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Østergaard HK, Launonen AP, Toft M, Fjalestad T, Sumrein BO, Døssing KV, Axelsen MH, Noe SS, Wagle T, Engebretsen KB, Laitinen MK, Mattila VM, Mechlenburg I. Physiotherapist-supervised exercises versus unsupervised home-based exercises after nonsurgically treated proximal humerus fracture: a multicenter randomized controlled trial. J Shoulder Elbow Surg 2024; 33:994-1003. [PMID: 38311103 DOI: 10.1016/j.jse.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/21/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Proximal humerus fracture (PHF) is a common fragility fracture in older adults and can have a substantial impact on upper limb function. Although most patients with PHF can be treated nonsurgically, it is unknown whether older adults benefit from supervised exercise therapy after PHF. Therefore, the objective of this trial was to investigate whether 10 weeks of physiotherapist-supervised exercises once a week were superior to 10 weeks of unsupervised home-based exercises in older adults with a nonsurgically treated displaced 2-part PHF. METHODS This was designed as an assessor-blinded, prospective, randomized controlled trial and took place in 3 Nordic countries. In total, 72 patients (≥60 years) with nonsurgically treated displaced 2-part PHF were randomized to either physiotherapist-supervised exercises once a week for 10 weeks, combined with daily home-based exercises, or to 10 weeks of daily unsupervised home-based exercises. The primary outcome measure was the Disability of the Arm, Shoulder, and Hand (DASH) with a primary endpoint at 3 months. Secondary outcomes were DASH (at 12 months), Constant-Murley Score, the 15D-instrument, Visual Analog Scale, General Self-Efficacy Scale, and Pain Catastrophizing Scale, with follow-up visits after 3 and 12 months. Non-union and patient death within 3 months were counted as complications. RESULTS The mean age of the patients in both groups was 72 years. At 3 months follow-up, the mean DASH score in the supervised group was 25.9 (SD 16.0) compared to 22.4 (SD 18.9) in the unsupervised group. The mean between-group difference (3.5, 95% CI -5.0 to 12.5) was not clinically relevant. None of the secondary outcome measures presented any clinically relevant or statistically significant between-group differences at 3 or 12 months follow-up. One patient in the supervised group and 3 in the unsupervised group were diagnosed with non-union. One patient from each group died before 3 months follow-up. CONCLUSIONS This trial provides no evidence that supervised exercises are superior to unsupervised home-based exercises in improving functional outcome or health-related quality of life in older patients with a nonsurgically treated 2-part PHF. Further, our results suggest that most older adults with a nonsurgically treated 2-part PHF can perform home-based exercises without the supervision of a physiotherapist.
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Affiliation(s)
- Helle K Østergaard
- Department of Orthopaedics, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Antti P Launonen
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Marianne Toft
- Department of Orthopaedics, Viborg Regional Hospital, Viborg, Denmark
| | - Tore Fjalestad
- Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Bakir O Sumrein
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Kaj V Døssing
- Department of Orthopaedics, Viborg Regional Hospital, Viborg, Denmark
| | - Mette H Axelsen
- Department of Orthopaedics, Viborg Regional Hospital, Viborg, Denmark
| | - Sidsel S Noe
- Department of Orthopaedics, Viborg Regional Hospital, Viborg, Denmark
| | - Tone Wagle
- Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Kaia B Engebretsen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Minna K Laitinen
- Department of Orthopaedics, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Ville M Mattila
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Kärnä L, Launonen AP, Luokkala T, Reito A. Routine follow-up imaging is not necessary in uneventful early recovery after distal radius fractures treated with volar locking plate in working-aged patients: A retrospective single-center cohort study. Scand J Surg 2024:14574969241234740. [PMID: 38618994 DOI: 10.1177/14574969241234740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND OBJECTIVE The purpose of our study was to evaluate whether routine follow-up radiographs after distal radius fracture (DRF) treated with volar locking plate (VLP) influenced clinical decision-making and treatment in working-aged patients (18-65 years). We evaluated the possible correlation between clinical status and problems with follow-up radiographs and analyzed the overall reoperation rate. METHODS The study population of this retrospective cohort study consisted of working-aged (18-65 years) patients with DRF who were treated with VLP between January 2010 and December 2020. Baseline data, follow-up visits, and radiographs were collected. Radiographs were classified as either routinely assigned or according to clinical findings. Patients were divided into four groups based on abnormal radiographic findings or major symptoms leading to reoperation. Patients also received patient-rated wrist evaluation (PRWE) questionnaire, which were analyzed. RESULTS A total of 861 patients were included in this study. Routine follow-up radiographs were available for 844 (98%) patients. In 7.0% of patients, 6-week radiographs led to a change of standard treatment protocol, most commonly additional imaging and/or clinical follow-up. Nine (1.1%) patients underwent an urgent reoperation, and 15 (1.8%) patients underwent reoperation later in the follow-up period. All these patients were exceptionally painful/symptomatic. In addition, 33 (3.9%) patients who underwent additional imaging and follow-up after abnormal radiograph, but did not undergo reoperation, were asymptomatic or suffered only mild pain. A total of 89 (10.5%) patients had reoperation for any reason during the follow-up period. CONCLUSIONS Routine follow-up radiographs after the treatment of DRF with VLP in the working-aged population rarely leads to changes in treatment strategy or reoperation in asymptomatic patients suggesting that it would be safe and cost-effective to reduce routine follow-up radiographs and focus instead on those patients with moderate-to-severe symptoms.
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Affiliation(s)
- Laura Kärnä
- Tampere University Hospital Elämänaukio 2 Tampere 33521 Finland
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Ax M, Palola V, Ponkilainen V, Launonen AP, Mattila VM. Duration of sick leave after operated and non-operated distal radial fracture: a Finnish cohort study of 19,995 patients. J Hand Surg Eur Vol 2024; 49:316-321. [PMID: 37624727 PMCID: PMC10882944 DOI: 10.1177/17531934231194673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
The purpose of this study was to investigate whether operative treatment for distal radial fracture reduces the length of sick leave and the costs of treatment. We identified 19,995 patients from a registry who received a state sick leave allowance between 2010 and 2019 owing to distal radial fractures. We compared these patients to a registry of operations and identified 4346 operated patients. Operated patients had a mean sick leave of 75 days, whereas non-operated patients had a sick leave of 63 days. In the operated group, the cost of sick leave was €7505 (UK£6419; US$8070), which was 34% higher than in the non-operated group. Over the analysed period, the duration of sick leave decreased. Although several studies have shown better early functional outcomes after operation, this does not seem to shorten sick leave.Level of evidence: III.
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Affiliation(s)
- Maarit Ax
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
| | - Vili Palola
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Antti P Launonen
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital, Elämänaukio, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital, Elämänaukio, Tampere, Finland
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Launonen AP, Sumrein BO, Reito A, Lepola V, Paloneva J, Berg HE, Felländer-Tsai L, Kask K, Rahnel T, Tootsi K, Märtson A, Jonsson KB, Wolf O, Ström P, Døssing K, Østergaard HK, Mechlenburg I, Mattila VM, Laitinen MK. Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial. PLoS Med 2023; 20:e1004308. [PMID: 38015877 PMCID: PMC10683994 DOI: 10.1371/journal.pmed.1004308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking. METHODS AND FINDINGS The primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. Between February 2011 and December 2019, 160 patients 60 years and older with 3- and 4-part PHFs were randomly assigned in 1:1:1 fashion in block size of 10 to undergo nonoperative treatment (control) or operative intervention with LP or HA. In total, 54 patients were assigned to the nonoperative group, 52 to the LP group, and 54 to the HA group. Five patients assigned to the LP group were reassigned to the HA group perioperatively due to high comminution, and all of these patients had 4-part fractures. In the intention-to-treat analysis, there were 42 patients in the nonoperative group, 44 in the LP group, and 37 in the HA group. The outcome assessors were blinded to the study group. The mean DASH score at 2-year follow-up was 30.4 (standard error (SE) 3.25), 31.4 (SE 3.11), and 26.6 (SE 3.23) points for the nonoperative, LP, and HA groups, respectively. At 2 years, the between-group differences were 1.07 points (95% CI [-9.5,11.7]; p = 0.97) between nonoperative and LP, 3.78 points (95% CI [-7.0,14.6]; p = 0.69) between nonoperative and HA, and 4.84 points (95% CI [-5.7,15.4]; p = 0.53) between LP and HA. No significant differences in primary or secondary outcomes were seen in stratified age groups (60 to 70 years and 71 years and over). At 2 years, we found 30 complications (3/52, 5.8% in nonoperative; 22/49, 45% in LP; and 5/49, 10% in HA group, p = 0.0004) and 16 severe pain-related adverse events. There was a revision rate of 22% in the LP group. The limitation of the trial was that the recruitment period was longer than expected due to a high number of exclusions after the assessment of eligibility and a larger exclusion rate than anticipated toward the end of the trial. Therefore, the trial was ended prematurely. CONCLUSIONS In this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments. TRIAL REGISTRATION ClinicalTrials.gov NCT01246167.
