Joint Surgery-American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 100:10, s. 811-817
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health-related quality of life in adults with idiopathic scoliosis diagnosed before maturity has been reported to be similar between brace-treated and surgically treated individuals. The aim of this study was to compare health-related quality of life in untreated, brace-treated, and surgically treated adults with idiopathic scoliosis diagnosed before skeletal maturity. Subgroup analyses were performed on the basis of age at the time of the study, age of onset, surgical characteristics, and curve magnitude. Methods: We included 1,187 adults with juvenile or adolescent idiopathic scoliosis with a mean age (and standard deviation) of 38.8 +/- 12.7 years. Of these, 347 were untreated, 459 had been brace-treated, and 381 had been surgically treated. The Scoliosis Research Society-22r (SRS-22r) and EuroQol 5-Dimensions (EQ-5D) were used. Statistical analyses were performed using analysis of covariance. Results: The mean SRS-22r subscore was 4.15 +/- 0.59 points for the untreated group, 4.10 +/- 0.57 points for the previously braced group, and 4.01 +/- 0.64 points for the surgically treated group (p = 0.007 adjusted for age and sex). The EQ-5D index was 0.82 +/- 0.20 for the untreated group, 0.82 +/- 0.20 for the previously brace-treated group, and 0.79 +/- 0.24 for the surgically treated group (p = 0.026, adjusted for age and sex). Brace cessation was at the mean age of 16.2 +/- 1.5 years, and the surgical procedure had been performed at the mean age of 15.3 +/- 2.1 years. A more caudal fusion was associated with a lower SRS-22r subscore and EQ-5D index. No differences were observed when comparing individuals with juvenile or adolescent onset scoliosis (all p > 0.05). Conclusions: Untreated adults with idiopathic scoliosis had similar health-related quality of life to previously brace-treated individuals, and they had marginally higher health-related quality of life compared with surgically treated individuals. Therefore, both surgical and brace treatments for idiopathic scoliosis could be considered successful from a health-related quality-of-life point of view in adulthood. The age of onset of idiopathic scoliosis does not seem to influence quality of life in adulthood.
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| 5. |
- Joelson, Anders, et al.
(författare)
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Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
- 2018
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Ingår i: Journal of Bone and Joint Surgery-American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 100:16, s. 1357-1365
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Tidskriftsartikel (refereegranskat)abstract
- Background: This case series of consecutive patients evaluated sagittal balance and health-related quality of life (HRQoL) 3 decades after in situ arthrodesis for high-grade isthmic spondylolisthesis. Methods: Global sagittal balance, pelvic parameters, and compensatory mechanisms were evaluated on standing lateral radiographs of the spine and pelvis for 28 of 39 consecutive patients, 28 to 41 years after in situ arthrodesis for high-grade L5 to S1 spondylolisthesis. The mean age at surgery was 14 years (range, 9 to 24 years), and the mean age at the time of follow-up was 48 years (range, 39 to 59 years). A subset of the radiographic parameters was compared with the corresponding data from an 8-year follow-up examination of the same patients. HRQoL was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire. Results: We found that 3 of the 28 patients had a global sagittal imbalance (T1 spinopelvic inclination of > 0 degrees). Signs of compensatory mechanisms, such as reduced thoracic kyphosis and pelvic retroversion, were frequent. There was a significant decrease in sacral slope compared with 8-year follow-up data (p = 0.01). The median SRS-22r subscore was on the same level as Swedish normative data. We found no association between radiographic parameters and SRS-22r outcome. Conclusions: Three decades after in situ arthrodesis for high-grade spondylolisthesis, radiographic signs of non-compensated sagittal imbalance were observed in only a few individuals. The patients had normal SRS-22r scores. There was no association between any radiographic parameter and SRS-22r outcome. The findings are relevant in the controversial discussion on whether to perform a reduction procedure to treat high-grade spondylolisthesis.
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| 6. |
- Joelson, Anders, 1970-, et al.
