| 21. |
- Jonsson, Eythor, 1982, et al.
(författare)
-
Elbow hemiarthroplasty and total elbow arthroplasty provided a similar functional outcome for unreconstructable distal humeral fractures in patients aged 60 years or older: a multicenter randomized controlled trial
- 2024
-
Ingår i: Journal of Shoulder and Elbow Surgery. - : Elsevier. - 1058-2746 .- 1532-6500. ; 33:2, s. 343-355
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Semiconstrained total elbow arthroplasty (TEA) is an established treatment for elderly patients with distal humeral fractures not amenable to stable internal fixation (unreconstructable). In recent years, there has been increasing interest in elbow hemiarthroplasty (EHA), a treatment option which does not entail restrictions on weight-bearing as opposed to TEA. These 2 treatments have not been compared in a randomized controlled trial (RCT). The aim of this study was to compare the functional outcome of EHA and TEA for the treatment of unreconstructable distal humeral fractures in elderly patients. Material and methods: This was a multicenter randomized controlled trial (RCT). Patients were included between January 2011 and November 2019 at one of 3 participating hospitals. The inclusion criteria were an unreconstructable distal humeral fracture, age ≥60 years and independent living. The final follow-up took place after ≥2 years. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Secondary outcome measures were the Mayo Elbow Performance Score (MEPS), the EQ-5D index, range of motion (flexion, extension, pronation, and supination) and grip strength. Results: Forty patients were randomized to TEA (n = 20) and EHA (n = 20). Five patients died before completing the final follow-up, leaving 18 EHA and 17 TEA patients for analysis. There were 31 women. The mean age was 74.0 (SD, 8.5) years in the EHA group and 76.9 (SD, 7.6) in the TEA group (P = .30). The mean DASH score was 21.6 points in the EHA group and 27.2 in the TEA group (P = .39), a difference of −5.6 points (95% CI: −18.6 to 7.5). There were no differences between treatment with EHA and TEA for the mean values of the MEPS (85.0 vs. 88.2, P = .59), EQ-5D index (0.92 vs. 0.86, P = .13), extension (29° vs. 29°, P = .98), flexion (126° vs. 136°, P = .05), arc of flexion-extension (97° vs. 107°, P = .25), supination (81° vs. 75°, P = .13), pronation (78° vs. 74°, P = .16) or grip strength (17.5 kg vs. 17.2 kg, P = .89). There were 6 adverse events in each treatment group. Conclusion: In this RCT, both elbow hemiarthroplasty (EHA) and total elbow arthroplasty (TEA) resulted in a good and similar functional outcome for unreconstructable distal humeral fractures in elderly patients at a minimum of 2 years of follow-up.
|
|
| 22. |
- Jonsson, Eythor, 1982, et al.
(författare)
-
The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period
- 2023
-
Ingår i: JSES International. - : Elsevier BV. - 2666-6383. ; 7:3, s. 499-505
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The Oxford Elbow Score (OES) is a well-validated, elbow-specific, patient-reported outcome measure (PROM), originally assigned a 4-week recall period. For PROMs, short recall periods could have some advantages, such as optimizing validity by minimizing the negative effects of inaccurate recollection and temporal trends (increase or decrease) in symptoms over the course of the recall period. Temporal trends in elbow function can, for example, be expected to occur over 4 weeks in patients recovering from an injury or surgery. The purpose of this study was to evaluate the measurement properties of the OES using a shortened, 7-day, recall period (OES-7d). Methods: The inclusion criteria were fracture, tendon rupture or dislocation affecting the elbow, and age ≥18 years. Patients with Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores of ≥10 points preinjury (pre-existing upper extremity condition) or concurrent upper extremity injuries were excluded. Patients completed the OES-7d, QuickDASH, and Single Assessment Numeric Evaluation-Function for the last 7 days preinjury (T1), the first 7 days postinjury (T2) and a 7-day period 3-5 months postinjury (T3). Correlations were assessed with Spearman's rho. Analyses of construct validity (correlation between scores) and internal consistency (Cronbach's alpha) were based on T3 data. Responsiveness was assessed by correlating changes in scores (change scores) between time points. Intra-rater reliability was assessed by calculating intraclass correlation coefficients based on 2 administrations (1- to 3-week interval) of PROMs in a separate group of patients who had sustained an elbow injury 1-2 years previously. Results: Seventy-five patients (45 women) were included between May 2020 and July 2021. Their mean age was 51.7 years. At T3, Spearman's rho was −0.91 for the correlation between OES total and QuickDASH scores and 0.76 for the correlation between OES total