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Affiliation(s)
- Antti P. Launonen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Bakir O. Sumrein
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Vesa Lepola
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Hans E. Berg
- Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden
| | - Li Felländer-Tsai
- Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden
| | - Kristo Kask
- Department of Orthopaedics, North Estonia Medical Centre, Tallinn, Estonia
| | - Timo Rahnel
- Department of Orthopaedics, North Estonia Medical Centre, Tallinn, Estonia
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, Tartu University, Tartu, Estonia
- Orthopaedics clinic, Tartu University Hospital, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, Tartu University, Tartu, Estonia
- Orthopaedics clinic, Tartu University Hospital, Tartu, Estonia
| | - Kenneth B. Jonsson
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Peter Ström
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Kaj Døssing
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Helle K. Østergaard
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Minna K. Laitinen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
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Palola V, Hevonkorpi TP, Ponkilainen VT, Launonen AP, Mattila VM. Sick leave length and the costs of operatively and conservatively treated distal radius fractures in the working age population: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:842. [PMID: 37880683 PMCID: PMC10601330 DOI: 10.1186/s12891-023-06963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Among the working population, a transient loss of working ability due to distal radius fracture (DRF) has a societal impact in terms of sick leave. Non-operative cast immobilization is the most common treatment option for DRF. However, these fractures are increasingly treated operatively. This retrospective cohort study of patients aged 20-64 with DRF compares the effects of different treatment strategies on sick leave length and overall cost of treatment. METHODS Multivariable regression analysis was used with treatment modality as an exposure and sick leave length as an outcome. Sick leave data were obtained from a national register. Costs were evaluated by adding the direct cost of the treatment modality to the mean cost of sick leave per patient in different treatment groups. RESULTS Of 614 working-age patients with a DRF who were treated at a tertiary hospital in Finland between January 2013 and December 2014, 521 were primarily treated non-operatively with cast immobilization and 93 were primarily operated. Of the primarily non-operatively treated patients, 48 were operated during follow-up. The mean follow-up was 5 years. The median time lost from work after DRF was 55 days (7.9 weeks), and the separated medians by treatment modality were 49 (7 weeks) and 70 days (10 weeks) for conservative and operative treatment, respectively. Multivariable linear regression analyses were performed for those patients who had sick leave (n = 292). Regression analysis also showed that operative treatment correlates with longer sick leave. CONCLUSIONS Operative treatment of distal radius fracture led more often to longer time lost from work than conservative treatment. Moreover, due to longer sick leave and the costs of the operation itself, operative treatment is over two times more expensive than conservative treatment. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Vili Palola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland.
| | - Teemu P Hevonkorpi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyvaskyla, Finland
| | - Ville T Ponkilainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyvaskyla, Finland
| | - Antti P Launonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Sumrein BO, Berg HE, Launonen AP, Landell P, Laitinen MK, Felländer-Tsai L, Mattila VM, Huttunen TT. Mortality following proximal humerus fracture-a nationwide register study of 147,692 fracture patients in Sweden. Osteoporos Int 2023; 34:349-356. [PMID: 36435907 PMCID: PMC9852167 DOI: 10.1007/s00198-022-06612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
UNLABELLED Little is known about survival after proximal humerus fracture. In this manuscript, we found the mortality to be high (almost four times higher than in age- and sex-matched controls). While frailty hip fracture has gained attention, we hope our manuscript will shed light on frailty proximal humerus fracture patients. INTRODUCTION Proximal humerus fractures (PHF) are common and occur mostly after the 6th decade of life. While mortality following PHF has been reported previously, mortality data after longer follow-up on a national level is lacking. METHODS We obtained data from the Swedish Hospital Discharge Register (SHDR), on all adult patients (≥ 18 years) with a diagnosis of PHF (S42.2, S42.20, or S42.21) for the period between 2001 and 2016. We used the Swedish Cause of Death Register (SCDR) to investigate mortality in the fracture cohort. We compared the mortality of fracture patients with age- and sex-matched population-based mortality data obtained from Statistics Sweden. RESULTS A total of 147 692 PHF patients were identified, with a male to female ratio of 1:3. The mean age was 69 years (range, 18 to 111). Most patients were treated non-surgically (n = 126,487, 86%). The crude mortality rate was 2.2% at 1 month, 4.1% at 3 months, 8.5% at 12 months, and 24% at 48 months after sustaining a PHF. Mortality increased with age; however, the standardized mortality rate (SMR) was highest among young patients. SMR was 5.4 in the 18- to 39-year age group, 3.9 in the 40- to 64-year age group, 1.8 in the 65-79-year age group, and 1.2 in the ≥ 80-year-old population. The age-adjusted SMR was 3.9 in the whole adult PHF population. CONCLUSION The mortality rate and SMR suggest that PHF patients are heterogeneous. Some older PHF patients may benefit from specialized care (e.g., orthogeriatric), and this should be evaluated in future studies.
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Affiliation(s)
- Bakir O Sumrein
- Department of Orthopedics and Traumatology, Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland.
| | - Hans E Berg
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, KarolinskaInstitutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Antti P Launonen
- Department of Orthopedics and Traumatology, Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - Peter Landell
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, KarolinskaInstitutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Minna K Laitinen
- Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, KarolinskaInstitutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ville M Mattila
- Department of Orthopedics and Traumatology, Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland
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Ax M, Reito A, Hevonkorpi TP, Palola V, Kukkonen J, Luokkala T, Laitinen MK, Launonen AP, Mattila VM. A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial. PLoS One 2023; 18:e0283946. [PMID: 37023069 PMCID: PMC10079055 DOI: 10.1371/journal.pone.0283946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Non-operative treatment is the most common treatment option for older patients with distal radius fracture (DRF). Traditionally, wrists have been placed in volar-flexion and ulnar deviation position (VFUDC). In recent years, there has been a trend towards using a functional position cast (FC). However, long-term results for these different casting positions are lacking. PATIENTS AND METHODS This randomized, controlled, prospective study evaluates the functional results and costs of the 2 casting positions in patients 65 and older with DRF. Primary end point in this study was Patient-Reported Wrist Evaluation (PRWE) at 24 months, and secondary end points were cost-effectiveness of treatment, health-related quality of life measurement (15D), short version of Disabilities of arm, shoulder and hand score (QuickDASH), and VAS at 24 months. The trial was registered in ClinicalTrials.gov (NCT02894983, https://clinicaltrials.gov/ct2/show/NCT02894983). RESULTS We enrolled 105 patients, of which 81 (77%) continued until 24-month follow-up. 8 patients (18%) were operated in the VFUDC group and 4 (11%) in the FC group. Patients in the VFUDC group also received more frequent physical therapy. The difference in PRWE score between the VFUDC and FC groups at 24 months was -4.31. The difference in the cost of treatment per patient was €590. Both findings favored FC. INTERPRETATION We found a slight, but consistent difference in the functional results between groups. These results suggest that VFUDC is not superior to FC when treating Colles' type DRF. Cost analysis revealed overall costs in the VFUDC group are nearly double those in the FC group, mostly due to more physical therapy, additional visits to hospital, and additional examinations. Therefore, we recommend FC in older patients with Colles' type DRF.
