| 1. |
- Kadum, Bakir, 1976-, et al.
(författare)
-
Geometrical analysis of stemless shoulder arthroplasty : a radiological study of seventy TESS total shoulder prostheses
- 2016
-
Ingår i: International Orthopaedics. - : Springer. - 0341-2695 .- 1432-5195. ; 40:4, s. 751-758
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to investigate the ability of a stemless shoulder prosthesis to restore shoulder anatomy in relation to premorbid anatomy. Methods This prospective study was performed between May 2007 and December 2013. The inclusion criteria were patients with primary osteoarthritis (OA) who had undergone stemless total anatomic shoulder arthroplasty. Radiographic measurements were done on anteroposterior X-ray views of the glenohumeral joint. Results Sixty-nine patients (70 shoulders) were included in the study. The mean difference between premorbid centre of rotation (COR) and post-operative COR was 1 ± 2 mm (range −3 to 5.8 mm). The mean difference between premorbid humeral head height (HH) and post-operative HH was −1 ± 3 mm (range −9.7 to 8.5 mm). The mean difference between premorbid neck-shaft angle (NSA) and post-operative NSA was −3 ± 12° (range −26 to 20°). Conclusions Stemless implants could be of help to reconstruct the shoulder anatomy. This study shows that there are some challenges to be addressed when attempting to ensure optimal implant positioning. The critical step is to determine the correct level of bone cut to avoid varus or valgus humeral head inclination and ensure correct head size.
|
|
| 2. |
- Wadsten, Charlotta, et al.
(författare)
-
A validation of DCIS registration in a population-based breast cancer quality register and a study of treatment and prognosis for DCIS during 20 years
- 2016
-
Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 55:11, s. 1338-1343
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: Sweden has a long history of population-based cancer registration. The aim of our study was to assess the validity of DCIS registration in a regional Breast Cancer Quality Register (BCQR) and to analyze trends in incidence, treatment and outcome of DCIS, over a 20-year period.MATERIAL AND METHODS: All patients with a diagnosis of primary DCIS reported in the BCQR of the Uppsala-Örebro healthcare region in Sweden 1992-2012 were included. Three hundred women were randomly selected and their medical records were compared to register data. The study period was divided into four time periods.RESULTS: A total of 2952 women were registered with a DCIS diagnosis. In the final validation cohort of 295 patients, 23 were found to have either recurrent DCIS or invasive breast cancer and eight had LCIS. The completeness and validity of key variables were 91-99%. Twenty of 31 local recurrences were registered (65%).The proportion of DCIS to all breast cancers was 9.5%. Tumor size increased over time. The frequency of mastectomy increased from 23.0% to 39.0%. The proportion of patients receiving radiotherapy after breast conserving surgery increased from 30.1% to 67.6%. The reported local recurrence rate was 9.7% after 10 years. Reported recurrences after BCS and mastectomy were 12.0 and 7.0%, respectively. The recurrence rate did not differ between women undergoing BCS with or without radiotherapy.CONCLUSION: Only 89.5% of reported DCIS was a primary pure DCIS. The completeness of primary treatment and tumor data was high. The proportion of reported local recurrences was disappointingly low, 65%. The proportion of DCIS was stable over time with a trend towards more intensified treatment. The reported recurrence rate was low independent of treatment and can reflect adequate patient selection, but also over treatment. Our results address the necessity to validate register data on a regular basis.