scores and Single Assessment Numeric Evaluation-Function values (construct validity). Spearman's rho for correlation between OES total and QuickDASH change scores from T2 to T3 (T3 minus T2) was −0.85 (responsiveness for improvement) and −0.88 for change scores from T1 to T2 (T2 minus T1, responsiveness for deterioration). For the OES domains, Cronbach's alpha was 0.83 for elbow function, 0.91 for pain and 0.90 for social-psychological domains. The intraclass correlation coefficient for the OES total score was 0.96. Conclusion: The OES demonstrated good measurement properties when used with a 7-day recall period (OES-7d). These results further establish the OES as a well-validated, elbow-specific PROM and support using a 7-day recall period.
|
|
| 23. |
- Moloney, Maria, et al.
(författare)
-
Distal ulna fractures in adults - subcapitular, transverse fractures did not benefit from surgical treatment
- 2023
-
Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer. - 0936-8051 .- 1434-3916. ; 143:1, s. 381-387
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Fractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome. Materials and methods Patients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5-7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists. Results Ninety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result. Conclusions Distal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.
|
|
| 24. |
- Moloney, Maria, et al.
(författare)
-
Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively
- 2020
-
Ingår i: Acta Orthopaedica. - : TAYLOR & FRANCIS LTD. - 1745-3674 .- 1745-3682. ; 91:1, s. 104-108
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Fractures of the distal ulna can occur in isolation or in conjunction with a distal radius fracture. They may result in incongruence and instability of the distal radioulnar joint. We investigated the incidence of distal ulna fractures, whether any fracture types were more common, and the methods of treatment used. Patients and methods - Data were collected from patients 18 years or older, treated for a fracture of the distal ulna in ostergotland, Sweden, during 2010-2012. Patients were identified in the patient registry. The fractures were classified according to the AO comprehensive classification of fractures. Results - The incidence of distal ulna fractures was 74/100,000 person-years. The most common fracture type was that of the ulnar styloid Q1 (79%), followed by the ulnar neck Q2 (11%). Rarest was ulna head fracture, type Q4 (1%). Incidental findings were a mean age of 63 years (SD 18), a concomitant distal radius fracture in 92% of the patients and that 79% were caused by falling from standing height. Internal fixation was performed in 30% of the Q2-Q6 fractures. This indicates that most were considered stable without internal fixation or stable after fixation of a concomitant radius fracture. Interpretation - Our results show that fractures of the distal ulna are not very common, and some fracture types are even rare. There seem to be no consensus on treatment.
|
|
| 25. |
- Moloney, Maria, et al.
(författare)
-
Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures
- 2022
-
Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 93, s. 438-443
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Classification of fractures can be valuable for research purposes but also in clinical work. Especially with rare fractures, such as distal ulna fractures, a treatment algorithm based on a classification can be helpful. We compared 3 different classification systems of distal ulna fractures and investigated their reliability and reproducibility. Patients and methods - patients with 97 fractures of the distal ulna, excluding the ulnar styloid, were included. All fractures were independently classified by 3 observers according to the classification by Biyani, AO/OTA 2007, and AO/OTA 2018. The classification process was repeated after a minimum of 3 weeks. We used Kappa value analysis to determine inter- and intra-rater agreement.Results - The inter-rater agreement of the AO/OTA 2007 classification was judged as fair,. 0.40, whereas the agreement of AO/OTA 2018 and Biyani was moderate at. 0.42 and 0.43 respectively. The intra-rater agreement was judged as moderate for all classifications. Interpretation - The differences between the classifications were small and the overall impression was that neither of them was good enough to be of substantial clinical value. The Biyani classification, being developed specifically for distal ulna fractures, was the easiest and most fitting for the fracture patterns seen in our material, but lacking options for fractures of the distal diaphysis. Standard radiographs were considered insufficient for an accurate classification. A better radiographic method combined with a revised classification might improve accuracy, reliability, and reproducibility.