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Affiliation(s)
- Maarit Ax
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Teemu P Hevonkorpi
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Vili Palola
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
| | - Juha Kukkonen
- Department of Orthopedics and Traumatology, Satakunta Central Hospital, Pori, Finland
| | - Toni Luokkala
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Minna K Laitinen
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Antti P Launonen
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
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Kärnä L, Launonen AP, Karjalainen T, Luokkala T, Ponkilainen V, Halonen L, Helminen M, Mattila VM, Reito A. LIMPER trials: immediate mobilisation versus 2-week cast immobilisation after distal radius fracture treated with volar locking plate - a study protocol for a prospective, randomised, controlled trial. BMJ Open 2022; 12:e064440. [PMID: 36368761 PMCID: PMC9660569 DOI: 10.1136/bmjopen-2022-064440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Open reduction and internal fixation with volar locking plate has become the most common fixation method in the treatment of unstable distal radius fracture (DRF). There is, however, no consensus as to whether or for how long a wrist should be immobilised after operative treatment. To date, there have been relatively few studies that have evaluated the effect of immediate postoperative mobilisation on functional outcomes. The aim of postoperative rehabilitation is to obtain a good function and to reduce impairment, recovery time, socioeconomical costs and absence from work. Therefore, there is a need for studies that evaluate the optimal method of postoperative rehabilitation to optimise wrist function and return to work. METHODS AND ANALYSIS This study is a prospective, randomised, controlled trial in which a total of 240 working-age patients who undergo volar plating for DRF will be randomly assigned to either an early mobilisation group or a postoperative 2-week casting group. The aim of the study will be to compare early postoperative outcomes between the study groups. The primary outcome will be patient-rated wrist evaluation at 2 months after operation. A coprimary outcome will be the total length of sick leave. Our follow-up period will be 1 year, and secondary outcomes will include pain, patient satisfaction, perceived ability to work and complications identified at different time points. We expect those patients who undergo immediate mobilisation will have at least as rapid a return to work and function as those patients who undergo postoperative immobilisation, indicating/meaning that there will be no need for postoperative casting. ETHICS AND DISSEMINATION This study will be conducted according to the Standard Protocol Items: Recommendations for Interventional Trials statement. The Ethics committee of Tampere University Hospital has approved the protocol. Ethics committee approval number is R21111, and it is accepted on 7 September 2021. The results of this study will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05150925.
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Affiliation(s)
- Laura Kärnä
- Tampere University Hospital, Tampere, Finland
| | | | | | - Toni Luokkala
- Central Finland Central Hospital, Jyvaskyla, Finland
| | | | - Lauri Halonen
- South Karelia Central Hospital, Lappeenranta, Finland
| | - Mika Helminen
- Health Sciences, Research Services, Tampere, Finland
- Health Sciences, Tampere University, Tampere, Finland
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Kuitunen I, Jokihaara J, Ponkilainen V, Reito A, Paloneva J, Mattila VM, Launonen AP. Emergency department visits due to hand trauma and subsequent emergency hand surgery in three Finnish hospitals during the first and second waves of COVID-19 pandemic. PLoS One 2022; 17:e0263435. [PMID: 35108329 PMCID: PMC8809559 DOI: 10.1371/journal.pone.0263435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introductions
The rate of acute hand trauma visits to emergency departments (ED) and surgeries decreased during the COVID-19 lockdown. Our aim was to analyze the influence of national lockdown during the first wave and the regional restrictions during the second wave on the rate of visits to the ED and urgent hand surgeries in Finland.
Methods
Material for this retrospective study was gathered from three Finnish hospitals All ED visits and urgent or emergency surgeries from January 2017 to December 2020 were included. Incidences per 100 000 persons with 95% confidence intervals (CI) were calculated and compared by incidence rate ratios (IRR).
Results
The incidence of hand injury was lower after the beginning of the lockdown in March 2020 (IRR 0.70 CI 0.63–0.78). After lockdown ended in May, the monthly incidences of ED visits returned to the reference level. During the lockdown, the incidence of fractures and dislocations was 42% lower in March (IRR 0.58 CI 0.50–0.68) and 33% lower in April 2020 (IRR 0.67 CI 0.57–0.80). The incidence of fracture repair surgeries was 43% lower in March 2020 (IRR 0.57 CI 0.35–0.93) and 41% lower in July 2020 (IRR 0.59 CI 0.36–0.98). Incidence of replantation was 49% higher in March 2020 (IRR 1.49 CI 0.53–4.20) and 200% higher in July 2020 (IRR 3.00 CI 0.68–13.2) but these increases had high uncertainty.
Conclusions
The rate of ED visits due to hand injuries decreased while the rate of emergency hand operations remained unchanged during the national COVID-19 lockdown in spring. After the lockdown, the incidences returned to reference level and were unaffected by regional restrictions during the second wave of pandemic.
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Affiliation(s)
- Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Mikkeli Central Hospital, Mikkeli, Finland
- * E-mail:
| | - Jarkko Jokihaara
- Department of Hand- and Microsurgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Ville Ponkilainen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Juha Paloneva
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Central Finland Hospital, Jyväskylä, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Antti P. Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Rantalaiho I, Laaksonen I, Launonen AP, Luokkala T, Flinkkilä T, Salmela M, Adolfsson L, Olsen B, Isotalo K, Ryösä A, Äärimaa V. Scandinavian Olecranon Research in the Elderly (SCORE): protocol for a non-inferiority, randomised, controlled, multicentre trial comparing operative and conservative treatment of olecranon fractures in the elderly. BMJ Open 2022; 12:e055097. [PMID: 35105643 PMCID: PMC8808415 DOI: 10.1136/bmjopen-2021-055097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The incidence of olecranon fractures is growing in the elderly population. The traditional operative approach is giving way among the elderly to conservative treatment, which seems to provide a comparable functional outcome with a lower complication burden. However, there is still a lack of reliable evidence to support this shift.The objective of this trial is to investigate whether conservative treatment of displaced olecranon fractures in patients aged 75 or older yields comparable results to those of operative treatment in terms of pain and daily function. METHODS AND ANALYSIS Scandinavian Olecranon Research in the Elderly (SCORE) is a randomised, controlled, multicentre, non-inferiority trial. Eligible patients will be randomised to either conservative or operative treatment. The sample size will be 68 patients and allocation done at a 1:1 ratio (34 patients per group). The randomisation is stratified according to the participating hospital and patient's sex. Both groups will receive the same postoperative physiotherapy and pain management. The primary outcome is Disabilities of the Arm, Shoulder and Hand at 1-year follow-up. Secondary outcomes are pain and satisfaction measured on visual analogue scales, Patient Reported Elbow Evaluation, range of motion of the elbow and extension strength of the elbow compared with the unaffected arm. Radiographs will be taken at each follow-up. Primary analysis of the results will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION The study protocol for this clinical trial has been approved by the Ethics Committee of the Hospital District of Southwest Finland and will be submitted for approval to the Regional Ethics Committees in Linköping, Sweden and Copenhagen, Denmark. Every recruiting centre will apply local research approvals. The results of this study will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04401462. PROTOCOL VERSION This is the second protocol version dated on 16 April 2020.
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Affiliation(s)
- Ida Rantalaiho
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti P Launonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Toni Luokkala
- Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Tapio Flinkkilä
- Department of Orthopedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Mikko Salmela
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - L Adolfsson
- Institution for Clinical and Experimental Medicine, Division of Orthopaedics, Linköping University, Linkoping, Sweden
| | - Bo Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Kari Isotalo
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Anssi Ryösä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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11
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Hevonkorpi TP, Raittio L, Vähä-Tuisku S, Launonen AP, Mattila VM. Long-term subjective results and radiologic prognosis of a distal radius fracture in working-aged patients - a prognostic cohort study of 201 patients. J Int Med Res 2021; 49:3000605211060985. [PMID: 34929107 PMCID: PMC8733368 DOI: 10.1177/03000605211060985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate long-term outcomes associated with distal radius fracture (DRF) in working-aged patients. The authors hypothesized that the majority of patients experience no permanent loss of function when measured with patient-rated wrist evaluation (PRWE). METHODS This was a retrospective cohort study of patients with a DRF aged between 18 and 65 years. The primary outcome measure was PRWE score at a minimum of 4 years after DRF. Secondary outcome measures were pain catastrophizing scale (PCS) and radiographic measurements. RESULTS Of 201 patients included, 179 were primarily treated non-operatively with a 5-week cast treatment and 22 were primarily operated. The mean follow-up duration was 5 years. The mean PRWE score was 10.9 (95% confidence interval 8.4, 13.4) and median PRWE was 3.5 (interquartile range, 0.0-13.0). There was minor correlation between PCS and PRWE score (correlation coefficient [CC] 0.3), and between PRWE score and dorsal angulation of the fracture measured after closed reduction (CC 0.2) and in one-week follow-up radiographs (CC 0.2). CONCLUSIONS Working-aged patients seem to gain nearly normal wrist function after DRF in longer follow-up. Pain catastrophizing appears to correlate with long-term treatment outcome.
