| 1. |
- Bhandari, Mohit, et al.
(author)
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Resolving controversies in hip fracture care : the need for large collaborative trials in hip fractures
- 2009
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In: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 23:6, s. 479-484
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Journal article (peer-reviewed)abstract
- Hip fractures are a significant cause of morbidity and mortality worldwide and the burden of disability associated with hip fractures globally vindicate the need for high-quality research to advance the care of patients with hip fractures. Historically, large, multi-centre randomized controlled trials have been rare in the orthopaedic trauma literature. Similar to other medical specialties, orthopaedic research is currently undergoing a paradigm shift from single centre initiatives to larger collaborative groups. This is evident with the establishment of several collaborative groups in Canada, in the United States, and in Europe, which has proven that multi-centre trials can be extremely successful in orthopaedic trauma research.Despite ever increasing literature on the topic of his fractures, the optimal treatment of hip fractures remains unknown and controversial. To resolve this controversy large multi-national collaborative randomized controlled trials are required. In 2005, the International Hip Fracture Research Collaborative was officially established following funding from the Canadian Institute of Health Research International Opportunity Program with the mandate of resolving controversies in hip fracture management. This manuscript will describe the need, the information, the organization, and the accomplishments to date of the International Hip Fracture Research Collaborative.
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| 2. |
- Borg, Tomas, et al.
(author)
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Quality of Life After Operative Fixation of Displaced Acetabular Fractures
- 2012
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In: Journal of Orthopaedic Trauma. - : Lippincott Williams & Wilkins. - 0890-5339 .- 1531-2291. ; 26:8, s. 445-450
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to determine quality of life (QoL) changes over time after internal fixation of acetabular fractures.Design: This pertains to a prospective cohort study, which was single centered.Setting: The study was conducted at the University Hospital.Patients: One hundred thirty-six patients (108 men, 28 women), age 17-83 years operated for an acetabular fracture during 2004-2008 were prospectively included and followed up for 2 years.Main Outcome Measures: QoL was evaluated via Short Form-36 (SF-36) and Life Satisfaction-11 at 6, 12, and 24 months. Radiographs were evaluated according to Matta at 2 years.Results: The most frequent fracture types were posterior wall (n31), associated anterior-posterior hemitransverse (n34), and associated both column (n29). One hundred twenty-nine patients could be assessed at 2 years, 4 did not respond, and 3 had died. The patients scored lower than norms in all 8 SF-36 domains with improvement over time for Physical Function (P < 0.0001) and Role Physical (P < 0.0001). The patients with postop reduction 0-1 mm scored better (P < 0.001-0.039) in 7 domains, all except vitality (P = 0.07), when compared with patients with residual displacement of >= 2 mm. Life satisfaction did not change with time and showed lower scores than normative in 9 of 11 items. Nineteen patients had undergone total hip replacement, and the strongest predictor was acetabular or femoral head impaction.Conclusions: QoL in surgically treated patients with displaced acetabular fracture keeps improving in physical SF-36 domains over a 2-year period although still lower than norms, and anatomical reduction results in better QoL outcome in most dimensions.
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| 3. |
- Conley, Robert B., et al.
(author)
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Secondary Fracture Prevention : Consensus Clinical Recommendations from a Multistakeholder Coalition
- 2020
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In: Journal of Orthopaedic Trauma. - 0890-5339. ; 34:4, s. 125-141
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Journal article (peer-reviewed)abstract
- Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fractureamong people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies are efficaciousandcanreduce risk of future fracture.Patientsneededucation,however, about thebenefitsandrisks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk.Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the earlypost-fractureperiod,prompt treatment is recommended.Adequate dietary or supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis shouldbe reevaluated for fracture risk routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse treatment effects.Patients shouldbestronglyencouraged to avoid tobacco, consume alcohol inmoderation atmost, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease).
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| 4. |
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| 5. |
- Ekström, Wilhelmina, et al.
