Acta Orthopaedica最新文献

{"title":"Nonoperative hip fracture care: how conservative should we be?","authors":"Antony Johansen, Bjarke Viberg","doi":"10.2340/17453674.2025.43190","DOIUrl":"https://doi.org/10.2340/17453674.2025.43190","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"174-175"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfaction and quality of dying with nonoperative end-of-life care for hospitalized and non-hospitalized frail older patients with (suspected) hip fractures: a combined cohort study.","authors":"Miliaan L Zeelenberg, Sverre A I Loggers, Pieter Joosse, Esther M M Van Lieshout, Taco Gosens","doi":"10.2340/17453674.2025.42998","DOIUrl":"https://doi.org/10.2340/17453674.2025.42998","url":null,"abstract":"<p><strong>Background and purpose: </strong> For frail institutionalized hip fracture patients who opt for nonoperative management (NOM), the additional treatment benefits of hospital admission and in-hospital diagnostics are not well evaluated. We aimed to describe and compare treatment satisfaction and quality of dying for patients who refrained from hospitalization after a hip fracture and patients who were treated nonoperatively after a short period of hospitalization.</p><p><strong>Methods: </strong>Both cohorts included very frail institutionalized hip fracture patients. The first group directly started supportive care in their own nursing home after a suspected hip fracture. The second opted for NOM during shared decision-making after admission and diagnostics at the hospital. Primary outcomes were treatment satisfaction and quality of dying measured by the Quality of Dying and Death Questionnaire (QODD). Secondary outcomes included health-related quality of life (EuroQoL-5D-5L and Qualidem), pain, and medication.</p><p><strong>Results: </strong> 20 non-hospitalized and 88 hospitalized patients were included. Overall treatment satisfaction by proxies was high for both the non-hospitalized 9 (interquartile range [IQR] 8-10) and hospitalized patients 8 (IQR 4-9). Quality of dying was rated higher in the non-hospitalized group with QODD 8.3, IQR 6.9-8.6 versus 7.0, IQR 5.7-7.8, and median difference 1.0 (95% confidence interval [CI] 0.1-1.8). Health-related quality of life, measured by the EQ-5D-5L utility score, was low in both groups but higher in non-hospitalized patients (0.30, IQR 0.15-0.32) than in hospitalized patients (0.25, IQR 0.03-0.32, median difference: 0.03, CI -0.03 to 0.09). Both groups reported similar pain levels, but hospitalized patients used higher standardized daily doses of opiates (68 mg vs 39 mg, median difference 24 mg, CI 7-42).</p><p><strong>Conclusion: </strong> Proxies of hospitalized and non-hospitalized patients report high treatment satisfaction after opting for NOM. Non-hospitalization may have a beneficial effect on quality of dying in selected patients who have pre-recorded do-not-hospitalize directives or shared decision-making after a suspected hip fracture.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"167-173"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of refracture and malunion in children treated for diaphyseal forearm fractures: a retrospective cohort study.","authors":"Hans-Christen Husum, Ole Rahbek, Per Hviid Gundtoft, Hans Christian Bang, Søren Kold, Jan Duedal Rölfing, Ahmed Abood","doi":"10.2340/17453674.2025.42851","DOIUrl":"https://doi.org/10.2340/17453674.2025.42851","url":null,"abstract":"<p><strong>Background and purpose: </strong> The optimal treatment modality for pediatric diaphyseal forearm fractures is debated. While nonoperative treatment and closed reduction reduces the need for surgery and surgical complications, flexible intramedullary nailing (FIN) may reduce refracture and malunion rates. We aimed to compare the relative risk (RR) of refracture and malunion between nonoperative, closed reduction (CR), and surgical treatment in children treated for diaphyseal forearm fractures.</p><p><strong>Methods: </strong> We performed a retrospective cohort study of children treated for a primary diaphyseal forearm fracture over a 9-year period at 2 university hospitals. Risk of refracture and malunion in the year following the fracture across treatment modalities was assessed by a modified Poisson regression while adjusting for the age of the patient at the time of fracture.