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Affiliation(s)
- Teemu P Hevonkorpi
- Department of Surgery, 236131Central Finland Central Hospital, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland
| | - Lauri Raittio
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland.,Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
| | - Susanna Vähä-Tuisku
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland.,Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
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12
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Reito A, Launonen AP. Paradigm shift in orthopaedics: From objective superiority to shared decision making. Injury 2021; 52:3549. [PMID: 33685644 DOI: 10.1016/j.injury.2021.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/21/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Aleksi Reito
- Department of Orthopaedics, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Antti P Launonen
- Department of Orthopaedics, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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13
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Uimonen M, Kuitunen I, Paloneva J, Launonen AP, Ponkilainen V, Mattila VM. The impact of the COVID-19 pandemic on waiting times for elective surgery patients: A multicenter study. PLoS One 2021; 16:e0253875. [PMID: 34228727 PMCID: PMC8259989 DOI: 10.1371/journal.pone.0253875] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A concern has been that health care reorganizations during the first COVID-19 wave have led to delays in elective surgeries, resulting in increased complications and even mortality. This multicenter study examined the changes in waiting times of elective surgeries during the COVID-19 pandemic in Finland. METHODS Data on elective surgery were gathered from three Finnish public hospitals for years 2017-2020. Surgery incidence and waiting times were examined and the year 2020 was compared to the reference years 2017-2019. The mean annual, monthly, and weekly waiting times were calculated with 95% confidence intervals (CI). The most common diagnosis groups were examined separately. FINDINGS A total of 88 693 surgeries were included during the study period. The mean waiting time in 2020 was 92.6 (CI 91.5-93.8) days, whereas the mean waiting time in the reference years was 85.8 (CI 85.1-86.5) days, resulting in an average 8% increase in waiting times in 2020. Elective procedure incidence decreased rapidly in the onset of the first COVID-19 wave in March 2020 but recovered in May and June, after which the surgery incidence was 22% higher than in the reference years and remained at this level until the end of the year. In May 2020 and thereafter until November, waiting times were longer with monthly increases varying between 7% and 34%. In gastrointestinal and genitourinary diseases and neoplasms, waiting times were longer in 2020. In cardiovascular and musculoskeletal diseases, waiting times were shorter in 2020. CONCLUSION The health care reorganizations due to the pandemic have increased elective surgery waiting times by as much as one-third, even though the elective surgery rate increased by one-fifth after the lockdown.
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Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
- * E-mail:
| | - Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Mikkeli Central Hospital, Mikkeli, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti P. Launonen
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Ville M. Mattila
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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14
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Kuitunen I, Ponkilainen VT, Uimonen MM, Paloneva J, Launonen AP, Mattila VM. Postponing elective surgery due to COVID-19 did not decrease the oncological surgery rate in Finland. Br J Surg 2021; 108:e191-e193. [PMID: 33655303 PMCID: PMC7989625 DOI: 10.1093/bjs/znab046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- I Kuitunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland.,Emergency Department, Mikkeli Central Hospital, Mikkeli, Finland
| | - V T Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - M M Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - J Paloneva
- School of Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - A P Launonen
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - V M Mattila
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
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15
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Kuitunen I, Ponkilainen VT, Launonen AP, Reito A, Hevonkorpi TP, Paloneva J, Mattila VM. The effect of national lockdown due to COVID-19 on emergency department visits. Scand J Trauma Resusc Emerg Med 2020; 28:114. [PMID: 33276799 PMCID: PMC7716110 DOI: 10.1186/s13049-020-00810-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 outbreak lead to nationwide lockdown in Finland on the March 16th, 2020. Previous data regarding to the patient load in the emergency departments during pandemics is scarce. Our aim is to describe the effect of national lockdown and social distancing on the number and reasons for emergency department (ED) visits and inpatient admissions in three large volume hospitals prior to and after the outbreak of the COVID-19 epidemic in Finland. METHODS Data for this register-based retrospective cohort study were collected from three large ED's in Finland, covering 1/6 of the Finnish population. All patients visiting ED's six weeks before and six weeks after the lockdown were included. Pediatric and gynecological patients were excluded. Numbers and reasons for ED visits and inpatient admissions were collected. Corresponding time period in 2019 was used as reference. RESULTS A total of 40,653 ED visits and 12,226 inpatient admissions were analyzed. The total number of ED visits decreased 16% after the lockdown, whereas the number of inpatient admissions decreased 15% (p < 0.001). This change in inpatient admissions was similar in all participating hospitals. Visits due to back or limb pain decreased 31% and infectious diseases 28%. The visit rate and inpatient admissions due to acute myocardial infarction and strokes remained stable throughout the study period. Interestingly, the rate of inpatient admissions due to psychiatric diagnoses remained unchanged, although the ED visit rate decreased by 19%. The number of ED visits (n = 282) and inpatient admissions (n = 55) due to COVID-19 remained low in the participating hospitals. CONCLUSIONS Changes in ED visits and inpatient admissions prior to and during the early phase of the COVID-19 outbreak were unpredictable, and our results may help hospitals and especially ED's focus their resources better. Surprisingly, there was a major decrease in the rate of ED visits due to back or limb pain and not so surprisingly in infectious diseases. Rates of acute myocardial infarctions and cerebral strokes remained stable. In summary, stabile resources for the treatment of patients with severe diseases will be needed in hospitals and ED's.
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Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, School of Medicine, Yliopistonranta 1, PL 1627, 70211, Kuopio, Finland.
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
| | - Ville T Ponkilainen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Teemu P Hevonkorpi
- Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Paloneva
- University of Eastern Finland, School of Medicine, Yliopistonranta 1, PL 1627, 70211, Kuopio, Finland
- Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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16
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Launonen AP, Huttunen TT, Lepola V, Niemi ST, Kannus P, Felländer-Tsai L, Berg HE, Laitinen MK, Mattila VM. Distal Biceps Tendon Rupture Surgery: Changing Incidence in Finnish and Swedish Men Between 1997 and 2016. J Hand Surg Am 2020; 45:1022-1028. [PMID: 33012613 DOI: 10.1016/j.jhsa.2020.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 06/15/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal biceps tendon rupture is a relatively rare injury usually occurring with excess external extension force applied to a flexed elbow. The aim of this study was to examine the incidence of distal biceps tendon rupture surgery in the Finnish and Swedish adult population between the years 1997 and 2016. A secondary aim was to investigate the distal biceps rupture incidence in the Swedish population in 2001 to 2016. METHODS We assessed the number and rate of distal biceps tendon rupture surgery using the Finnish and Swedish Hospital Discharge Register as databases. The study included the entire Finnish and Swedish adult population aged 18 years and older between January 1, 1997 and of December 31, 2016. RESULTS During the study period, 2,029 patients had a distal biceps tendon rupture in Finland, and the corresponding figure was 2,000 in Sweden. The rate of distal biceps tendon rupture surgery increased steeply, but equally, in both countries, in Finnish men from 1.3 per 100,000 person-years in 1997 to 9.6 in 2016, and in Swedish men from 0.2 in 1997 to 5.6 in 2016. The incidence of distal biceps tendon rupture in Sweden increased in men from 1.6 to 10.0 per 100,000 person-years from 2001 to 2016. CONCLUSIONS There was a 7-fold and a 28-fold increase in the incidence of distal biceps tendon rupture surgery in Finnish and Swedish men during 1997 to 2016. The incidence of distal biceps tendon rupture rose 6-fold in Swedish men in 2001 to 2016. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Antti P Launonen
- Department of Orthopedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland.
| | - Tuomas T Huttunen
- Department of Emergency, Anesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland
| | - Vesa Lepola
- Department of Orthopedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Seppo T Niemi
- UKK Institute for Health Promotion Research, Tampere
| | - Pekka Kannus
- UKK Institute for Health Promotion Research, Tampere
| | | | - Hans E Berg
- Karolinska University Hospital, Stockholm, Sweden
| | - Minna K Laitinen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville M Mattila
- Department of Orthopedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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17
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Ponkilainen V, Kuitunen I, Hevonkorpi TP, Paloneva J, Reito A, Launonen AP, Mattila VM. The effect of nationwide lockdown and societal restrictions due to COVID-19 on emergency and urgent surgeries. Br J Surg 2020; 107:e405-e406. [PMID: 32770538 PMCID: PMC7436678 DOI: 10.1002/bjs.11847] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Ville Ponkilainen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Ilari Kuitunen
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.,University of Eastern Finland, School of Medicine, Yliopistonranta 1, 70211, Kuopio, Finland
| | - Teemu P Hevonkorpi
- Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Paloneva
- University of Eastern Finland, School of Medicine, Yliopistonranta 1, 70211, Kuopio, Finland.,Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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18
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Abstract
We found no clear evidence of the clinical superiority of distal radius fracture surgery among older adults at one year. Surgical treatment, however, may yield a faster recovery to previous level of activity in elderly patients. With operative treatment, hardware-based problems may warrant secondary operations and implant removal, whereas in non-operative treatment, symptomatic loss of alignment and malunion can occur. In elderly patients, non-operative treatment can be considered to be the gold standard.
