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Osbeck I, Cöster M, Montgomery F, Atroshi I. Surgically treated adult acquired flatfoot deformity: Register-based study of patient characteristics, health-related quality of life and type of surgery according to severity. Foot Ankle Surg 2023; 29:367-372. [PMID: 36948921 DOI: 10.1016/j.fas.2023.03.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/20/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Population-level data describing patient characteristics and interventions used in surgical treatment of adult acquired flatfoot deformity (AAFD) is lacking. METHODS We analyzed baseline patient-reported data including PROMs and surgical interventions for patients with AAFD reported to the Swedish Quality Register for Foot and Ankle Surgery (Swefoot) 2014-2021. RESULTS 625 feet with primary AAFD surgery were registered. Median age was 60 (range 16-83) years and 64% were women. Mean preoperative EQ-5D index and Self-Reported Foot and Ankle Score (SEFAS) were low. In stage IIa (n = 319) 78% had medial displacement calcaneal osteotomy and 59% had flexor digitorium longus transfer, with some regional variations. Spring ligament reconstruction was less common. In stage IIb (n = 225), 52% had lateral column lengthening, and in stage III (n = 66), 83% had hind-foot arthrodesis. CONCLUSIONS Patients with AAFD have low health-related quality of life before surgery. Treatment in Sweden follows best-available evidence but regional variations exist. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ida Osbeck
- Department of Clinical Sciences Lund - Orthopedics, Lund University, Lund, Sweden.
| | - Maria Cöster
- Department of Clinical Sciences Malmö - Orthopedics, Lund University, Lund, Sweden; Department of Surgical sciences - Uppsala University, Uppsala, Sweden
| | - Fredrik Montgomery
- Department of Clinical Sciences Malmö - Orthopedics, Lund University, Lund, Sweden
| | - Isam Atroshi
- Department of Clinical Sciences Lund - Orthopedics, Lund University, Lund, Sweden; Department of Orthopedics, Hässleholm Hospital, Hässleholm, Sweden
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Cöster M, Tengman E, Brax Olofsson L, Montgomery F. [Surgical interventions have been shown to improve the function in patients with foot drop after a stroke]. Lakartidningen 2021; 118:21071. [PMID: 34498242] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Foot drop (FD) can be caused by a variety of diseases and injuries. FD leads to walking difficulties and reduced balance which also can lead to a higher risk of falling. Patient with a stroke often have an equinovarus deformity of the foot together with the DF. There is a need to optimize and standardize the treatment for patients with FD across different medical specialities. Surgical interventions, with goals of producing a balanced functional foot, have been shown to improve the function and quality of life and decrease the use of braces and walking aids in patients with FD after a CVI. In Sweden data regarding FD surgery is collected in the National Quality Registry for Foot and Ankle Surgery (Riksfot), but there is also an ongoing multicentre study, investigating the patient-reported and functional results of surgery due to FD caused by a CVI.
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Affiliation(s)
- Maria Cöster
- docent, överläkare, institutionen för kliniska vetenskaper, Lunds universitet; orto-pedkliniken, Skånes universitetssjukhus Malmö; Capio Movement, Halmstad
| | - Eva Tengman
- med dr, fysioterapeut, institutionen för samhällsmedicin och rehabilitering, Umeå universitet
| | - Lisbeth Brax Olofsson
- överläkare, orto-pedkliniken, Rörelseorganens centrum, Norrlands universitetssjukhus, Umeå
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von Schewelov T, Magnusson H, Cöster M, Karlsson C, Rosengren BE. Osteoarthritis of the Distal Interphalangeal and First Carpometacarpal Joints is Associated with High Bone Mass in Women and Small Bone Size and Low Lean Mass in Men. Open Orthop J 2015; 9:399-404. [PMID: 26401163 PMCID: PMC4578130 DOI: 10.2174/1874325001509010399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/26/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine if primary hand osteoarthritis (OA) is associated with abnormal bone and anthropometric traits. Methods: We used DXA to measure total body bone mineral density (BMD), femoral neck width (bone size) and total body lean and fat mass in 39 subjects with hand OA (primary DIP and/or CMC I) and 164 controls. Data are presented as mean Z-scores or Odds Ratios (OR) with 95% confidence intervals. Results: Women with hand OA had (compared to controls) higher BMD (0.5(0.1,0.9)) but similar bone size (-0.3(-0.8,0.2)), lean mass (0.3(-0.3,0.9)), fat mass (-0.1(-0.6,0.5)) and BMI (0.0(-0.6,0.6)). Men with hand OA had (compared to controls) similar BMD (-0.1(-0.7,0.6)), smaller bone size (-0.5(-1.1,-0.01)), lower lean mass (-0.6(-1.1,-0.04)), and similar fat mass (-0.2(-0.7,0.4)) and BMI -0.1(-0.6,0.6). In women, each SD higher BMD was associated with an OR of 1.8 (1.03, 3.3) for having hand OA. In men each SD smaller bone size was associated with an OR of 1.8 (1.02, 3.1) and each SD lower proportion of lean body mass with an OR of 1.9 (1.1, 3.3) for having hand OA. Conclusion: Women with primary DIP finger joint and/or CMC I joint OA have a phenotype with higher BMD while men with the disease have a smaller bone size and lower lean body mass.