</p><p><strong>Results: </strong> We included 837 patients for analysis, of whom 4% were treated nonoperatively, 6% were treated with closed reduction, and 90% with FIN. Compared with FIN, the RR of refracture was higher for the nonoperative group (9.8, 95% confidence interval [CI] 5.9-16.3) and CR group (2.5, CI 1.2-5.3). Compared with the FIN group, the nonoperative and CR groups had higher risk of malunion with RR of 15.3 (CI 11.0-21.4) and 8.5 (CI 5.8-12.5) respectively. Of those treated non-surgically, 84% remained without any surgery. In FIN patients, surgical revision due to infection was seen in 1.4% of patients.</p><p><strong>Conclusion: </strong> The risk of refracture and malunion in children treated for diaphyseal forearm fractures was significantly higher for closed reduction and nonoperative treatment compared with FIN treatment.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"189-194"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Falling rates but projected rising numbers of fractures in elderly Norwegians: a study of fracture rates in the Norwegian patient registry from 2010 to 2021, extrapolated to 2041.","authors":"Jørgen Andvig, Lars G Johnsen, Sara M Nilsen, Gudrun W Bjørnelv, Andreas Asheim","doi":"10.2340/17453674.2024.42634","DOIUrl":"https://doi.org/10.2340/17453674.2024.42634","url":null,"abstract":"<p><strong>Purpose: </strong> Our aim was to calculate rates of major fractures by fracture location in elderly Norwegians over the years 2010 to 2021 and thereby estimate the volume of fractures in this population by 2041.</p><p><strong>Methods: </strong> We identified fractures in persons aged 65 years and over from the Norwegian Patient Registry. We summarized age- and sex-specific numbers of fractures and incidence rates by fracture location. Extrapolating adjusted incidence rates combined with population projections from Statistics Norway, we estimated the expected numbers of fracture cases for the following 20 years.</p><p><strong>Results: </strong> The total number of major fractures rose from 22,581 in 2010 to 27,596 in 2021. While the number of hip fractures was relatively stable (8,164 to 8,194 over the period), there were substantial increases in the number of fractures in the upper extremities, spine and pelvis, and lower extremities. Annual changes in incidence rates adjusted for age and sex were 0.6% (95% confidence interval [CI] 0.4-0.7), 1.2% (CI 0.9-1.4), 0.4% (CI 0.1-0.7), and -1.9% (CI -2.0 to -1.7) for upper extremity, spine and pelvis, lower extremity, and hip respectively. Extrapolating trends in incidence rates, we estimate a 64% (95% prediction interval 48-70) overall increase in the number of major fractures by 2041 compared with 2021, primarily due to the aging of the population.</p><p><strong>Conclusion: </strong> Incidence rates of hip fractures decreased over the period, while rates of other major fractures increased. We can expect a substantial increase in the number of fractures over the coming years, primarily due to the expected aging of the population.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"182-188"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between a real-time bioparticle detection device and a traditional microbiological active air sampler monitoring air quality in an operating room during elective arthroplasty surgery: a prospective feasibility study.","authors":"Lise-Lott Larsson, Johan Nordenadler, Gunilla Björling, Li Felländer-Tsai, Stergios Lazarinis, Bengt Ljungqvist, Janet Mattsson, Berit Reinmüller, Harald Brismar","doi":"10.2340/17453674.2025.43002","DOIUrl":"https://doi.org/10.2340/17453674.2025.43002","url":null,"abstract":"<p><strong>Background and purpose: </strong> The standard method for controlling operating room (OR) air quality is measuring bacteria-carrying particles per volume unit of air: colony forming units (CFU/m3). The result takes at least 2 days after sampling. Another method is real-time measurements of fluorescing bioparticles per unit volume of air (FBP/dm3). We aimed to compare simultaneous measurements of FBP/50 dm3 and CFU/m3 during ongoing arthroplasty surgery.