| 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. |
- 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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| 4. |
- 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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| 5. |
- Larsson, Sune
(author)
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Calcium phosphates : what is the evidence?
- 2010
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In: Journal of Orthopaedic Trauma. - : Lippincott Williams & Wilkins. - 0890-5339 .- 1531-2291. ; 24:Suppl.1, s. S41-S45
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Journal article (peer-reviewed)abstract
- A number of different calcium phosphate compounds such as calcium phosphate cements and solid beta-tricalcium phosphate products have been introduced during the last decade. The chemical composition mimics the mineral phase of bone and as a result of this likeness, the materials seem to be remodeled as for normal bone through a cell-mediated process that involves osteoclastic activity. This is a major difference when compared with, for instance, calcium sulphate compounds that after implantation dissolve irrespective of the new bone formation rate. Calcium phosphates are highly biocompatible and in addition, they act as synthetic osteoconductive scaffolds after implantation in bone. When placed adjacent to bone, osteoid is formed directly on the surface of the calcium phosphate with no soft tissue interposed. Remodeling is slow and incomplete, but by adding more and larger pores, like in ultraporous beta-tricalcium phosphate, complete or nearly complete resorption can be achieved. The indications explored so far include filling of metaphyseal fracture voids or bone cysts, a volume expander in conjunction with inductive products, and as a carrier for various growth factors and antibiotics. Calcium phosphate compounds such as calcium phosphate cement and beta-tricalcium phosphate will most certainly be part of the future armamentarium when dealing with fracture treatment. It is reasonable to believe that we have so far only seen the beginning when it comes to clinical applications.
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| 6. |
- Larsson, Sune
(author)
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Periarticular fractures around the hip and knee : fix or replace?
- 2011
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In: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 25:Suppl 2, s. S90-S94
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Journal article (peer-reviewed)abstract
- The number of periarticular fragility fractures around the hip and knee is increasing. If surgical treatment is indicated, open reduction and internal fixation or replacement can often be viable options. In contrast to secondary replacement, the use of replacement in the acute stage might be advantageous because early rehabilitation and weightbearing can be initiated. This article describes the current literature related to internal fixation or primary replacement in periarticular fractures around the hip and knee.
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| 7. |
- Marsell, Richard, et al.
(author)
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Emerging bone healing therapies
- 2010
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In: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 24:3, Suppl 1, s. S4-S8
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Journal article (peer-reviewed)abstract
- Fracture healing is a biologically optimized process. Despite the expectation of unimpaired healing, approximately 5% to 10% of the 7.9 million fractures sustained annually in the United States have difficulty achieving union. Not only does this cause morbidity for patients, but also enormous healthcare and socioeconomic costs. Hence, there is a compelling need to find novel therapies to enhance fracture healing. In this article, we summarize current data on therapies to enhance skeletal healing and review their suggested biologic functions, proposed clinical applications, and known efficacies.
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| 8. |
- Moroni, Antonio, et al.
(author)
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Can we improve fixation and outcomes? : Use of bone substitutes
- 2009
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In: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 23:6, s. 422-425
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Journal article (peer-reviewed)abstract
- Hip fractures secondary to osteoporosis are common in the elderly. Stabilizing these fractures until union is achieved is a challenge due to poor bone stock and insufficient purchase of the implant to the bone. The reported high rate of complications has prompted extensive research in the development of fixation techniques. Furthermore, manipulation of both the local fracture environment in terms of application of growth factors, scaffolds, and mesenchymal cells and the systemic administration of agents promoting bone formation and bone strength has been considered as a treatment option with promising results. There are only a few evidence-based studies reporting on fixation augmentation techniques. This article reports on the efficacy of bone graft substitutes for the fixation of hip fractures, in particular calcium phosphates, which have been used as granules, cements, and implant coatings.
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| 9. |
- Neuhaus, V., et al.
(author)
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Scapula fractures: Interobserver reliability of classification and treatment
- 2014
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In: Journal of Orthopaedic Trauma. - : Lippincott, Williams andamp; Wilkins. - 0890-5339 .- 1531-2291. ; 28:3, s. 124-129
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Journal article (peer-reviewed)abstract
- Objectives: There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. Design: Web-based reliability study. Setting: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. Participants: One hundred three orthopaedic surgeons evaluated 35 movies of three-dimensional computerized tomography reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. Main Outcome Measurements: Fleiss kappa (κ) was used to assess the reliability of agreement between the surgeons. Results: The overall agreement on the OTA/AO classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) and for the 9 groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intraarticular extension of the fracture (Fossa (F), κ = 0.79) was substantial and the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53); however, PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA. Conclusions: The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions. Copyright © 2013 by Lippincott Williams and Wilkins.
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| 10. |
- Per-Henrik, Ågren, et al.
(author)
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Factors affecting long-term treatment results of displaced intraarticular calcaneal fractures: a post hoc analysis of a prospective, randomized, controlled multicenter trial
- 2014
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In: Journal of Orthopaedic Trauma. - : Lippincott Williams & Wilkins. - 0890-5339 .- 1531-2291. ; 28:10, s. 564-568
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Journal article (peer-reviewed)abstract
- Objectives: To study the factors affecting long-term treatment results of displaced intraarticular calcaneal fractures (DIACFs). Design: A post hoc analysis. Settings: Tertiary care teaching hospitals. Patients: Eight to twelve years of results from a randomized controlled multicenter trial of operative versus nonoperative treatment (n = 56) were divided into 2 groups: the superior 50% results (n = 28) and the inferior 50% results (n = 28), regardless of the treatment given. The determinant of this division was a visual analog score for pain and function. Interventions: The operative treatment consists of open reduction and internal fixation, whereas the nonoperative treatment consists of nonweight bearing and early range of motion exercise. Main Outcome Measurements: A visual analog score for pain and function, the short-form 36 (SF-36) general health outcome questionnaire, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Olerud-Molander score. We compared age, sex, fracture type (Sanders classification), treatment given, Böhler angle, residual articular surface step-off at healing, type of occupation, and injury insurance between the 2 groups. Results: Patients of the superior group had higher physical SF-36, AOFAS, and Olerud-Molander score than in the inferior group. Operative treatment, better Böhler angle and articular surface restoration, light labor/retirement, and absence of injury insurance were more common in the superior group. Age, sex, pretreatment Böhler angle, and fracture type were comparable in the superior and inferior groups. Conclusions: The decision making for definitive treatment of intraarticular calcaneal fractures is multifactorial with a spectrum of results and trends such as patient demographic features that should be considered in choosing the best treatment option.
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