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Affiliation(s)
- Thord von Schewelov
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Håkan Magnusson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
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Dinter J, Mühlhaus J, Jacobi S, Wienchol CL, Cöster M, Meister J, Höfig C, Müller A, Köhrle J, Grüters A, Krude H, Mittag J, Schöneberg T, Kleinau G, Biebermann H. New G protein coupled receptor targets for 3-iodotyronamine. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cöster M, Rosengren B, Carlsson Å, Montgomery F, Karlsson M. [Patient-reported SEFAS: Questionnaire good evaluation method in foot and ankle disorders]. Lakartidningen 2015; 112:C9LS. [PMID: 25668801] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There is need for structured evaluation of disability before and after surgery. The patients' subjective aspects of their symptoms should be one part of this evaluation, preferably captured by patient-reported outcome measures (PROMs). There are several PROMs, either generic or region-specific questionnaires, but no » gold standard « for foot or ankle evaluation. We translated the Self-reported Foot and Ankle Score (SEFAS) and evaluated the psychometric properties of the score in terms of reliability, validity and responsiveness in patients with a variety of foot and ankle disorders. In this report we recommend a validation process for PROMs and report that SEFAS shows good results when doing this. As SEFAS is a PROM, the instrument seems suitable for use in national registers.
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Affiliation(s)
- Maria Cöster
- Institutionen för kliniska vetenskaper, Lunds universitet - Ortopediska kliniken Malmö, Sweden Institutionen för kliniska vetenskaper, Lunds universitet - Ortopediska kliniken Malmö, Sweden
| | - Björn Rosengren
- Institutionen för kliniska vetenskaper, Lunds universitet - Ortopediska kliniken, SUS, Malmö Malmö, Sweden Institutionen för kliniska vetenskaper, Lunds universitet - Ortopediska kliniken, SUS, Malmö Malmö, Sweden
| | - Åke Carlsson
- Registerhållare - Svenska Fotledsregistret Malmö, Sweden Institutionen för kliniska vetenskaper - Ortopediska kliniken, SUS, Malmö Malmö, Sweden
| | - Fredrik Montgomery
- Registerhållare - Riksfot, svenska fotkirurgiska registret Malmö, Sweden Registerhållare - Riksfot, svenska fotkirurgiska registret Malmö, Sweden
| | - Magnus Karlsson
- Institutionen för kliniska vetenskaper, Lunds universitet - Ortopediska kliniken, SUS, Malmö Malmö, Sweden Institutionen för kliniska vetenskaper, Lunds universitet - Ortopediska kliniken, SUS, Malmö Malmö, Sweden
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Karlsson MK, Magnusson H, Cöster M, Karlsson C, Rosengren BE. Patients with knee osteoarthritis have a phenotype with higher bone mass, higher fat mass, and lower lean body mass. Clin Orthop Relat Res 2015; 473:258-64. [PMID: 25280553 PMCID: PMC4390976 DOI: 10.1007/s11999-014-3973-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 03/08/2014] [Accepted: 09/19/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although knee osteoarthritis (OA) is common, its etiology is poorly understood. Specifically, it is not known whether knee OA is associated with abnormal anthropometric and musculoskeletal characteristics known to be associated with OA in general. We recently studied this topic for patients with hip arthritis; however, it is important to evaluate it for knee OA separately, because there are reports indicating that patients with primary OA in different joints may have a different phenotype. QUESTIONS/PURPOSES Do patients with primary