(författare)
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Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
- 2018
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : Stanford University Press. - 0021-9355 .- 1535-1386. ; 100:16, s. 1357-1365
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This case series of consecutive patients evaluated sagittal balance and health-related quality of life (HRQoL) 3 decades after in situ arthrodesis for high-grade isthmic spondylolisthesis.METHODS: Global sagittal balance, pelvic parameters, and compensatory mechanisms were evaluated on standing lateral radiographs of the spine and pelvis for 28 of 39 consecutive patients, 28 to 41 years after in situ arthrodesis for high-grade L5 to S1 spondylolisthesis. The mean age at surgery was 14 years (range, 9 to 24 years), and the mean age at the time of follow-up was 48 years (range, 39 to 59 years). A subset of the radiographic parameters was compared with the corresponding data from an 8-year follow-up examination of the same patients. HRQoL was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire.RESULTS: We found that 3 of the 28 patients had a global sagittal imbalance (T1 spinopelvic inclination of >0°). Signs of compensatory mechanisms, such as reduced thoracic kyphosis and pelvic retroversion, were frequent. There was a significant decrease in sacral slope compared with 8-year follow-up data (p = 0.01). The median SRS-22r subscore was on the same level as Swedish normative data. We found no association between radiographic parameters and SRS-22r outcome.CONCLUSIONS: Three decades after in situ arthrodesis for high-grade spondylolisthesis, radiographic signs of noncompensated sagittal imbalance were observed in only a few individuals. The patients had normal SRS-22r scores. There was no association between any radiographic parameter and SRS-22r outcome. The findings are relevant in the controversial discussion on whether to perform a reduction procedure to treat high-grade spondylolisthesis.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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| 7. |
- Karlsson, M. K., et al.
(författare)
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Characteristics of Prevalent Vertebral Fractures Predict New Fractures in Elderly Men
- 2016
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Ingår i: Journal of Bone and Joint Surgery-American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 98:5, s. 379-385
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies have shown that specific characteristics of prevalent vertebral fractures are associated with a markedly low bone mineral density. This study evaluates if these characteristics also predict subsequent fractures. Methods: MrOS (Mister Osteoporosis) Sweden is a population-based, prospective observational study that includes 3014 community-living men who are sixty-nine to eighty-one years of age. At baseline, 1453 men underwent lateral thoracic and lumbar spine radiography; radiographs of 1427 men were readable. A radiologist identified and characterized prevalent vertebral fractures. Incident fractures during the next five and ten years were objectively registered with use of radiographs. The annual fracture incidence and relative risk of sustaining new fractures were assessed for men with and without baseline prevalent vertebral fracture. Data are presented as the mean and the 95% confidence interval. Results: There were 215 men (15.1%) with at least one prevalent vertebral fracture. During the five-year follow-up, these men had a relative risk of 3.3 (95% confidence interval, 2.6 to 4.3) of sustaining new fractures. The relative risk of sustaining any fracture was especially high in men with two or more prevalent vertebral fractures at 5.5 (95% confidence interval, 3.7 to 7.8), in men with different types of prevalent vertebral fractures at 5.7 (95% confidence interval, 3.6 to 8.5), in men with prevalent fractures in both the thoracic and lumbar regions at 6.4 (95% confidence interval, 4.5 to 8.8), and in men with prevalent fractures with a degree of vertebral body compression in the three worst quartiles, with the relative risk for the worst quartile at 4.0 (95% confidence interval, 2.6 to 5.9). Conclusions: Older men with a prevalent vertebral fracture have three times increased risk of sustaining new fractures compared with men without a vertebral fracture. Older men with two or more prevalent vertebral fractures, different types of fractures (wedge, biconcave, and/or crush), fractures in both the thoracic and lumbar regions, and a degree of vertebral body compression in the three worst quartiles are at an especially high risk of sustaining new fractures. Older men with prevalent vertebral fractures should be considered for fracture-prevention efforts.
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| 8. |
- Kay, J., et al.
(författare)
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A Historical Analysis of Randomized Controlled Trials in Anterior Cruciate Ligament Surgery
- 2017
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Ingår i: Journal of Bone and Joint Surgery - American Volume. - : Ovid Technologies (Wolters Kluwer Health). - 0021-9355 .- 1535-1386. ; 99:24, s. 2062-2068
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of this systematic review was to comprehensively assess the quality of reporting of randomized controlled trials (RCTs) relating to anterior cruciate ligament (ACL) reconstruction. Specifically, this review explored factors related to the quality of the RCTs and trends in the quality of reporting over time. Methods: The online databases PubMed, Ovid (MEDLINE), and Embase were used to search for all RCTs on the topic of ACL reconstruction from database inception until April 14, 2016. The quality of reporting was evaluated using the Detsky quality index and the Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting trials of non-pharmacologic treatments. A multivariate regression analysis was used to assess predictors of quality reporting. Results: The online search yielded 2,933 articles, 412 of which met the inclusion criteria and were assessed for quality of reporting. There was a significant (p < 0.0001) increase in the number of RCTs published over time. The mean Detsky score (and standard deviation) across all included RCTs was 68.9% +/- 13.2%. The strongest predictors of quality reporting were the inclusion of a CONSORT flow diagram (b-coefficient, 10.0; 95% confidence interval [CI]: 8.45 to 11.61; p < 0.0001) and being published in the year 2009 or later (b-coefficient, 5.2; 95% CI: 3.87 to 6.45; p < 0.0001). The factors demonstrating the greatest improvement over time were the inclusion of a full description of the randomization procedure (p = 0.001) and prospective calculation of the sample size (p = 0.002). Conclusions: There has been a significant increase in both the quantity and quality of RCTs relating to ACL reconstruction over time. Specifically, the reporting of a methodologically sound randomization process and prospective calculation of sample size have significantly improved in recent years. However, since the year 2009, the number of trials and reporting in these trials has remained relatively consistent. The use of a CONSORT flow diagram is a strong predictor of high-quality reporting.