|
|
| 3. |
- Wadsten, Mats, 1969-
(författare)
-
Distal Radius Fractures : aspects on radiological and clinical outcome and evaluation of a new classification system
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Distal radius fracture (DRF) is the most common fracture encountered in clinical practice. Every year, more than 20000 people in Sweden suffer from this injury. It has been shown that there is a correlation between malalignment and function following distal radial fractures and malunion may cause persistent pain and disability.A problem has been in making a correct initial assessment of the fracture. Many fractures are unstable despite an acceptable position on the initial radiographic examination or following a successful closed fracture reduction.Numerous classification systems have been developed for evaluation of DRF in order to predict the outcome. However, the values of these are limited since they have not shown satisfactory reliability. Furthermore, the utility of these systems to predict radiographic or clinical outcome is not yet proven. These shortcomings may be one reason why optimal DRF management is still controversial. Requests for a new classification system of DRF, predictive of outcome and easy to use, have been made.Improvement in initial assessment of DRF will benefit a large group of patients, as well as the society, by reducing persistent symptoms and disability.Study I: In this study we evaluated the interobserver and intraobserver reliability of a new classification system (the Buttazzoni classification). Two hundred and thirty-two patients with acute DRF were blindly evaluated using the new classification by three orthopaedic surgeons twice with a 1-year interval. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable with other commonly used classification systems.Study II: This was a prospective multicenter study of fracture stability in 428 DRF. The study investigated whether cortical comminution and intra-articular involvement, as well as the new classification system, could predict displacement in DRF. Logistic regression analysis showed that initial position of the fracture and volar or dorsal comminution predicted later displacement, while intra-articular involvement did not. Volar comminution was the strongest predictor of displacement. The new classification system, which is the first to include volar comminution as a separate parameter, was highly predictive of fracture instability. Furthermore we found that it is quite common for non-operatively treated fractures to displace at a later stage than two weeks.Study IV: In study II it was found that late displacement of DRF, still in acceptable radiologic position after 10-14 days, occurred in approximately 1/3 of cases. Despite this, we have not been able to find any study focusing on evaluating the clinical outcome in patients with late displacement. Two hundred and nine unilateral DRF from study II were still in good position after 10-14 days and were included in the study. One hundred and seventy five patients had radiographs taken at a minimum of 3 months and a clinical examination 1 year after the fracture. Late displaced distal radius fractures had significantly higher loss of ROM and grip strength compared to fractures that didn’t displace. No significant differences were seen in subjective outcome.In conclusion, initial position of the fracture predicted later displacement and was the most important parameter in predicting clinical outcome. Comminution of the fracture also affected radiological stability and clinical outcome. Volar comminuted fractures are highly unstable and need surgical intervention if displacement is to be avoided. Intra-articular involvement affected clinical outcome. Late displacement is common in DRF and may result in loss of range of motion and grip strength. To detect late displacement, DRF should be followed for more than 2 weeks.The new classification system had a moderate reliability and reproducibility. The classification was found predictive of radiologic and objective clinical outcome. However, it was not predictive of subjective outcome. The classification system was also predictive of fractures at risk for late displacement.
|
|
| 4. |
- Wadsten, Mats Å., et al.
(författare)
-
Influence of Cortical Comminution and Intra-articular Involvement in Distal Radius Fractures on Clinical Outcome : A Prospective Multicenter Study
- 2017
-
Ingår i: Journal of wrist surgery. - : Thieme Medical Publishers. - 2163-3916 .- 2163-3924. ; 6:4, s. 285-293
-
Tidskriftsartikel (refereegranskat)abstract
- Aim The purpose of this prospective multicenter study was to test the predictive value of cortical comminution and intra-articular involvement on function and quality of life in distal radius fractures (DRFs) using the Buttazzoni's classification system. Patients and Method We studied 406 patients between skeletal maturity and 74 years of age with DRF. Fractures with acceptable radiographic alignment were immobilized with a cast. Fractures with nonacceptable radiographic alignment underwent closed reduction and 4 to 6 weeks cast immobilization. Radiographs were obtained after reduction and at 10 to 14 days. Redisplaced fractures were offered surgical treatment. One-year follow-up included grip strength, range of motion (ROM), quickDASH, EQ-5D (including visual analog scale [VAS] for health status), and VAS pain. Results We found no statistically significant differences in QuickDASH, EQ-5D questionnaire, EQ-5D health status VAS, and VAS pain among the Buttazzoni classes. However, initial displacement was associated with worse quickDASH score, worse EQ-5D score, reduced grip strength, and reduced ROM. Dorsal comminution was associated with worse quickDASH score, reduced flexion, and reduced pronation-supination ability. Volar comminution predicted loss of extension, while intra-articular involvement was associated with reduced flexion-extension arc and worse EQ-5D score. There was a significant difference in ROM between noncomminuted and comminuted fracture classes. Conclusion Initial fracture position, type of comminution, and intra-articular involvement influenced the clinical outcome in DRF.
|
|
| 5. |
- Wadsten, Mats Å., et al.
(författare)
-
The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life
- 2018
-
Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 43:2, s. 131-136
-
Tidskriftsartikel (refereegranskat)abstract
- Late displacement of distal radius fractures, still in acceptable radiological position after 1–2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10–14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires.
|
|
