| 1. |
- Ekström, Wilhelmina, et al.
(författare)
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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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Ingår i: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 21:1, s. 18-25
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Tidskriftsartikel (refereegranskat)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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| 2. |
- Karlsson Thur, Charlotte
(författare)
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Ankle fracture surgery : clinical and epidemiological aspects
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ankle fractures are one of the most common fractures treated in orthopaedic surgery today and the trend towards surgical treatment has increased over the past decades. The ankle is though a sensitive area for surgical intervention concerning the surrounding soft tissues and early soft tissue complications such as infection are dreaded. Later sequelae, such as gait deviation and post-traumatic arthritis, might also lead to significant morbidity for these patients. The aim of this thesis was firstly to describe the epidemiology of ankle fractures in a large population and trends over time. Secondly, the aim was to study complications following ankle fracture surgery and to assess possible risk factors for complications, both in a clinical setting as well as in a large population. Thirdly, the aim was to study the gait pattern following ankle fracture surgery with a three-dimensional gait analysis method focusing on the foot and ankle. Study I is a population-based study of adult inpatients treated following ankle fractures in Sweden 1987-2004. The study included 91,410 patients, corresponding to a total annual incidence rate of 71 per 105 person-years. The annual increase of hospital admissions was 0.2% and was dominated by an increase in fracture incidence in the elderly women (0.9%). Mean age at admission was significantly higher in the female population. Study II is a population-based study of complications in adult inpatients following open reduction and internal fixation of ankle fractures in Sweden 2005-2010. The study included 23,411 patients. Infection was the most common short term complication with an overall rate of 3.7%. The highest risk of infection was seen in patients with open fractures. Other risk factors were diabetes, increasing age, fracture type and transport accidents. The 90 day amputation and mortality rates were 0.04% and 0.5% respectively. The overall rate of diagnosis of post- traumatic osteoarthritis (OA) over the study period was 1.8%. Risk of post-traumatic OA was increased in the presence of previous short term complications such as technical failure and infection. Arthrodesis surgery followed the pattern of osteoarthritis, while intervention with prosthesis surgery was rare. Study III and Study IV were clinical studies, where patients admitted to hospital after sustaining an ankle fracture requiring surgery were asked to participate in a follow-up study. The patients were assessed regarding risk factors for early post-operative complications, as well as possible gait deviations one year following surgery. 108 patients were included for early post-operative follow up where complications were defined as positive culture from surgical wound site and/or prescription of antibiotics because of suspected surgical site infection. The rate of positive cultures obtained was 10% and 19% of patients were treated with antibiotics. Age (≥60 years) was found as a risk factor for both positive culture and for receiving antibiotics. Care related factors such as timing of surgery did not affect the outcome measures significantly. 18 of the above included patients accepted further follow up assessing gait pattern following surgery. The patients were examined after a mean time of 13 months post-operatively. Three-dimensional gait analysis with The Oxford foot model was performed to assess kinematic changes in the injured ankle joint or joints in the foot. Both the injured ankle joint and the forefoot were found to have a decreased range of motion as compared to the non-injured side and controls. The Oxford foot model was an objective way of assessing ankle fractures post-operatively.
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| 3. |
- Lundblad, Henrik, et al.
(författare)
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Can Na18F PET/CT bone scans help when deciding if early intervention is needed in patients being treated with a TSF attached to the tibia : insights from 41 patients.
- 2020
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Ingår i: European Journal of Orthopaedic Surgery & Traumatology. - : Springer Nature. - 1633-8065 .- 1432-1068. ; 31:2, s. 349-364
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To demonstrate the usefulness of positron emission tomography (PET)/computed tomography (CT) bone scans for gaining insight into healing bone status earlier than CT or X-ray alone.METHODS: Forty-one prospective patients being treated with a Taylor Spatial Frame were recruited. We registered data obtained from successive static CT scans for each patient, to align the broken bone. Radionuclide uptake was calculated over a spherical volume of interest (VOI). For all voxels in the VOI, histograms and cumulative distribution functions of the CT and PET data were used to assess the type and progress of new bone growth and radionuclide uptake. The radionuclide uptake difference per day between the PET/CT scans was displayed in a scatter plot. Superimposing CT and PET slice data and observing the spatiotemporal uptake of 18F- in the region of healing bone by a time-sequenced movie allowed qualitative evaluation.RESULTS: Numerical evaluation, particularly the shape and distribution of Hounsfield Units and radionuclide uptake in the graphs, combined with visual evaluation and the movies enabled the identification of six patients needing intervention as well as those not requiring intervention. Every revised patient proceeded to a successful treatment conclusion.CONCLUSION: Numerical and visual evaluation based on all the voxels in the VOI may aid the orthopedic surgeon to assess a patient's progression to recovery. By identifying slow or insufficient progress at an early stage and observing the uptake of 18F- in specific regions of bone, it might be possible to shorten the recovery time and avoid unnecessary late complications.
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| 4. |
- Lundblad, Henrik, et al.