|
|
| 26. |
- Moloney, Maria
(författare)
-
Ulnar fractures and ligament injuries of the wrist
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Falling over on an outstretched hand with the wrist extended is a common accident that can cause a multitude of injuries in the wrist. Research has mainly focused on distal radius fractures while injuries of the distal ulna and adjacent ligaments have taken a back seat. If not treated adequately, these injuries may result in ulnar-sided wrist pain, sometimes referred to as the “black box” of hand surgery. The distal radio-ulnar joint (DRUJ) enables forearm rotation where the radio-carpal unit rotates around the fixed ulna, stabilised most importantly by the triangular fibrocartilage complex (TFCC). Painless rotation and stability of the forearm under load is important for upper limb function. If full function is to be restored after wrist injury, it is important to treat not only injury to the radius but also those to the ulna and TFCC.The aims of this thesis were to evaluate the long-term results of TFCC injury repair, and contribute to our knowledge on fractures of the distal ulna, their epidemiology, radiographic classification and results of treatment.The long-term outcome of 47 patients with a foveal TFCC tear was evaluated by patient-rated wrist evaluation (PRWE) and radiography 20 years after open repair. The median PRWE score was 22.6 (7-48.5), and 34 % had had further surgery after the initial repair, half of these due to recurrence of DRUJ instability. Signs of osteoarthritis were seen in the radiocarpal joint in 17.5 % and in the DRUJ in 34 %. Higher PRWE scores were seen in patients with osteoarthritis or those who had undergone further surgery. Radio-carpal osteoarthritis was less frequently seen in patients who had undergone initial arthroscopy. This study highlights the importance of arthroscopy in identifying associated injuries. Twenty years after foveal TFCC tear repair patient reported outcomes were similar to those of distal radius fractures.Apart from fractures of the styloid process, distal ulna fractures are rare. All distal ulna fractures in the county of Östergötland 2010-2012 were identified. A total of 766 fractures were found (incidence 74/100 000 person-years), the majority of which were fractures of the ulnar styloid process(79%) usually caused by a fall from standing height. Most patients were female (76%), mean age at the time of injury was 63 years and 92 % had a concomitant distal radius fracture. Second after styloid fractures were fractures of the ulnar neck. A retrospective study of 96 patients with 97 fractures of the distal ulna (excluding the styloid) showed that 40 % were treated by internal fixation. The median PRWE score was 15, with significantly worse scores in patients with an internally fixed distal ulna fracture compared to patients not operated. When classifying these fractures according to AO/OTA 2018, transverse extra-articular fractures (2U3A2.3) had a significantly better outcome when not treated surgically, and these probably do not require internal fixation if the distal radius provides stability and alignment. All 97 fractures were classified by three independent observers according to three classification systems: Biyani, AO/OTA 2007, and AO/OTA 2018. Classification was repeated after a minimum of 3 weeks. Reliability and reproducibility were calculated. The reliability was judged as fair for AO/OTA 2007, and moderate for Biyani and AO/OTA 2018. The reproducibility was moderate for all three systems. These results together with the observers´ opinion that Biyani is an easier system to use, leads us to conclude that a slightly modified Biyani-system together with improved radiological techniques that provide more information about the fracture pattern, may well improve accuracy, reliability and reproducibility.A better classification of distal ulna fractures could help us in the evaluation of new and existing treatments as well as providing the information necessary for designing treatment algorithm. After careful consideration, internal fixation is probably the treatment of choice for certain types of fracture, but this needs further investigation.
|
|
| 27. |
- Müller, Sebastian A, et al.