Cite this article: EFORT Open Rev 2020;5:361-370. DOI: 10.1302/2058-5241.5.190060
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Affiliation(s)
- Toni Luokkala
- Department of Orthopaedics, Central Finland Central Hospital, Jyväskylä, Finland
| | - Minna K Laitinen
- Department of Orthopaedics, Helsinki University Hospital, Helsinki, Finland
| | - Teemu P Hevonkorpi
- Department of Orthopaedics, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere, Finland
| | - Lauri Raittio
- Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere, Finland.,Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
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19
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Launonen AP, Laitinen MK, Sumrein BO, Niemi ST, Kannus P, Mattila VM. Trends in scapular fractures: a nationwide 17-year study in Finland. JSES Int 2020; 4:59-62. [PMID: 32544933 PMCID: PMC7075765 DOI: 10.1016/j.jses.2019.10.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to examine the trends in the number and incidence of scapular fractures causing hospitalization in the Finnish adult population between 1998 and 2014. Methods We assessed the number and incidence of scapular fractures resulting in hospital admission and fixation with a plate in Finland in 1998 through 2014 using the Finnish National Hospital Discharge Register as the database. In each year, the study included the entire Finnish adult population. Results A total of 3843 adult patients with scapular fractures were hospitalized, and the incidence of fracture increased from 4.8 (per 100,000 person-years) in 1998 to 6.6 in 2014. The fracture was operated on with plating in 476 cases (12.4%). The annual number and incidence of scapular fixation with plates did not show constant trend changes during the study period except in the years 2011 through 2013, when there was a sudden increase in the number of these operations. This increase leveled off in 2014. Conclusion The incidence of hospital-treated scapular fractures increased in Finland in 1998 through 2014. Treatment of scapular fractures with a plate did not show consistent trend changes in Finland during this period.
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Affiliation(s)
- Antti P Launonen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Minna K Laitinen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Bakir O Sumrein
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Seppo T Niemi
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pekka Kannus
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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20
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Launonen AP. Understanding fracture populations by epidemiology. Acta Orthop 2020; 91:236-237. [PMID: 32396407 PMCID: PMC8023877 DOI: 10.1080/17453674.2020.1763571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie, Tampere, Finland,E-mail:
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Raittio L, Launonen AP, Hevonkorpi T, Luokkala T, Kukkonen J, Reito A, Laitinen MK, Mattila VM. Two casting methods compared in patients with Colles' fracture: A pragmatic, randomized controlled trial. PLoS One 2020; 15:e0232153. [PMID: 32469881 PMCID: PMC7259650 DOI: 10.1371/journal.pone.0232153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Distal radius fractures are common fractures and the cornerstone of treatment remains immobilization of the wrist in a cast. At present, there is a scarcity of studies that compare different cast immobilization methods. The objective of the study was therefore to compare volar-flexion and ulnar deviation cast to functional cast position in the treatment of dorsally displaced distal radius fracture among elderly patients. Methods and findings We performed a pragmatic, randomized, controlled trial in three emergency centers in Finland. After closed reduction of the fracture, the wrist was placed in either volar-flexion and ulnar deviation cast or functional cast position. The follow-up was 12 months. The primary outcome was patient-rated wrist evaluation (PRWE) score at 12 months. The secondary outcomes were Quick-DASH score, grip strength, health-related quality of life (15D), and pain catastrophizing scale. The number of complications was also recorded. In total, 105 participants were included in the study. Of these, 88% were female and the mean age was 73.5 (range 65–94) years. In the primary analysis, the mean difference in patient-rated wrist evaluation measure between groups was -4.9 (95% CI: -13.1.– 3.4., p = .24) in favor of the functional cast position. Operative treatment due to loss of reduction of fracture was performed for four patients (8%) in the FC group and for seven patients (13%) in the volar-flexion and ulnar deviation cast group (OR: 0.63, 95% CI: 0.16–2.1). Conclusion In this study, the data were consistent with a wide range of treatment effects when comparing two different cast positions in the treatment of distal radius fracture among elderly patients at 12-month follow-up. However, the functional cast is more likely to be superior when compared to volar-flexion and ulnar deviation cast. Trial registration ClinicalTrials.gov identifier: NCT02894983 Accessible: https://clinicaltrials.gov/ct2/show/NCT02894983
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Affiliation(s)
- Lauri Raittio
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- * E-mail:
| | - Antti P. Launonen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Teemu Hevonkorpi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Toni Luokkala
- Central Finland Central Hospital, Jyväskylä, Finland
| | | | - Aleksi Reito
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Minna K. Laitinen
- Division of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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Karelson MC, Jokihaara J, Launonen AP, Huttunen T, Mattila VM. Lower nationwide rates of arthroscopic procedures in 2016 compared with 1997 (634925 total arthroscopic procedures): has the tide turned? Br J Sports Med 2020; 55:1018-1023. [PMID: 32241819 PMCID: PMC8408579 DOI: 10.1136/bjsports-2019-101844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2020] [Indexed: 11/08/2022]
Abstract
Objectives To assess the rates and secular trends of different joint arthroscopies—shoulder, elbow, wrist, hip, knee and ankle—in Finland between 1997 and 2016. Design Retrospective nationwide registry study. Participants All adults in Finland with any arthroscopic intervention procedure code for knee, shoulder, ankle, wrist, elbow or hip arthroscopy between 1 January 1997 and 31 December 2016 were included. Main outcome measures Incidence rate of arthroscopic surgery per 100 000 person-years. Results The rate of knee and shoulder arthroscopies declined after reaching a peak in 2006 and 2007, respectively. The rates of wrist, elbow and hip joint arthroscopies declined after their 2014 peak. At the same time, the median age of patients who had knee, ankle and hip arthroscopy decreased, whereas the age of patients who had shoulder arthroscopy increased. Conclusions Numerous randomised controlled trials point to lack of efficacy of the most common knee and shoulder arthroscopic procedures. It should not be assumed that this has contributed to decreased rates of arthroscopic surgery. The concurrent decrease in most of the other joint arthroscopic procedures was unexpected.
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Affiliation(s)
- Margit C Karelson
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Department of Hand and Microsurgery, Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tuomas Huttunen
- Department of Emergency, Anesthesia and Pain Medicine; Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere University, Tampere, Pirkanmaa, Finland.,Coxa Hospital Ltd, Tampere, Pirkanmaa, Finland
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23
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Karelson M, Launonen AP, Jokihaara J, Havulinna J, Mattila VM. Pain, function, and patient satisfaction after arthroscopic treatment of elbow in a retrospective series with minimum of 5-year follow-up. J Orthop Surg (Hong Kong) 2020; 27:2309499019832808. [PMID: 30827185 DOI: 10.1177/2309499019832808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The clinical indications for elbow arthroscopic procedures have expanded through last decades. The aim of the study was to assess the functional results and patient satisfaction after arthroscopic treatment of various elbow conditions after a minimum 5-year follow-up. METHODS We conducted a retrospective study of a consecutive patient cohort who had undergone unilateral elbow arthroscopy between 2008 and 2010. The main outcomes were Disabilities of the Arm, Shoulder and Hand (DASH) score and a specific patient-reported outcome measure questionnaire after a minimum 5-year follow-up. RESULTS In total, there were 93 patients in the cohort with different diagnoses. Majority of patients were suffering from elbow osteoarthrosis. After the average follow-up of 72 months (range 60-96 months), the response rate was 67%. Eighty two percent of patients were satisfied with the pain relief and locking of the elbow was relieved in 70% of patients. Elbow range of motion (ROM) improved in 80% of the 55 patients who had a limited ROM before the operation. The overall patient satisfaction after elbow arthroscopic treatment was good. There were no differences in median DASH score between patients with or without post-traumatic condition, but the median DASH score for patients who had severe (grade 3) osteoarthrosis before the operation was significantly worse. There were no major complications reported in this cohort. CONCLUSIONS Arthroscopic treatment of various elbow conditions was associated with good patient satisfaction and reduced symptoms without major complications. Level of Evidence: Level IV, therapeutic case series.