knee OA have a phenotype with higher bone mineral density (BMD), higher body mass index (BMI), larger skeletal size, lower lean body mass, and higher fat content? METHODS We included 38 women and 74 men (mean age, 61 years; range, 34-85 years) with primary knee OA and 122 women and 121 men as control subjects. We used dual-energy x-ray absorptiometry to measure total body BMD (g/cm2), femoral neck width (cm), fat and lean mass (%), and BMI (kg/m2). Z scores were calculated for each individual. Data are presented as means with 95% confidence intervals. RESULTS Women with knee OA had the following Z scores: total body BMD 0.8 (0.5-1.0); BMI 1.6 (1.1-2.0); femoral neck width 0.1 (-0.3 to 0.4); proportion of lean mass -1.0 (-1.5 to -0.6); and proportion of fat mass 1.0 (0.6-1.4). Men with knee OA had the following Z scores: total body BMD 0.5 (0.3-0.7); BMI 0.9 (0.6-1.1); femoral neck width 0.3 (0.1-0.7); proportion of lean mass -0.9 (-1.1 to -0.8); and proportion of fat mass 0.7 (0.5-0.9). CONCLUSIONS Women and men with idiopathic knee OA have a phenotype with higher BMD, higher BMI, proportionally higher fat mass, and proportionally lower lean body mass. Men also have a larger skeletal size. CLINICAL RELEVANCE A higher BMD may lead to stiffer bone, a higher BMI to a greater joint load, and a proportionally lower lean body (muscle) mass to lower joint-protective ability, and all trait deviations probably predispose for knee OA.
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Affiliation(s)
- Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Håkan Magnusson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
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Karlsson MK, Karlsson C, Magnusson H, Cöster M, von Schewelov T, Nilsson JÅ, Brudin L, Rosengren BE. Individuals with primary osteoarthritis have different phenotypes depending on the affected joint - a case control study from southern sweden including 514 participants. Open Orthop J 2014; 8:450-6. [PMID: 25614774 PMCID: PMC4298037 DOI: 10.2174/1874325001408010450] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 01/28/2023] Open
Abstract
Objective: The aim of this study was to evaluate whether primary osteoarthritis (OA), independent of affected joint, is associated with a phenotype that is different from the phenotype in a normative cohort.
Material and Methods: We included 274 patients with primary OA, 30 women and 32 men (mean age 66 years, range 42-84) with primary hip OA, 38 women and 74 men (mean age 61 years; range 34-85) with primary knee OA, 42 women and 19 men (men age 64 years, range 42-87) with primary ankle or foot OA and 20 women and 19 men (mean age 66 years, range 47-88) with primary hand or finger OA. Of all patients included with OA, 23% had hip OA, 41% knee OA, 22% ankle or foot OA and 14% hand or finger OA. Serving as references were 122 women and 118 men of the same ages who were population-based, included as a control cohort. We measured total body BMD (g/cm2) and proportion of fat and lean mass (%) with dual energy X-ray absorptiometry. Height, weight and BMI (kg/m2) were also assessed. We then calculated Z-scores (number of standard deviations difference from the mean value of the control cohort) in the OA patients and compared these between the groups.
Results: Individuals with hand OA and controls had similar phenotype. Individuals with lower extremity OA, irrespective of the affected joint, had similar weight, BMI and BMD, but higher than in individuals with hand OA and controls (all p<0.05). Individuals with lower extremity OA had higher fat and lower lean mass than individuals with hand OA and controls (all p<0.001).
