| 1. |
- Ali, Muhanned, et al.
(author)
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Assessment of a novel computer software in diagnosing radiocarpal osteoarthritis on plain radiographs of patients with previous distal radius fracture
- 2020
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In: Osteoarthritis and Cartilage Open. - : Elsevier BV. - 2665-9131. ; 2:4
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Journal article (peer-reviewed)abstract
- Objective: Osteoarthritis (OA) has primarily been diagnosed with plain radiographs assessed visually by examiners with regard to joint space width and presence of subchondral sclerosis, cysts and osteophytes. The increasing use of artificial intelligence has seen software developed to examine plain radiographs for diagnosing OA, based on observed OA-associated subchondral bone microarchitecture changes. A software for computerized texture analysis has been developed to identify knee OA. The aim of this study was to assess the software's ability to identify radiocarpal OA.Design: Presence of radiocarpal OA on 63 wrist radiographs of patients with a previous distal radius fracture was assessed independently by two surgeons experienced in assessing radiographs, and classified according to Kellgren-Lawrence (38 OA, 25 no OA). First, the computer software, not previously trained to identify wrist OA, assessed presence of radiocarpal OA on the 63 radiographs. In a second step, 144 labeled wrist radiographs with and without radiocarpal OA was used to train the computer software. Presence of OA on the original 63 radiographs were then reassessed by the software. Sensitivity, specificity and area under the curve (AUC) were calculated to determine the software's ability to discriminate between cases with and without OA.Results: Before training, sensitivity was 76% (95% CI 59–88), specificity 25% (10–47), and AUC 0.50 (0.35–0.65). After training, sensitivity was 46% (29–63), specificity 70% (47–87), and AUC 0.58 (0.43–0.73).Conclusion: The software for computerized texture analysis of subchondral bone developed to identify knee OA could not detect OA of the radiocarpal joint.
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| 2. |
- Ali, Muhanned, et al.
(author)
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Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations : A Long-Term Follow-up
- 2018
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In: Journal of Bone and Joint Surgery. American volume. - : LIPPINCOTT WILLIAMS & WILKINS. - 0021-9355 .- 1535-1386. ; 100:8, s. 633-639
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Journal article (peer-reviewed)abstract
- Background: The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. Methods: In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of >= 10 degrees, ulnar variance of >= 3 mm, and/or radial inclination of <= 15 degrees. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. Results: Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Mal union was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. Conclusions: Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain.
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| 3. |
- Ali, Muhanned, et al.
(author)
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Distal Radius Malunions
- 2021
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In: Evidence-Based Orthopedics : Second Edition - Second Edition. - : Wiley. - 9781119414001 - 9781119413936 ; , s. 855-859
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Book chapter (peer-reviewed)abstract
- This chapter presents a clinical scenario of a 59-year-old healthy woman who had injures in her dominant wrist after a fall at home. Her wrist radiographs show a displaced extra-articular distal radius fracture with a dorsal angulation of 15 ° (from 0 °) and an ulnar variance of 3 mm. The treating surgeon has a discussion with the patient about surgical and nonsurgical treatment options and the expected outcomes in case the fracture heals with malunion or in a near anatomical position. They also discuss which treatment method would be most effective in restoring near normal anatomy. Treatment of displaced distal radius fractures has shifted toward increasing use of open reduction and fixation with volar locking-plate. Distal radius osteotomy (sometimes combined with ulnar osteotomy) is a major surgical procedure that requires substantial postoperative rehabilitation.
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| 4. |
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| 5. |
- Apelqvist, Anna, et al.
(author)
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Pneumatic wound compression after hip fracture surgery did not reduce postoperative blood transfusion
- 2009
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 80:1, s. 26-31
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Journal article (peer-reviewed)abstract
- Background and purpose Patients with fracture of the proximal femur often undergo blood transfusion. A pneumatic compression bandage has been shown to reduce transfusion after primary hip arthroplasty for osteoarthritis. In this randomized trial, we evaluated the efficacy of this bandage following surgery for hip fracture. Patients and methods 288 patients, 50 years or older with 292 fractured hips treated with hemiarthroplasty or internal fixation (except pinning), were randomized to an experimental group with pneumatic wound compression applied after surgery (n = 138) and a control group with the same dressing but no compression (n = 154). Transfusion threshold was blood hemoglobin below 100 g/L. The primary outcome measures were the number of blood units and the proportion of patients transfused after surgery. Results The primary outcome measures were similar in both groups. The mean number of postoperatively transfused blood units was 1.3 in the compression group and 1.1 in the non-compression group. Blood transfusion was given to 84 patients (62%) in the compression group and to 85 patients (55%) in the non-compression group. Interpretation Pneumatic wound compression does not reduce the need for transfusion after hip fracture surgery.