(author)
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Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate
- 2007
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In: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 21:1, s. 18-25
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Journal article (peer-reviewed)abstract
- Objective: To compare outcome between the proximal femoral nail (PFN) and the Medoff sliding plate (MSP) in patients with unstable trochanteric or subtrochanteric fractures. Methods: This was a consecutive prospective randomized clinical study. In all, 203 patients admitted to two university hospitals with an unstable trochanteric or a subtrochanteric fracture type were included. Surgery was performed with a short intramedullary nail or a dual-sliding plate device. Follow up visits occurred at 6 weeks, 4 months, and 12 months. Functional outcome was measured by walking ability, rising from a chair, curb test, and additional assessments of abductor strength, pain, living conditions, and complications. Results: The ability to walk 15 m at 6 weeks was significantly better in the PFN group compared to the MSP group with an odds ratio 2.2 (P = 0.04, 95% confidence limits 1.03-4.67). No statistical difference in walking ability could be found between trochanteric and subtrochanteric fractures. The major complication rate (8% in the PFN group and 4% in the MSP group) did not differ statistically (P = 0.50) but reoperations were more frequent in the PFN group (9%) compared to the MSP group (1%; P < 0.02). Conclusions: There were no major differences in functional outcome or major complications between the treatment groups. Reasons other than the operated fracture seem to be equally important in determining the long-term functional ability of the patients in our study. An advantage with the MSP was the lower reoperation rate.
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| 6. |
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| 7. |
- Heetveld, Martin J., et al.
(author)
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Internal Fixation Versus Arthroplasty for Displaced Femoral Neck Fractures: What is the Evidence?
- 2009
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In: Journal of Orthopaedic Trauma. - 0890-5339. ; 23:6, s. 395-402
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Research review (peer-reviewed)abstract
- A review of the current evidence for internal fixation versus hemiarthroplasty versus primary total hip arthroplasty for displaced femoral neck fractures was undertaken. At the meta-analysis level no difference in postoperative pain, function, or quality of life can yet be demonstrated. A significant difference in mortality has also not been found, but a trend towards higher mortality after primary arthroplasty is possible. Internal fixation (IF) has less morbidity, but a higher risk of revision and less cost-effectiveness. Independent adjudication for IF technique is rare in studies and bias towards higher revision rates due to technical failure is an issue. Randomized trials comparing IF with arthroplasty remain underpowered in specific subgroups of patients, in which IF revision rates could be acceptable. In hemiarthroplasty the data suggest minimal differences in outcome between the prosthesis types. The cementless Austin-Moore prosthesis is out-dated. Currently a cemented unipolar or bipolar, depending on costs, hemi-arthroplasty is the treatment of choice for an elderly patient with functional limitations before the fracture. The role of modern, uncemented hemiarthroplasty designs are uncertain until more data are published. Total hip arthroplasty (THA) should be considered in any active older patient with a displaced femoral neck fracture. Patients with concomitant osteoarthritis, rheumatoid arthritis, or renal failure do poorly with other treatment options and Should be treated with THA. Randomized trials have shown THA to be a cost-effective treatment with lower revision rates than IF THA may also appear to be superior to hemiarthroplasty in specific subgroups, but larger trials are needed to confirm this observation.
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| 8. |
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| 9. |
- Kihlström, Caroline, et al.
(author)
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Surgical Versus Nonsurgical Treatment of Lateral Clavicle Fractures : A Short-Term Follow-Up of Treatment and Complications in 122 Patients.
- 2021
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In: Journal of Orthopaedic Trauma. - : Wolters Kluwer. - 0890-5339 .- 1531-2291. ; 35:12, s. 667-672
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To assess the total number of procedures in initially surgically and nonsurgically treated patients with lateral clavicle fractures and to compare patient-reported outcome measures (PROMs).DESIGN: Retrospective cohort study.SETTING: Level 1 trauma center.PATIENTS: One hundred twenty-two patients with lateral clavicle fractures treated at Uppsala University Hospital from 2013 to 2015 were included in a patient record review. A subgroup of 30 patients was assessed at a study follow-up visit at a median of 3 years postinjury.INTERVENTION: Comparisons between initially surgically and nonsurgically treated patients.MAIN OUTCOME MEASUREMENTS: Rates of surgical treatment, reoperations, and delayed surgeries. PROM subgroup: Constant score; Disabilities of the Arm, Shoulder and Hand score; and Visual Analog Scale over satisfaction with the cosmetic results and interview-based information on subjective complaints and reflections.RESULTS: Of 23 surgically treated patients (22 Neer type II and V fractures), 10 underwent subsequent implant removal, after which 1 developed symptomatic nonunion. Of 99 nonsurgically treated patients (36 Neer type II and V fractures), 2 underwent delayed surgery because of symptomatic nonunion. In the PROM subgroup, the surgically treated patients had worse Constant scores, complained of infraclavicular sensory deficits, and were less satisfied with the cosmetic result than the nonsurgically treated patients.CONCLUSIONS: Half of the surgically treated patients underwent implant removal, whereas delayed surgeries in nonsurgically treated patients were very rare. Nonsurgical treatment should be considered more often as an alternative to surgery even for the usually surgically treated Neer type II and V lateral clavicle fractures.LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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