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Affiliation(s)
- Margit Karelson
- 1 Department of Hand Surgery, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- 2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- 1 Department of Hand Surgery, Tampere University Hospital, Tampere, Finland.,3 The School of Medicine, University of Tampere, Tampere, Finland
| | | | - Ville M Mattila
- 2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.,3 The School of Medicine, University of Tampere, Tampere, Finland
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24
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Launonen AP, Fjalestad T, Laitinen MK, Lähdeoja T, Ekholm C, Wagle T, Mattila VM. Nordic Innovative Trials to Evaluate osteoPorotic Fractures (NITEP) Collaboration: The Nordic DeltaCon Trial protocol-non-operative treatment versus reversed total shoulder arthroplasty in patients 65 years of age and older with a displaced proximal humerus fracture: a prospective, randomised controlled trial. BMJ Open 2019; 9:e024916. [PMID: 30700485 PMCID: PMC6352806 DOI: 10.1136/bmjopen-2018-024916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The proximal humerus fracture (PHF) is one of the most common fractures in the elderly. The majority of PHFs are treated non-operatively, while 15%-33% of patients undergo surgical treatment. Recent randomised controlled trial (RCT) and meta-analyses have shown that there is no difference in outcome between non-operative treatment and locking plate or hemi-arthroplasty. During the past decade, reverse total shoulder arthroplasty (RTSA) has gained popularity in the treatment of PHF, although there is a lack of RCTs comparing RTSA to non-operative treatment. METHODS This is a prospective, single-blinded, randomised, controlled, multicentre and multinational trial comparing RTSA with non-operative treatment in displaced proximal humeral fractures in patients 65-85 years. The primary outcome in this study is QuickDASH-score measured at 2 years. Secondary outcomes include visual analogue scale for pain, grip strength, Oxford shoulder score, Constant score and the number of reoperations and complications.The hypothesis of the trial is that operative treatment with RTSA produces better outcome after 2 and 5 years measured with QuickDASH. ETHICS AND DISSEMINATION In this protocol, we describe the design, method and management of the Nordic DeltaCon trial. The ethical approval for the trial has been given by the Regional Committee for Medical and Health Research Ethics, Norway. There have been several examples in orthopaedics of innovations that result in failure after medium-term follow-ups . In order to prevent such failures and to increase our knowledge of RSTA, we feel a large-scale study of the effects of the surgery on the outcome that focuses on the complications and reoperations is warranted. After the trial 2-year follow-up, the results will be disseminated in a major orthopaedic publication. TRIAL REGISTRATION NUMBER NCT03531463; Pre-Results.
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Affiliation(s)
| | | | | | | | - Carl Ekholm
- Sahlgrenska University Hospital, Göteborg, Sweden
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25
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Sumrein BO, Mattila VM, Lepola V, Laitinen MK, Launonen AP, Jonsson K, Wolf O, Ström P, Berg H, Felländer-Tsai L, Mechlenburg I, Døssing K, Østergaard H, Rahnel T, Märtson A. Intraobserver and interobserver reliability of recategorized Neer classification in differentiating 2-part surgical neck fractures from multi-fragmented proximal humeral fractures in 116 patients. J Shoulder Elbow Surg 2018; 27:1756-1761. [PMID: 29866397 DOI: 10.1016/j.jse.2018.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimal fracture classification should be simple and reproducible and should guide treatment. For proximal humeral fractures, the Neer classification is commonly used. However, intraobserver and interobserver reliability of the Neer classification has been shown to be poor. In clinical practice, it is essential to differentiate 2-part surgical neck fractures from multi-fragmented fractures. Thus, the aim of this study was to evaluate whether surgeons can differentiate 2-part surgical neck fractures from multi-fragmented fractures using plain radiographs and/or computed tomography (CT). METHODS Three experienced upper limb specialists and trauma surgeons (B.O.S., A.P.L., and V.L.) independently reviewed and classified blinded plain radiographs and CT scans of 116 patients as showing 2-part surgical neck fractures or multi-fragmented fractures. Each imaging modality was reviewed and classified separately by each surgeon, after which each surgeon reviewed both modalities at the same time. This process was repeated by all surgeons after 24 weeks. Intraobserver and interobserver analyses were conducted using Cohen and Fleiss κ values, respectively. RESULTS The κ coefficient for interobserver reliability showed substantial correlation (0.61-0.73) and was as follows: 0.73 for radiographs alone, 0.61 for CT scans alone, and 0.72 for radiographs and CT scans viewed together. After 24 weeks, the process was repeated and intraobserver reliability was calculated.The κ coefficient for intraobserver reliability showed substantial correlation (0.62-0.75) and was as follows: 0.62 for radiographs alone, 0.64 for CT scans alone, and 0.75 for radiographs and CT scans viewed together. CONCLUSION Clinicians were able to differentiate 2-part surgical neck fractures from multi-fragmented fractures based on plain radiographs reliably.
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Affiliation(s)
- Bakir O Sumrein
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland.
| | - Ville M Mattila
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
| | - Vesa Lepola
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Minna K Laitinen
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
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26
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Abstract
UNLABELLED The aim of the present study was to investigate the incidence of scaphoid fracture surgery by obtaining data from the national discharge register in Finland, a country of 5 million inhabitants, for the period from 1997 to 2014. A total of 1380 patients with scaphoid fracture were treated surgically. Half of the patients were aged under 28 years and 84% were men. The surgical treatment of scaphoid fractures was classified into two groups. There were 640 (46%) primary fracture fixations and 740 (54%) treatments of fracture nonunion. The overall incidence of all scaphoid fixations increased twofold (from 14.8 to 30.1 per 1,000,000 person-years) and threefold in the primary fixation group (from 5.5 to 17.8 per 1,000,000 person-years) during the study period. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lauri T Raittio
- 1 Department of Orthopaedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland.,2 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jarkko Jokihaara
- 3 Department of Hand- and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- 2 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,4 Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
| | - Olli V Leppänen
- 2 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,3 Department of Hand- and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- 1 Department of Orthopaedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- 1 Department of Orthopaedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland.,2 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Hevonkorpi TP, Launonen AP, Raittio L, Luokkala T, Kukkonen J, Reito A, Sumrein BO, Laitinen MK, Mattila VM. Nordic Innovative Trial to Evaluate OsteoPorotic Fractures (NITEP-group): non-operative treatment versus surgery with volar locking plate in the treatment of distal radius fracture in patients aged 65 and over - a study protocol for a prospective, randomized controlled trial. BMC Musculoskelet Disord 2018; 19:106. [PMID: 29621979 PMCID: PMC5887252 DOI: 10.1186/s12891-018-2019-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the literature, there are numerous studies that compare different surgical procedures in the treatment of distal radius fractures (DRF). It is, however, unknown whether operative treatment and better restoration of anatomy with volar locking plate yields a better functional outcome in the elderly population when compared with non-operative treatment. METHODS AND DESIGN This study is a prospective, randomized, controlled, multi-center trial. The purpose will be to compare the non-operative and operative treatment of initially or early malaligned distal radius fractures in patients aged 65 and older. The primary outcome in this study will be the patient rated wrist evaluation (PRWE) score measured after 1 and 2 years. DISCUSSION We expect that initial operative treatment of a DRF with volar locking plate will not yield superior results when compared with non-operative treatment with cast immobilization in terms of functional outcome, pain, disability, quality of life, grip strength, and number of complications. TRIAL REGISTRATION This trial is registered on clinicaltrials.gov , identifier NCT02879656 , registration date 08/17/2016.