</p><p><strong>Methods: </strong> 18 arthroplasties were performed in a modern OR with turbulent mixed airflow ventilation. The sampling heads of a BioAerosol Monitoring System (BAMS) and a microbiological active air sampler (Sartorius MD8 Air Sampler) were placed next to each other, and 6 parallel 10-minute registrations of FBP/50 dm3 and CFU/m3 were performed for each surgery. Parallel measurements were plotted against each other, Passing-Bablok nonparametric linear regression was performed, and the Spearman correlation coefficient (r) was calculated.</p><p><strong>Results: </strong> The r between FBP ≥ 3 μm/50 dm3 and CFU/m3 sampled for 96 x 10-minute intervals, was 0.70 (95% confidence interval [CI] 0.57-0.79). In the 25th percentile with the lowest 10-minute FBP ≥ 3μm/50 dm3, there were no CFU measurements with ≥ 10 and 4% with ≥ 5 CFU/m3. In the 75th percentile with the highest 10-minute FBP ≥ 3 μm/50 dm3, there were 58% CFU measurements with ≥ 10 and 88% with ≥ 5 CFU/m3. The r between FBP ≥ 3 μm/50 dm3 and CFU/m3 means sampled during 18 operations was 0.87 (CI 0.68-0.95).</p><p><strong>Conclusion: </strong> Low FBP ≥ 3 μm/50 dm3 measured by BAMS indicates low CFU/m3; conversely, high FBP ≥ 3 μm/50 dm3 indicates high CFU/m3. Real-time measurements of FBP ≥ 3 μm/50 dm3 can be used as a supplement to CFU/m3 monitoring OR air bacterial load.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"176-181"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in functional profile after lumbar spinal surgery: a register-based study among 1,451 patients.","authors":"Konsta K J Koivunen, Sara S Widbom-Kolhanen, Katri I Pernaa, Jari P A Arokoski, Mikhail Saltychev","doi":"10.2340/17453674.2025.42850","DOIUrl":"10.2340/17453674.2025.42850","url":null,"abstract":"<p><strong>Background and purpose: </strong> The Oswestry Disability Index has usually only been used as a composite score but, according to previous studies, disability caused by back pain may be too broad a concept to be explained by a single number. We aimed to analyze changes in each ODI item's score from preoperative to 3, 12, and 24 months after surgery by creating a functional profile.</p><p><strong>Methods: </strong> This was a register-based study of 1,451 patients undergoing lumbar spinal surgery between 2018 and 2021. The patients responded to a repeated survey preoperatively and 3, 12, and 24 months after surgery. The significance of change in the ODI items' scores was assessed by a symmetry test.</p><p><strong>Results: </strong> All the ODI items' scores and total score improved between baseline and 3-month follow-up (P < 0.001). The magnitude of this improvement varied across different items. After 3 months, no significant change was seen for most of the items.</p><p><strong>Conclusion: </strong> During a postoperative 2-year follow-up, individual items of the ODI demonstrated changes of different magnitude. The results imply that the use of a single composite score of the ODI might be insufficient to describe changes in functioning among patients undergoing lumbar spinal surgery. Instead, in some situations, creating a functional profile based on the scores from individual items may be a better solution to describe the changes in disability level.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"161-166"},"PeriodicalIF":2.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1-year results of lumbar spinal stenosis surgery in Finland: a national FinSpine register study.","authors":"Juho Hatakka, Inari Laaksonen, Joel Kostensalo, Keijo T Mäkelä, Henri Salo, Katri Pernaa","doi":"10.2340/17453674.2025.42849","DOIUrl":"10.2340/17453674.2025.42849","url":null,"abstract":"<p><strong>Background and purpose: </strong> While the rates of lumbar spinal stenosis (LSS) surgery have increased continuously internationally, the role of fusion surgery in the treatment of LSS has been under debate. We aimed to assess the outcome of LSS surgery at 1 year postoperatively and to compare decompression surgery with or without fusion based on the Finnish national spine register FinSpine data.</p><p><strong>Methods: </strong> FinSpine data of surgically treated LSS from 2015 to 2022 was included. The primary outcome was Oswestry Disability Index (ODI), and secondary ones were Visual Analogue Scale for leg and back pain. Predetermined minimal clinically important difference (MCID) for all outcome measures was used to assess the clinical significance of differences in outcomes. Propensity score matching was utilized to ensure that the treatment groups were comparable.