(författare)
-
Fluoroscopy of the Elbow : A Cadaveric Study Defining New Standard Projections to Visualize Important Anatomical Landmarks
- 2021
-
Ingår i: JB & JS open access. - : Lippincott, Williams & Wilkins. - 2472-7245. ; 6:2
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite new 3-dimensional imaging modalities, 2-dimensional fluoroscopy remains the standard intraoperative imaging modality. The elbow has complex anatomy, and defined standard fluoroscopic projections are lacking. Therefore, the aim of this study was to define standard projections of the elbow for intraoperative fluoroscopy. Methods: This study consisted of 2 parts. In part I, dissected cadaveric elbows were examined under fluoroscopy, and their radiographic anatomical features were assessed, with focus on projections showing defined anatomical landmarks. In part II, projections from part I were verified on entire cadavers to simulate intraoperative imaging. Standard projections for anteroposterior (AP) and lateral views as well as oblique and axial views were recorded. Results: Eight standardized projections could be defined and included 3 AP, 1 lateral, 2 oblique, and 2 axial views. By applying these specific projections, we could visualize the epicondyles, the trochlea with its medial and lateral borders, the capitellum, the olecranon, the greater sigmoid notch, the coronoid process including its anteromedial facet, the proximal radioulnar joint with the radial tuberosity, and the anterior and posterior joint lines of the distal part of the humerus. These standard projections were reliably obtained using a specific sequence. Conclusions: Knowledge about radiographic anatomy and standard projections is essential for visualizing important landmarks. With the presented standard projections of the elbow, important anatomical landmarks can be clearly examined. Thus, fluoroscopic visualization of anatomical fracture reduction and correct implant placement should be facilitated. Clinical Relevance: This basic science cadaveric study defines fluoroscopic standard projections of the elbow essential for visualization of anatomical landmarks during surgery.
|
|
| 28. |
- Nestorson, Jens, 1969-
(författare)
-
Arthroplasty in Elbow Fracture Treatment
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Open reduction and internal fixation is the treatment of choice for distal humeral fractures. Stable fixation is required to allow early mobilisation and to reduce the risk of poor functional results. In an elderly patient with osteoporotic bone and with a comminuted intra-articular fracture stable internal fixation can be difficult to achieve. In these cases elbow arthroplasty is an option.An irreparable radial head fracture can be treated by excision or replacement. The indications for the respective procedure are unclear since reports include an array of different associated soft-tissue and bony injuries.The aim of this thesis was to evaluate the use, complication rates and functional outcome of elbow arthroplasty as primary treatment for complex distal humeral fractures and assess the usefulness of radial head replacement in Mason IV fracture dislocations.50 patients, aged 56-89 years were treated for a distal humeral fracture with primary hemi-arthroplasty using the Kudo© humeral component or the Latitude® prosthesis. The functional outcome was assessed retrospectively. The majority of the 50 patients treated with a primary hemi-arthroplasty for a distal humeral fracture had a good or excellent functional result and regained a functional arc of movement of at least 100 degrees at medium term follow-up. There were six patients suffering secondary surgery and two with persistent ulnar nerve symptoms. Wear of the olecranon fossa was seen, mainly in the eight patients treated with a non-anatomical implant (Kudo®). Functional results were comparable to total elbow arthroplasty and open reduction and internal fixation (ORIF) for distal humeral fractures. The use of implants that are more anatomical seemed to reduce the degree of olecranon wear but long-term results are lacking.The nationwide use of primary arthroplasty for a distal humeral fracture between 1999 and 2014 was examined using three different registers. The survival rates in relation to prosthetic desing, age and sex were investigated using Cox regression analysis and number of adverse events recorded.In total 405 patients were treated with primary arthroplasty for a distal humeral fracture. The mean age at surgery was 75 years and the mean observation time was 67 months. Eighteen patients had undergone revision surgery and another 26 patients suffered an adverse event, 24 of which required secondary surgery.Increasing age reduced the risk for revision and there was no significant difference in survival between total- and hemi arthroplasty. The cumulative survival rate at 5 years was 99% (CI 98-100) and at 10 years 90% (CI 85-96). Elbow arthroplasty as primary treatment for distal humeral fractures produced reliable results with regards to revision surgery and adverse events.18 patients, age 19-79 years, treated with radial head replacement, and 14 patients, age 29-70 years, treated with radial head resection, for a Mason IV fracture dislocation were retrospectively reviewed.There were no significant differences in functional outcome in patients treated with replacement or excision for a Mason IV fracture dislocation. The rate of secondary surgery was higher in patients treated with replacement and ulno-humeral osteoarthritis was more pronounced in patients treated with radial head excision but follow-up was longer in these patients. Functional results were not improved by using radial head arthroplasty for Mason IV fracture dislocation. Secondary osteoarthritis is a concern in patients treated with excision but did not affect functional outcome after a mean follow-up time of 108 months.