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Affiliation(s)
| | - Antti P Launonen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Lauri Raittio
- School of Medicine, University of Tampere, 33014, Tampere, Finland
| | - Toni Luokkala
- Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Juha Kukkonen
- Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
| | - Aleksi Reito
- Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Bakir O Sumrein
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Minna K Laitinen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Ville M Mattila
- School of Medicine, University of Tampere, 33014, Tampere, Finland
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
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28
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Hevonkorpi TP, Launonen AP, Huttunen TT, Kannus P, Niemi S, Mattila VM. Incidence of distal radius fracture surgery in Finns aged 50 years or more between 1998 and 2016 - too many patients are yet operated on? BMC Musculoskelet Disord 2018; 19:70. [PMID: 29499673 PMCID: PMC5834887 DOI: 10.1186/s12891-018-1983-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background Although optimal treatment of distal radius fractures is controversial, surgery has gained popularity. The purpose of this study was to evaluate recent trends in the surgical treatment of distal radius fractures in Finns aged 50 years or more. Methods A nationwide hospital discharge register-based study was conducted among all patients 50 years of age or older who had a surgically treated distal radius fracture in Finland between 1998 and 2016. The number and rate of different surgical procedures were calculated per 100,000 person-years. Results Altogether 21,965 surgically treated distal radius fractures were identified. During the study period the rate of percutaneous pinning and external fixation diminished while the rate of plate fixation significantly increased. The rate of operative treatment increased continually from 1998 to 2008 whereupon the peak of the incidence was achieved. After 2008, the rate of operative treatment of distal radius fracture remained quite constant, ranging between 61.1 and 67.8 per 100,000 person-years. Conclusions Plate fixation has almost completely replaced both external fixation and percutaneous pinning in the surgical treatment of distal radius fractures in Finland. Despite growing evidence for less invasive treatment options in elderly patients, operative treatment of distal radius fracture is still rather popular today.
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Affiliation(s)
- Teemu P Hevonkorpi
- Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland. .,School of Medicine, University of Tampere, Tampere, Finland.
| | - Antti P Launonen
- Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland
| | - Pekka Kannus
- School of Medicine, University of Tampere, Tampere, Finland.,Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Seppo Niemi
- Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics at Karolinska University Hospital, Karolinska Institutet, Solna and Huddinge, Sweden
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29
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Sumrein BO, Huttunen TT, Launonen AP, Berg HE, Felländer-Tsai L, Mattila VM. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int 2017; 28:901-907. [PMID: 27787593 DOI: 10.1007/s00198-016-3808-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/10/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Proximal humeral fracture is the third most common osteoporotic fracture. To our knowledge, this is the first nationwide population-based registry study in adults that includes both inpatient and outpatient visits. Thus, we were able to report the true incidence rates and trends in the treatment of proximal humeral fractures. INTRODUCTION Proximal humeral fractures are among the most common osteoporotic fractures. Valid epidemiologic population-based data, including both inpatient and outpatient visits, however, are lacking. METHODS To investigate the Swedish national incidence rates and treatment trends of proximal humeral fractures, we obtained data from the Swedish Hospital Discharge Register between 2001 and 2012. All adult patients (≥18 years of age) in the Swedish Hospital Discharge Register were included. Outpatient visits have been included in the register since 2001. RESULTS We identified 98,770 patients (women n = 72,063; 73 %) with proximal humeral fractures between 2001 and 2012. In 2001, the sex-specific incidence of proximal humeral fractures was 134.5 per 100,000 person-years for women and 49.2 for men. In 2012, the corresponding values were 174.6 for women and 68.1 for men, increasing 30 % in women and 39 % in men. A total of 17,013 surgical procedures were conducted between 2001 and 2012. Open reduction and internal fixation with a plate was the most common procedure (n = 5050, 30 %), followed by endoprosthetic implantation (n = 3962, 23 %) and intramedullary nailing (n = 3376, 20 %). The proportion of surgically treated patients increased from 12.1 % in 2001 to 16.8 % in 2012 for women and from 15.1 % in 2001 to 17.1 % in 2012 for men. CONCLUSION The Swedish national incidence of proximal humeral fractures has been increasing, although it seems to have peaked in the elderly population during 2008-2010. The rate of surgical treatment has increased substantially, particularly open reduction and internal fixation with a plate. To our knowledge, this is the first nationwide epidemiologic study for Sweden reporting the incidence of proximal humeral fractures and including all inpatient and outpatient visits.
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Affiliation(s)
- B O Sumrein
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland.
| | - T T Huttunen
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland
| | - A P Launonen
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - H E Berg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - L Felländer-Tsai
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - V M Mattila
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
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30
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Launonen AP, Sumrein BO, Lepola V. Treatment of proximal humerus fractures in the elderly. Duodecim 2017; 133:353-358. [PMID: 29205983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A proximal humerus fracture typically occurs when an elderly woman falls directly onto her shoulder or on her outstretched arm. Local pain in the shoulder and immobility of the upper arm raise a suspicion of a significant injury. Other bone and tendon injuries in the shoulder region as well as dislocation of the shoulder should be considered on differential diagnosis. Diagnosis is achieved by plain X-ray. Most fractures can be treated conservatively. Consultation with an orthopedist is needed, if there are several fracture fragments with extensive dislocation.
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Huttunen TT, Launonen AP, Berg HE, Lepola V, Felländer-Tsai L, Mattila VM. Trends in the Incidence of Clavicle Fractures and Surgical Repair in Sweden: 2001-2012. J Bone Joint Surg Am 2016; 98:1837-1842. [PMID: 27807117 DOI: 10.2106/jbjs.15.01284] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clavicle fractures are common injuries causing substantial morbidity. Recent literature suggests that the incidence of surgically treated clavicle fractures has increased. However, it is unknown whether the increase is caused by more surgeons choosing operative over nonoperative treatment for the injury or an increase in the actual incidence of clavicle fractures. The aim of this study was to assess both the national incidence of clavicle fractures and the rate of surgical treatment of those fractures in Sweden. METHODS We assessed the incidence and trends of clavicle fractures and rates of surgery in Sweden. The validated Swedish Hospital Discharge Register offers a unique opportunity to assess both outpatient and inpatient visits and was used to conduct a national register-based study including all adults (≥18 years of age) with a diagnosis of clavicle fracture in Sweden between 2001 and 2012. RESULTS A total of 44,609 clavicle fractures occurred in Sweden between 2001 and 2012. The incidence of clavicle fractures increased from 35.6 per 100,000 person-years in 2001 to 59.3 per 100,000 person-years in 2012. Interestingly, the highest incidence rates were observed in the oldest age groups. The increase in the rate of surgically treated clavicle fractures (705%) was greater than the increase in the actual fracture incidence (67%). Most (77%) of the surgically treated patients were men. Open reduction and plate fixation was the most common surgical procedure. Overall, the proportion of surgically treated clavicle fractures increased markedly. CONCLUSIONS Although the incidence of clavicle fractures increased in Sweden between 2001 and 2012, the rate of surgical treatment of clavicle fractures increased much more than could be expected solely based on the increase in the fracture incidence. The observed changes in the rates of surgery require additional studies since there is still controversy regarding the indications for surgical treatment.