</p><p><strong>Results: </strong> There were 8,647 LSS patients in the data, of whom 6,751 (77%) were the subject of decompression surgery. Over 90% of patients without spondylolisthesis received decompression alone. At 1-year follow-up, ODI was on average 20.6 (95% confidence interval [CI] 19.3-21.9]) for the fusion group and 23.3 (CI 22.5-24.0) for the decompression group. Differences in ODI, VAS leg pain, or VAS back pain were below the MCID. The share of patients reaching ODI percentage change score ≥ 30% was 74% (CI 71-78) in the fusion group and 66% (CI 63-68) in the decompression group.</p><p><strong>Conclusion: </strong> Most of the LSS patients experienced significant improvement after LSS surgery. We found no clinical differences between decompression surgery with and without fusion.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"154-160"},"PeriodicalIF":2.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Staples, tension-band plates, and percutaneous epiphysiodesis screws used for leg-length discrepancy treatment: a systematic review and proportional meta-analysis.","authors":"Bjoern Vogt, Adrien Frommer, Georg Gosheger, Andrea Maria Laufer, Robert Rödl, Gregor Toporowski","doi":"10.2340/17453674.2025.43005","DOIUrl":"10.2340/17453674.2025.43005","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"151-152"},"PeriodicalIF":2.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter: Staples, tension-band plates, and percutaneous epiphysiodesis screws used for leg-length discrepancy treatment: a systematic review and proportional meta-analysis.","authors":"Maria Tirta, Søren Kold, Ole Rahbek","doi":"10.2340/17453674.2025.43082","DOIUrl":"10.2340/17453674.2025.43082","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"153"},"PeriodicalIF":2.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA).","authors":"Jake Von Hintze, Ville Ponkilainen, Annette W-Dahl, Nils P Hailer, Ove Furnes, Anne M Fenstad, Mona Badawy, Alma B Pedersen, Martin Lindberg-Larsen, Mika J Niemeläinen, Keijo Mäkelä, Antti Eskelinen","doi":"10.2340/17453674.2025.42999","DOIUrl":"10.2340/17453674.2025.42999","url":null,"abstract":"<p><strong>Background and purpose: </strong> In complex primary total knee arthroplasty (TKA), constrained condylar knee (CCK) or rotating hinge knee (RHK) designs may be required to provide stability or address bony deficiencies. We analyzed trends in incidence of these designs in primary TKA and evaluated the mid- to long-term survivorship of CCK and RHK in 4 Nordic countries.</p><p><strong>Methods: </strong> From 2000 to 2017, 5,134 CCK and 2,515 RHK primary TKAs were identified from the NARA database. Kaplan-Meier (K-M) survival and flexible parametric survival model (FPSM) analyses were performed to estimate revision risk, expressed as hazard ratio (HR) with 95% confidence intervals (CI), with minimally stabilized (MS) TKA acting as the control group (n = 456,137).</p><p><strong>Results: </strong> The incidence of CCK and RHK implants increased significantly in Finland, while it was moderate in Denmark, Norway, and Sweden. With revision for any reason as the endpoint the 15-year K-M cumulative revision risk for RHK was 13.6% (CI 10.4-16.7) and for CCK it was 11.3% (CI 9.1-13.5). Compared with MS TKA, the hazard ratio for revision was 2.1 (CI 1.8-2.3) for CCK and 2.5 (CI 2.1-2.8) for RHK. Periprosthetic joint infection (PJI) was the most common reason for revision, accounting for 44% of CCK and 47% of RHK cases. After excluding revisions for PJI, the hazard ratio remained high for both designs, at 1.5 (CI 1.3-1.7) for CCK and 1.6 (CI 1.3-2.0) for RHK compared with MS.</p><p><strong>Conclusion: </strong> The incidence of CCK and RHK increased during the study period. Both designs showed consistent 15-year revision risks of 11-14%, with no major differences between them. The higher revision risk compared with MS TKAs may reflect the complexity of the surgeries.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"142-150"},"PeriodicalIF":2.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}