| 1. |
- Grävare Silbernagel, Karin, 1965, et al.
(författare)
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Underben
- 2018
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Ingår i: Ortopedi : patofysiologi, sjukdomar och trauma hos barn och vuxna. - : Studentlitteratur. - 9789144090849 ; , s. 379-396
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Westin, Olof, et al.
(författare)
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Acute Ultrasonography Investigation to Predict Reruptures and Outcomes in Patients With an Achilles Tendon Rupture
- 2016
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Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 4:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: The optimal treatment for acute Achilles tendon ruptures is still an ongoing debate. Acute ultrasonography (US) investigation to measure the diastasis between the tendon ends has previously been used to classify acute Achilles tendon ruptures; however, no study has used US to predict reruptures and functional outcomes. Purpose: To investigate whether acute US can be used to predict the risk of reruptures and outcomes after treatment of an acute Achilles tendon rupture. Methods: Forty-five patients (37 men, 8 women) with amean age of 39 +/- 9.2 years (range, 23-59 years) from a cohort of 97 patients participating in a randomized controlled study comparing surgical and nonsurgical treatment were included. US was performed within 72 hours from the index injury. Diastasis between the tendon ends was documented. Reruptures were documented, and the patients' functional outcomes were measured 12 months after injury. Results: Patients with a diastasis of >10 mm treated nonsurgically had a higher degree of rerupture. In the nonsurgically treated group, 3 of 4 patients with a diastasis of >10 mm suffered from rerupture (P < .001). Moreover, in the nonsurgical group, there was significantly worse outcomes in patients with a diastasis of >5 mm in terms of patient-reported outcomes using the Achilles tendon Total Rupture Score (ATRS) (P = .004) and heel-rise height at 12 months (P = .048) compared with the group with a lesser degree of tendon separation. Conclusion: US may be a useful tool to predict the risk of rerupture and greater degree of functional deficit. It may be an important measure in a clinical treatment algorithm for deciding whether a patient will benefit from surgical intervention after an acute Achilles tendon rupture.
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| 3. |
- Brandt Knutsson, Sara, et al.
(författare)
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Femoral fracture classification in the Swedish Fracture Register - A validity study
- 2019
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- © 2019 The Author(s). Background: A total of more than 270,000 fractures are registered in the Swedish Fracture Register (SFR), a national quality register. Fractures are classified following the AO/OTA classification, commonly by a junior doctor. As a step in the process of validating the data in the SFR, several studies of the accuracy of the fracture classification have already been published. The aim of this study was to evaluate the accuracy of femoral fracture classification in the SFR. Methods: One hundred and eighteen femur fractures were randomly selected from the SFR. Three experienced orthopaedic surgeons individually classified these fractures on two separate occasions and a gold standard classification was established. This classification was compared with the original classification in the SFR. Inter- and intraobserver agreement was calculated. Results: The agreement between the classification in the SFR and the gold standard classification was kappa = 0.65 for the AO/OTA group and kappa = 0.83 for the AO/OTA type. This corresponds to substantial and almost perfect agreement, according to Landis and Koch. The kappa values for interobserver agreement ranged from 0.64-0.76 for the AO/OTA group and 0.76-0.85 for the AO/OTA type. The kappa values for intraobserver agreement ranged from 0.79-0.81 for the AO/OTA group and 0.91-0.93 for the AO/OTA type. Conclusions: The classification of femoral fractures in the Swedish Fracture Register is substantial (AO/OTA group) to almost perfect (AO/OTA type) and as accurate as in previous studies. The present study also shows that the agreement between the SFR classification and a gold standard classification is in the same range of agreement as between experienced raters. In contrast to previous studies, the classifications in the SFR are made by an unselected group of mostly inexperienced classifiers. The results indicate that the fracture classification in a national quality register can be accurate enough to permit the evaluation of fracture treatment in specific groups of fractures.
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| 4. |
- 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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| 5. |
- Wennergren, David, et al.
(författare)
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High reliability in classification of tibia fractures in the Swedish Fracture Register.
- 2016
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Ingår i: Injury. - 1879-0267. ; 47:2, s. 478-82
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish Fracture Register (SFR) was started in 2011 and registers fractures of all types, treated either surgically or non-surgically. Twenty-six orthopaedic departments in Sweden are affiliated and a total of 84,000 fractures have been registered. The physician who establishes the diagnosis of the fracture registers and classifies it according to the AO/OTA classification. The accuracy of the classification of fractures is important for the reliability of the data in the SFR. This study aimed to evaluate how accurate the classification of tibia fractures in the register is.Three experienced trauma surgeons (raters) were presented with the radiographs of 114 patients with tibia fractures randomly allocated from the SFR. The raters classified the fractures independently and blinded to clinical patient information in two classification sessions with a time interval of one month. The AO/OTA classification coded by the three expert raters (our predefined gold standard) was compared with the classifications in the SFR. Inter- and intra-observer agreement was evaluated. The degree of agreement was reported using the approach of Landis and Koch.The accuracy of the SFR, defined as agreement between the SFR and the gold standard classification, was kappa=0.75 for the AO/OTA type and 0.56 for the AO/OTA group, corresponding to substantial and moderate agreement, respectively. Inter-observer agreement across the three expert raters was kappa=0.74 for the AO/OTA type and 0.53 for the AO/OTA group. Intra-observer agreement was kappa=0.74-0.79 for the AO/OTA type and 0.62-0.64 for the AO/OTA group.This study shows that the accuracy of classification of tibia fractures in the SFR was substantial for the AO/OTA type (kappa=0.75) and moderate for the AO/OTA group (kappa=0.56) as defined by Landis and Koch. This degree of accuracy is similar to that in previous studies. We interpret this as meaning that the results of this study demonstrate the high reliability of the data in the SFR and enable the SFR to be used for further scientific analysis.
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| 6. |
- Wennergren, David, et al.
(författare)
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Implementation of the Swedish Fracture Register
- 2018
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Ingår i: Unfallchirurg. - 0177-5537. ; 121:12, s. 949-955
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- © 2018, The Author(s). Large financial resources are needed to treat fractures. Surprisingly little is, however, known about actual numbers, treatment methods or outcomes. A large population-based observational study can add valuable knowledge, especially if patient-reported results are included. There is no previous national fracture register with prospectively collected data on fractures of all types, treated surgically as well as non-surgically. With the implementation of the Swedish Fracture Register (SFR), we have shown that this is possible. More than 285,000 fractures have been registered. The database is increasing at a rate of 70,000 fractures a year, i. e. one fracture every 7 min. The aim of this article is to describe the first seven years in the history of the SFR, with opportunities for the future as well as limitations.
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