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| 9. |
- Modig, Karin, et al.
(författare)
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"Obesity Paradox" Holds True for Patients with Hip Fracture
- 2019
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : Wolters Kluwer. - 0021-9355 .- 1535-1386. ; 101:10, s. 888-895
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hip fractures are associated with high mortality and reduced quality of life. Studies have reported a high body mass index (BMI) as being positively associated with survival when linked to old age and some chronic diseases. This phenomenon is called the “obesity paradox.” The association between BMI and survival after hip fracture has not been thoroughly studied in large samples, nor has to what extent the association is altered by comorbidities, sex, and age. The objective of this study was to investigate the association of BMI with survival after hip fracture and with the probability of returning to living at home after hip fracture.Methods: This cohort study was based on data from a prospectively maintained national registry of patients with hip fracture. A total of 17,756 patients ‡65 years of age who were treated for hip fracture during the period of 2013 to 2016, and followed until the end of 2017, were included. BMI was clinically assessed at hospital admission, comorbidity was measured with the American Society of Anesthesiologists (ASA) score, and the date of death was retrieved from a national database. Self-reported data on living arrangements were assessed on admission and 4 months after fracture. Multivariable regression models were used to estimate the associations.Results: Despite ASA scores being similar among all BMI groups, obese patients had the highest 1-year survival and patients with a BMI of <22 kg/m2 had the lowest. Adjustment for potential confounders strengthened the associations. For the chance of returning to living at home, no advantage was seen for obese patients, but patients with a BMI of <22 kg/m2 had clearly worse odds compared with patients who were of normal weight, overweight, or obese.Conclusions: The obesity paradox appears to be true for hip fracture patients aged 65 and older. Attention should be given to patients with malnutrition and underweight status rather than to those with overweight status or obesity when developing the orthogeriatric care.
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| 10. |
- Modig, Karin, et al.
(författare)
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"Obesity Paradox" Holds True for Patients with Hip Fracture : A Registry-Based Cohort Study
- 2019
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : LIPPINCOTT WILLIAMS & WILKINS. - 0021-9355 .- 1535-1386. ; 101:10, s. 888-895
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hip fractures are associated with high mortality and reduced quality of life. Studies have reported a high body mass index (BMI) as being positively associated with survival when linked to old age and some chronic diseases. This phenomenon is called the "obesity paradox." The association between BMI and survival after hip fracture has not been thoroughly studied in large samples, nor has to what extent the association is altered by comorbidities, sex, and age. The objective of this study was to investigate the association of BMI with survival after hip fracture and with the probability of returning to living at home after hip fracture.Methods: This cohort study was based on data from a prospectively maintained national registry of patients with hip fracture. A total of 17,756 patients >= 65 years of age who were treated for hip fracture during the period of 2013 to 2016, and followed until the end of 2017, were included. BMI was clinically assessed at hospital admission, comorbidity was measured with the American Society of Anesthesiologists (ASA) score, and the date of death was retrieved from a national database. Self-reported data on living arrangements were assessed on admission and 4 months after fracture. Multi-variable regression models were used to estimate the associations.Results: Despite ASA scores being similar among all BMI groups, obese patients had the highest 1-year survival and patients with a BMI of <22 kg/m(2) had the lowest. Adjustment for potential confounders strengthened the associations. For the chance of returning to living at home, no advantage was seen for obese patients, but patients with a BMI of <22 kg/m(2) had clearly worse odds compared with patients who were of normal weight, overweight, or obese.Conclusions: The obesity paradox appears to be true for hip fracture patients aged 65 and older. Attention should be given to patients with malnutrition and underweight status rather than to those with overweight status or obesity when developing the orthogeriatric care.
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