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| 6. |
- Atroshi, Isam, et al.
(author)
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Carpal tunnel syndrome and keyboard use at work - A population-based study
- 2007
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In: Arthritis and Rheumatism. - : Wiley. - 1529-0131 .- 0004-3591. ; 56:11, s. 3620-3625
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Journal article (peer-reviewed)abstract
- Objective. To investigate the relationship between carpal tunnel syndrome (CTS) and keyboard use at work in a general population. Methods. A health status questionnaire was mailed to 2,465 persons of working age (25-65 years) who were randomly selected from the general population of a representative region of Sweden. The questionnaire required the subjects to provide information about the presence and severity of pain, numbness and tingling in each body region, employment history, and work activities, including average time spent using a keyboard during a usual working day. Those reporting recurrent hand numbness or tingling in the median nerve distribution were asked to undergo a physical examination and nerve conduction testing. The prevalence of CTS, defined as symptoms plus abnormal results on nerve conduction tests, was compared between groups of subjects that differed in their intensity of keyboard use, adjusting for age, sex, body mass index, and smoking status. Results. Eighty-two percent responded to the questionnaire, and 80% of all symptomatic persons attended the examinations. Persons who had reported intensive keyboard use on the questionnaire were significantly less likely to be diagnosed as having CTS than were those who had reported little keyboard use, with a prevalence that increased from 2.6% in the highest keyboard use group (>= 4 hours/day), to 2.9% in the moderate use group (1 to <4 hours/day), 4.9% in the low use group (<1 hour/day), and 5.2% in the no keyboard use at work group (P for trend = 0.032). Using >= 1 hour/day to designate high keyboard use and <1 hour/ day to designate low keyboard use, the prevalence ratio of CTS in the groups with high to low keyboard use was 0.55 (95% confidence interval 0.32, 0.96). Conclusion. Intensive keyboard use appears to be associated with a lower risk of CTS.
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| 7. |
- Atroshi, Isam, et al.
(author)
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Collagenase treatment of Dupuytrens contracture using a modified injection method
- 2015
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In: Acta Orthopaedica. - : Informa Healthcare: Creative Commons Attribution Non-Commercial / Informa Healthcare. - 1745-3674 .- 1745-3682. ; 86:3, s. 310-315
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Journal article (peer-reviewed)abstract
- Background and purpose - Treatment of Dupuytrens contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods - We studied 164 consecutive hands with DC, palpable cord, and extension deficit of greater than= 20 degrees in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7-34) days after finger extension. Results - A skin tear occurred in 66 hands (40%). The largest diameter of the tear was less than= 5 mm in 30 hands and greater than 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59 degrees (SD 26) as opposed to 32 degrees (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of greater than= 75 degrees. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55 degrees (SD 28). Interpretation - Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.
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| 8. |
- Atroshi, Isam, et al.
(author)
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Costs for collagenase injections compared with fasciectomy in the treatment of Dupuytren's contracture: a retrospective cohort study
- 2014
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In: BMJ Open. - : BMJ. - 2044-6055. ; 4:1, s. 004166-004166
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Journal article (peer-reviewed)abstract
- Objectives: To compare collagenase injections and surgery (fasciectomy) for Dupuytren's contracture (DC) regarding actual total direct treatment costs and short-term outcomes. Design: Retrospective cohort study. Setting: Orthopaedic department of a regional hospital in Sweden. Participants: Patients aged 65 years or older with previously untreated DC of 30 degrees or greater in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints of the small, ring or middle finger. The collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre. The controls were 16 patients randomly selected among those operated on with fasciectomy at the same centre during the preceding 3 years. Interventions: Treatment with collagenase was given during two standard outpatient clinic visits (injection of 0.9 mg, distributed at multiple sites in a palpable cord, and next-day finger extension under local anaesthesia) followed by night-time splinting. Fasciectomy was carried out in the operating room (day surgery) under general or regional anaesthesia using standard technique, followed by therapy and splinting. Primary and secondary outcome measures: Actual total direct costs (salaries of all medical personnel involved in care, medications, materials and other relevant costs), and total MCP and PIP extension deficit (degrees) measured by hand therapists at 612 weeks after the treatment. Results: Collagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy. Total treatment cost for collagenase injection was US$1418.04 and for fasciectomy US $2102.56. The post-treatment median (IQR) total extension deficit was 10 (0-30) for the collagenase group and 10 (0-34) for the fasciectomy group. Conclusions: Treatment of DC with one collagenase injection costs 33% less than fasciectomy with equivalent efficacy at 6 weeks regarding reduction in contracture.
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