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| 2. |
- Clementson, Martin, et al.
(författare)
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Acute scaphoid fractures : Guidelines for diagnosis and treatment
- 2020
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Ingår i: EFORT Open Reviews. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 5:2, s. 96-103
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Tidskriftsartikel (refereegranskat)abstract
- In cases of suspected scaphoid fracture where the initial radiographs are negative, a supplementary MRI, or alternatively CT, should be carried out within three to five days. Fracture classification, assessment of dislocation as well as evaluation of fracture healing is best done on CT with reconstructions in the coronal and sagittal planes, following the longitudinal axis of the scaphoid. After adequate conservative management, union is achieved at six weeks for approximately 90% of nondisplaced or minimally displaced (≤ 0.5 mm) scaphoid waist fractures. Scaphoid waist fractures with moderate displacement (0.5-1.5 mm) can be treated conservatively, but require prolonged cast immobilization for approximately eight to ten weeks. Internal fixation is recommended for all scaphoid waist fractures with dislocation ≥ 1.5 mm. Distal scaphoid fractures can be treated conservatively. The majority heal uneventfully after four to six weeks of immobilization, depending on fracture type. In general, proximal scaphoid fractures should be treated with internal fixation.
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| 3. |
- Dahlin, Lars B., et al.
(författare)
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Nerve injuries of the upper extremity and hand
- 2017
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Ingår i: EFORT OPEN REVIEWS. - : BRITISH EDITORIAL SOC BONE & JOINT SURGERY. - 2058-5241 .- 2396-7544. ; 2:5, s. 158-170
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Tidskriftsartikel (refereegranskat)abstract
- A nerve injury has a profound impact on the patient's daily life due to the impaired sensory and motor function, impaired dexterity, sensitivity to cold as well as eventual pain problems. To perform an appropriate treatment of nerve injuries, a correct diagnosis must be made, where the injury is properly classified, leading to an optimal surgical approach and technique, where timing of surgery is also important for the outcome. Knowledge about the nerve regeneration process, where delicate processes occur in neurons, non-neuronal cells (i. e. Schwann cells) and other cells in the peripheral as well as the central nervous systems, is crucial for the treating surgeon. The surgical decision to perform nerve repair and/or reconstruction depends on the type of injury, the condition of the wound as well as the vascularity of the wound. To reconnect injured nerve ends, various techniques can be used, which include both epineurial and fascicular nerve repair, and if a nerve defect is caused by the injury, a nerve reconstruction procedure has to be performed, including bridging the defect using nerve-grafts or nerve transfer techniques. The patients must be evaluated properly and regularly after the surgical procedure and appropriate rehabilitation programmes are useful to improve the final outcome.
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- Makela, K. T., et al.
(författare)
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The benefits of collaboration: the Nordic Arthroplasty Register Association
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 391-400
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Tidskriftsartikel (refereegranskat)abstract
- The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process.
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| 5. |
- Mjöberg, Bengt
(författare)
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Is early migration enough to explain late clinical loosening of hip prostheses?
- 2020
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Ingår i: EFORT Open Reviews. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 5:2, s. 113-117
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Forskningsöversikt (refereegranskat)abstract
- Prosthetic loosening has been debated for decades, both in terms of the timing and nature of the triggering events. Multiple radiostereometric studies of hip prostheses have now shown that early migration poses a risk of future clinical failure, but is this enough to explain late clinical loosening? To answer this question, the progression of loosening from initiation to radiographic detection is described; and the need for explanations other than early prosthetic loosening is analysed, such as stress-shielding, particle disease, and metal sensitivity. Much evidence indicates that prosthetic loosening has already been initiated during or shortly after the surgery, and that the subsequent progression of loosening is affected by biomechanical factors, fluid pressure fluctuations and inflammatory responses to necrotic cells and cell fragments, i.e. the concept of late loosening appears to be a misinterpretation of late-detected loosening. Clinical implications: atraumatic surgery and initial prosthetic stability are crucial in ensuring low risk of prosthetic loosening.
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| 6. |
- Varnum, C., et al.