(författare)
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Can Spatiotemporal Fluoride (18F-ˆ’) Uptake be Used to Assess Bone Formation in the Tibia? : A Longitudinal Study Using PET/CT
- 2017
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Ingår i: Clinical Orthopaedics and Related Research. - : Springer. - 0009-921X .- 1528-1132. ; 475:5, s. 1486-1498
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Tidskriftsartikel (refereegranskat)abstract
- When a bone is broken for any reason, it is important for the orthopaedic surgeon to know how bone healing is progressing. There has been resurgence in the use of the fluoride (18F-ˆ’) ion to evaluate various bone conditions. This has been made possible by availability of positron emission tomography (PET)/CT hybrid scanners together with cyclotrons. Absorbed on the bone surface from blood flow, 18F-ˆ’ attaches to the osteoblasts in cancellous bone and acts as a pharmacokinetic agent, which reflects the local physiologic activity of bone. This is important because it shows bone formation indicating that the bone is healing or no bone formation indicating no healing. As 18F-ˆ’ is extracted from blood in proportion to blood flow and bone formation, it thus enables determination of bone healing progress.
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| 5. |
- Lundblad, Henrik, et al.
(författare)
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Using PET/CT Bone Scan Dynamic Data to Evaluate Tibia Remodeling When a Taylor Spatial Frame Is Used : Short and Longer Term Differences
- 2015
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Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141. ; 2015, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Eighteen consecutive patients, treated with a Taylor Spatial Frame for complex tibia conditions, gave their informed consentto undergo Na18F− PET/CT bone scans. We present a Patlak-like analysis utilizing an approximated blood time-activity curveeliminating the need for blood aliquots. Additionally, standardized uptake values (SUV) derived from dynamic acquisitions werecompared to this Patlak-like approach. Spherical volumes of interest (VOIs) were drawn to include broken bone, other (normal)bone, and muscle. The SUV?(?) (? = max, mean) and a series of slopes were computed as (SUV?(??) − SUV?(??))/(?? − ??), forpairs of time values ?? and ??. A Patlak-like analysis was performed for the same time values by computing ((VOI?(??)/VOI?(??)) −(VOI?(??)/VOI?(??)))/(??−??), where p = broken bone, other bone, andmuscle and e = expected activity in aVOI. Paired comparisonsbetween Patlak-like and SUV? slopes showed good agreement by both linear regression and correlation coefficient analysis(? = 84%, ?? = 78%-SUVmax, ? = 92%, and ?? = 91%-SUVmean), suggesting static scans could substitute for dynamic studies.Patlak-like slope differences of 0.1 min−1 or greater between examinations and SUVmax differences of ∼5 usually indicated goodremodeling progress, while negative Patlak-like slope differences of −0.06 min−1 usually indicated poor remodeling progress in thiscohort.
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| 6. |
- Sanchez-Crespo, Alejandro, et al.
(författare)
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Predictive value of [(18)F]-fluoride PET for monitoring bone remodeling in patients with orthopedic conditions treated with a Taylor spatial frame
- 2017
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - : Springer Science and Business Media LLC. - 1619-7070 .- 1619-7089. ; 44:3, s. 441-448
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The Taylor Spatial Frame (TSF) is used to correct orthopedic conditions such as correction osteotomies in delayed fracture healing and pseudarthrosis. Long-term TSF-treatments are common and may lead to complications. Current conventional radiological methods are often unsatisfactory for therapy monitoring. Hence, an imaging technique capable of quantifying bone healing progression would be advantageous.METHODS: A cohort of 24 patients with different orthopedic conditions, pseudarthrosis (n = 10), deformities subjected to correction osteotomy (n = 9), and fracture (n = 5) underwent dynamic [(18)F]-fluoride (Na(18)F) PET/CT at 8 weeks and 4 months, respectively, after application of a TSF. Parametric images, corresponding to the net transport rate of [(18)F]-fluoride from plasma to bone, K i were calculated. The ratio of the maximum K i at PET scan 2 and 1 ([Formula: see text]) as well as the ratio of the maximum Standard Uptake Value at PET scan 2 and 1 ([Formula: see text]) were calculated for each individual. Different treatment end-points were scored, and the overall treatment outcome score was compared with the osteoblastic activity progression as scored with [Formula: see text] or [Formula: see text].RESULTS: [Formula: see text] and [Formula: see text] were not correlated within each orthopedic group (p > 0.1 for all groups), nor for the pooled population (p = 0.12). The distribution of [Formula: see text] was found significantly different among the different orthopedic groups (p = 0.0046) -also for [Formula: see text] (p = 0.022). The positive and negative treatment predictive values for [Formula: see text] were 66.7 % and 77.8 %, respectively. Corresponding values for [Formula: see text] were 25 % and 33.3 % CONCLUSIONS: The [Formula: see text] obtained from dynamic [(18)F]-fluoride-PET imaging is a promising predictive factor to evaluate changes in bone healing in response to TSF treatment.
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