|
|
| 29. |
- Nicolescu, Dan, et al.
(författare)
-
Tuberculum majus-fraktur – inte alltid en benign skada : Viktigt att identifiera skadan, förstå skademekanismen och anpassa behandlingen till patientens funktionsnivå [Fractures of the greater tuberosity - An overview of diagnostics and treatment]
- 2023
-
Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 120
-
Forskningsöversikt (refereegranskat)abstract
- Fractures of the greater tuberosity comprise 14-15 percent of all proximal humeral fractures according to the Swedish National Fracture database. This fracture type can lead to prolonged pain and functional impairment if treated suboptimally. The purpose of this article is to describe the anatomy and the injury mechanisms, summarize present literature and guide through the diagnosis and treatment of this fracture. The literature that addresses this injury is limited and treatment consensus is not clearly defined. This fracture can occur isolated as well as associated with glenohumeral dislocations, rotator cuff ruptures and humeral neck fractures. In some cases diagnosis may be difficult. Patients with pain out of proportion despite normal X-ray should be further assessed both clinically and radiologically. Missed fractures can lead to long term pain and functional impairment, especially among young overhead athletes. It is consequently important to identify such injuries, understand the pathomechanics and adapt the treatment based on the patient's activity level and functional needs.
|
|
| 30. |
- Nordqvist, Jenny, 1976-, et al.
(författare)
-
A short activity-related scale for measuring shoulder function in patients with subacromial pain : the DASH 7
- 2017
-
Ingår i: JSES Open Access. - : Elsevier. - 2468-6026. ; 1:2, s. 113-118
-
Tidskriftsartikel (refereegranskat)abstract
- Background Subacromial pain is a common cause of shoulder dysfunction that negatively affects quality of life. Currently, most outcome measures for shoulder pain are applied to a heterogeneous group of patients. Of these measures, the Disabilities of the Arm, Shoulder, and Hand (DASH) is the most widely recognized test with which to assess patients with subacromial pain. The primary aim of this study was to assess the content validity of DASH for patients with subacromial pain, with a secondary aim to test responsiveness to a modified set of DASH items tailored to these patients. Methods There were 129 patients who reported activities in the Patient-Specific Functional Scale (PSFS). To assess validity, 5 independent physiotherapists matched PSFS activities to the most appropriate DASH item. DASH items identified as being of greatest importance to patients were those corresponding to the highest number of PSFS-matched activities. Calculations were made for responsiveness and internal consistency. Results Physiotherapists matched DASH items to 271 PSFS activities, reaching agreement for almost 80%. Seven DASH items (DASH 7) were identified as being particularly important. Effect size data (Cohen's d) were 0.93 for DASH 7, 0.92 for DASH 30, and 0.85 for QuickDASH; the corresponding Cronbach's α values (for DASH 7, DASH 30, and QuickDASH) were 0.84, 0.94, and 0.86, respectively. Conclusions DASH 7 is a short, patient-centered, and activity-related scale that can measure shoulder function in patients with subacromial pain using a quarter of the original DASH items. DASH 7 demonstrated responsiveness, with a satisfactory level of internal consistency.
|
|