(författare)
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Impact of hip arthroplasty registers on orthopaedic practice and perspectives for the future
- 2019
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Ingår i: Efort Open Reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 4:6, s. 368-376
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Tidskriftsartikel (refereegranskat)abstract
- Total hip arthroplasty (THA) registers are established in several countries to collect data aiming to improve the results after THA. Monitoring of adverse outcomes after THA has focused mainly on revision surgery, but patient-reported outcomes have also been investigated. Several surgery-related factors influencing the survival of the THA have been thoroughly investigated and have changed clinical practice. These factors include surgical approach, specific implants, the size of the components, type of fixation and different bone cements. Register data have been used to examine the risk of venous thromboembolism and bleeding after THA. These investigations have resulted in shorter duration of thromboprophylaxis and a reduced frequency of blood transfusion. Registers may provide specific information to surgeons on the outcome of all THAs that they have performed with a detailed analysis of revisions rates and reasons for the revisions. A number of other stakeholders can use register data to provide benchmarks. The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man supplies data to the Orthopaedic Device Evaluation Panel (ODEP), which provides benchmarks at 3, 5, 7, 10, and 13 years graded from A*, A, B and C. Future perspectives: National registers have to play a major role in documenting the quality of THA in order to describe best practice and report implant outliers. The registers have to be used for research and post-market surveillance and register data may be a source for intelligent decision tools.
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| 7. |
- Arner, M
(författare)
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Developing a national quality registry for hand surgery: challenges and opportunities
- 2016
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Ingår i: EFORT open reviews. - : Bioscientifica. - 2058-5241 .- 2396-7544. ; 1:4, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- The Scandinavian National Healthcare Quality Registries (NQRs) have brought about considerable improvements since their introduction in the 1970s. One such registry – HAKIR (‘hand surgery’) – was established in 2010 and was likely the first NQR for hand surgery. Patient-reported outcome and reoperations due to post-operative complications are registered in HAKIR, as well as hand function in selected groups of surgical procedures. Creating simple logistics for collecting data and careful planning are important factors when establishing a new NQR. Continuous surveillance of data validity and coverage are crucial for success. With perseverance, large databases for clinical research can be created, along with the establishment of national multi-professional collaboration in healthcare improvement work.Cite this article: Arner, M. Developing a national quality registry for hand surgery: challenges and opportunities. EFORT Open Rev 2016;1:100-106. DOI: 10.1302/2058-5241.1.000045.
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| 9. |
- Ström, Peter
(författare)
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Glenoid fractures of the shoulder
- 2020
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Ingår i: EFORT OPEN REVIEWS. - : BRITISH EDITORIAL SOC BONE & JOINT SURGERY. - 2396-7544 .- 2058-5241. ; 5:10, s. 620-623
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Tidskriftsartikel (refereegranskat)abstract
- Glenoid fractures of the shoulder are uncommon. Any scapular fracture involving the glenoid should be scrutinized carefully for a surgical treatment option. Classification is helpful in deciding the surgical tactic.Cite this article: EFORT Open Rev 2020;5:620-623. DOI: 10.1302/2058-5241.5.190057
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| 10. |
- Adolfsson, Lars, 1955-
(författare)
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Post-traumatic stiff elbow
- 2018
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Ingår i: EFORT open reviews. - : British Editorial Society of Bone & Joint Surgery. - 2058-5241 .- 2396-7544. ; 3:5, s. 210-216
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Forskningsöversikt (refereegranskat)abstract
- Post-traumatic and post-operative stiffness of the elbow joint is relatively common and may in pronounced cases markedly interfere with normal upper extremity function.Soft-tissue contractures and heterotopic bone formation are two major causes of limited movement.Extensive recent research has elucidated many of the pathways contributing to these conditions, but the exact mechanisms are still unknown.In the early phase of soft-tissue contractures conservative treatment may be valuable, but in longstanding cases operative treatment is often necessary.Several different options are available depending on the severity of the condition and the underlying offending structures. Surgical treatment may allow significant gains in movement but rarely complete restoration, and complications are not uncommon.The following presentation reviews the recent literature on pathomechanisms and treatment alternatives. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170062.
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