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Affiliation(s)
- Tuomas T Huttunen
- Department of Anesthesia (T.T.H.) and Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation (A.P.L., V.L., and V.M.M.), Tampere University Hospital, Tampere, Finland .,School of Medicine, University of Tampere, Tampere, Finland
| | - Antti P Launonen
- Department of Anesthesia (T.T.H.) and Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation (A.P.L., V.L., and V.M.M.), Tampere University Hospital, Tampere, Finland
| | - Hans E Berg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Division of Orthopedics and Biotechnology, Karolinska Institutet; and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Vesa Lepola
- Department of Anesthesia (T.T.H.) and Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation (A.P.L., V.L., and V.M.M.), Tampere University Hospital, Tampere, Finland
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Division of Orthopedics and Biotechnology, Karolinska Institutet; and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ville M Mattila
- Department of Anesthesia (T.T.H.) and Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation (A.P.L., V.L., and V.M.M.), Tampere University Hospital, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Division of Orthopedics and Biotechnology, Karolinska Institutet; and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Launonen AP, Lepola V, Laitinen M, Mattila VM. Do Treatment Policies for Proximal Humerus Fractures Differ among Three Nordic Countries and Estonia? Results of a Survey Study. Scand J Surg 2016; 105:186-90. [PMID: 26929283 DOI: 10.1177/1457496915623149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Proximal humerus fractures are common fragility injuries. The incidence of these fractures has been estimated to be 82-105 per 105 person-years. Treatment of this fracture, especially in the elderly, is controversial. Our study group published a systematic review of the available literature and concluded that non-operative methods are favored over operative methods in three- and four-part fractures. The aim of this multinational study was to compare treatment policies for proximal humerus fractures among the Nordic countries and Estonia. MATERIALS AND METHODS The study was conducted as a questionnaire-based survey, using the Internet-based program, Webropol(®) (webropol.com). The questionnaire link was sent to the surgeons responsible for treating proximal humerus fractures in major public hospitals in Estonia, Finland, Norway, and Sweden. Questionnaire included questions regarding the responder's hospital, patient characteristics, and examinations taken before decision making. Clinical part included eight example patient cases with treatment options. RESULTS Of the 77 recipients of the questionnaire, 59 responded; consequently, the response rate was 77%. Based on the eight presented displaced fracture examples, in both Estonia and Norway and in Finland, 41% and 38%, respectively, preferred surgical treatment with locking plate. In Sweden, the percentage was 28%. The pre- and post-operative protocols showed a similarity in all participant countries. CONCLUSION Our survey revealed a remarkable uniformity in the current practice of operative treatments and rehabilitation for proximal humerus fractures in the participant countries.
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Affiliation(s)
- A P Launonen
- Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - V Lepola
- Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - M Laitinen
- Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - V M Mattila
- Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
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Affiliation(s)
- Antti P Launonen
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
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Launonen AP, Lepola V, Flinkkilä T, Laitinen M, Paavola M, Malmivaara A. Treatment of proximal humerus fractures in the elderly: a systemic review of 409 patients. Acta Orthop 2015; 86:280-5. [PMID: 25574643 PMCID: PMC4443467 DOI: 10.3109/17453674.2014.999299] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/17/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE There is no consensus on the treatment of proximal humerus fractures in the elderly. PATIENTS AND METHODS We conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score. RESULTS After 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health-related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10-29%). INTERPRETATION Nonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment.
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Affiliation(s)
- Antti P Launonen
- Department of Orthopaedics , Tampere University Hospital , Tampere
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Launonen AP, Lepola V, Saranko A, Flinkkilä T, Laitinen M, Mattila VM. Epidemiology of proximal humerus fractures. Arch Osteoporos 2015; 10:209. [PMID: 25675881 DOI: 10.1007/s11657-015-0209-4] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/06/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED There are only a few previous population-based studies that include both inpatient and outpatient treatment data. The aim of this study was to investigate the epidemiology of proximal humerus fractures. The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. PURPOSE Proximal humerus fractures are the third most common osteoporotic fracture type observed in elderly patients, after wrist and hip fractures. However, few previous population-based studies include both inpatient and outpatient treatment data. The aim of this study was to investigate the incidence, fracture morphology, and treatment method provided in cases of proximal humerus fractures. METHODS We retrospectively studied patient records from a mid-sized town in Finland between the years 2006 and 2010. The following data were collected from the medical records: age, sex, date of the fracture, laterality of the fracture, mechanism of injury, treatment method, and other associated fractures at the time of the original injury. Sex and age distributions of the patient population at risk (>18 years old) were calculated for the study period. RESULTS A total of 678 patients (females n = 503, 73 %) with 692 proximal humerus fractures were identified. The unadjusted incidence was 82 (95 % CI 76 to 88) per 100,000 person-years, 114 (95 % CI 104 to 124), and 47 (95 % CI 41 to 54) per 100,000 person-years in females and males, respectively. Incidence increased toward the older age groups. Clear seasonal variation was observed, two-part fractures were most common (428, 62 %), the majority of the fractures (n = 539, 78 %) were treated nonoperatively with a sling. CONCLUSION The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. It is evident that proximal humerus fractures cause considerable morbidity among elderly people and consume health care resources.
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Affiliation(s)
- Antti P Launonen
- Department of Orthopaedics, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland,
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Huttunen TT, Launonen AP, Pihlajamäki H, Kannus P, Mattila VM. Trends in the surgical treatment of proximal humeral fractures - a nationwide 23-year study in Finland. BMC Musculoskelet Disord 2012; 13:261. [PMID: 23273247 PMCID: PMC3537526 DOI: 10.1186/1471-2474-13-261] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/26/2012] [Indexed: 02/07/2023] Open
Abstract
Background Proximal humeral fractures are common osteoporotic fractures. Most proximal humeral fractures are treated non-surgically, although surgical treatment has gained popularity. The purpose of this study was to determine changes in the surgical treatment of proximal humeral fractures in Finland between 1987 and 2009. Methods The study covered the entire adult (>19 y) population in Finland over the 23-year period from 1st of January 1987 to 31st of December 2009. We assessed the number and incidence of surgically treated proximal humeral fractures in each year of observation and recorded the type of surgery used. The cohort study was based on data from Finnish National Hospital Discharge Register. Results During the 23-year study period, a total of 10,560 surgical operations for proximal humeral fractures were performed in Finland. The overall incidence of these operations nearly quadrupled between 1987 and 2009. After the year 2002, the number of patients treated with plating increased. Conclusion An increase in the incidence of the surgical treatment of proximal humeral fractures was seen in Finland in 1987–2009. Fracture plating became increasingly popular since 2002. As optimal indications for each surgical treatment modality in the treatment of proximal humeral fractures are not known, critical evaluation of each individual treatment method is needed.
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Affiliation(s)
- Tuomas T Huttunen
- Department of Anesthesia, Valkeakoski Regional Hospital, Valkeakoski, Finland.
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Launonen AP, Lepola V, Flinkkilä T, Strandberg N, Ojanperä J, Rissanen P, Malmivaara A, Mattila VM, Elo P, Viljakka T, Laitinen M. Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study. BMC Musculoskelet Disord 2012; 13:167. [PMID: 22954329 PMCID: PMC3520878 DOI: 10.1186/1471-2474-13-167] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 08/31/2012] [Indexed: 11/25/2022] Open
Abstract
Background Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. A comprehensive study by Palvanen et al. demonstrated an increase in the annual fracture rate of 13.7% per year over the past 33 years. Should this trend continue, the fracture rate would triple over the next three decades. The increasing incidence of low-energy fractures raises questions about the optimal treatment in terms of functional outcome, pain, and rehabilitation time, as well as the economical impact. Despite the high incidence and costs of proximal humerus fractures, there is currently no valid scientific evidence for the best treatment method. Several publications, including a Cochrane review outline the need for high-quality, well-designed randomized controlled trials. Methods/Design The study is a prospective, randomized, national multi-center trial. The hypothesis of the trial is that surgical treatment of displaced proximal humerus fractures achieves better functional outcome, pain relief, and patient satisfaction compared to conservative treatment. The trial is designed to compare conservative and surgical treatment of proximal humerus fractures in patients 60 years and older. The trial includes two strata. Stratum I compares surgical treatment with locking plates to conservative treatment for two-part fractures. Stratum II compares multi-fragmented fractures, including three- and four-part fractures. The aim of Stratum II is to compare conservative treatment, surgical treatment with the Philos locking plate, and hemiarthroplasty with an Epoca prosthesis. The primary outcome measure will be the Disabilities of the Arm, Shoulder and Hand (DASH) score and the secondary outcome measures will be the EuroQol-5D (EQ-5D) value, OSS, Constant-Murley Score, VAS, and 15D. Recruiting time will be 3 years. The results will be analyzed after the 2-year follow-up period. Discussion This publication presents a prospective, randomized, national multi-center trial. It gives details of patient flow, randomization, aftercare and also ways of analysis of the material and ways to present and publish the results. Trial registration ClinicalTrials.gov identifier: NCT01246167
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Affiliation(s)
- Antti P Launonen
- Department of Orthopaedics, Tampere University Hospital, Teiskontie 35, PL2000, Tampere 33521, Finland.
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