Conclusion: Individuals with primary OA in the lower extremity have a phenotype with higher BMD, higher BMI, proportionally higher fat content and lower lean body mass content. The different skeletal phenotypes in our patients with OA in the lower extremity and patients with hand OA indicate that separate pathophysiologic pathways may be responsible for primary OA in different joints
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Affiliation(s)
- Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Håkan Magnusson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Tord von Schewelov
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Jan Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Lars Brudin
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
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Karlsson MK, Magnusson H, von Schewelov T, Cöster M, Karlsson C, Rosengren BE. Patients with Osteoarthritis in all Three Knee Compartments and Patients with Medial Knee Osteoarthritis Have a Phenotype with High Bone Mass and High Fat Mass but Proportionally Low Lean Mass. Open Orthop J 2014; 8:390-6. [PMID: 25408779 PMCID: PMC4235065 DOI: 10.2174/1874325001408010390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Cross-sectional studies have shown that patients with primary hip osteoarthritis (OA) have higher bone mineral density (BMD), higher BMI, lower lean body mass, and higher fat content. But it is unknown if this phenotype is found also in patients with knee OA and if it precedes OA or manifests as a result of the disease. PATIENTS AND METHODS We included 21 women and 18 men (mean age, 71 years; range, 48-85 years) with primary OA in all three knee compartments, 17 women and 56 men (mean age, 55 years; range, 34-74 years) with primary medial knee OA and 122 women and 121 men without OA as controls. We measured total body BMD (g/cm(2)), fat and lean mass (%) by dual energy X-ray absorptiometry and also registered height and weight to calculate BMI (kg/m(2)). Z-scores were calculated for each individual. Data are presented as means with 95% confidence intervals within brackets. RESULTS Individuals with primary OA in all three knee compartments had the following Z-scores: total body BMD 0.4 (0.0, 0.9); BMI 1.2 (0.7, 1.6); proportion of lean mass -0.6 (-1.1, -0.1); proportion of fat mass 0.4 (0.0, 1.8). Individuals with medial knee OA had the following Z-scores: total body BMD 0.4 (0.3, 0.6); BMI 1.1 (0.8, 1.4); proportion of lean mass -0.8 (-1.3, -0.9); proportion of fat mass 0.9 (0.7, 1.1). INTERPRETATIONS A phenotype with higher BMD, higher BMI, higher fat mass, and proportionally lower lean body mass is evident in individuals with primary OA in all three knee compartments and in patients with only medial knee OA.
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Affiliation(s)
- Magnus K Karlsson
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Håkan Magnusson
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Thord von Schewelov
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Maria Cöster
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Caroline Karlsson
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Björn E Rosengren
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
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Karlsson MK, Ribom EL, Nilsson JÅ, Karlsson C, Cöster M, Vonschewelov T, Mallmin H, Ljunggren Ö, Ohlsson C, Mellström D, Lorentzon M, Leung PC, Lau E, Cauley JA, Barrett-Connor E, Stefanick ML, Orwoll E, Rosengren BE. International and ethnic variability of falls in older men. Scand J Public Health 2013; 42:194-200. [DOI: 10.1177/1403494813510789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Fallers and especially recurrent fallers are at high risk for injuries. The aim of this study was to evaluate fall epidemiology in older men with special attention to the influence of age, ethnicity and country of residence. Methods: 10,998 men aged 65 years or above recruited in Hong Kong, the United States (US) and Sweden were evaluated in a cross-sectional retrospective study design. Self-reported falls and fractures for the preceding 12 months were registered through questionnaires. Group comparisons were done by chi-square test or logistic regression. Results: The proportion of fallers among the total population was 16.5% in ages 65–69, 24.8% in ages 80–84 and 43.2% in ages above 90 ( P <0.001). The corresponding proportions of recurrent fallers in the same age groups were 6.3%, 10.1% and 18.2%, respectively ( P <0.001), and fallers with fractures 1.0%, 2.3% and 9.1%, respectively ( P <0.001). The proportion of fallers was highest in the US, intermediate in Sweden and lowest in Hong Kong (in most age groups P <0.05). The proportion of fallers among white men in the US was higher than in white men in Sweden (all comparable age groups P <0.01) but there were no differences in the proportion of fallers in US men with different ethnicity. Conclusions: The proportion of fallers in older men is different in different countries, and data in this study corroborate with the view that society of residence influences fall prevalence more than ethnicity.
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Affiliation(s)
- Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Eva L Ribom
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - J-Å Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Thord Vonschewelov
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Hans Mallmin
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Östen Ljunggren
- Department of Medical Sciences, University Hospital, Uppsala, Sweden
| | - Claes Ohlsson
- Centre for Bone Research, Departments of Internal Medicine and Geriatrics at the Sahlgrenska Academy, Gothenburg University, Sweden
| | - Dan Mellström
- Departments of Internal Medicine and Geriatrics, Gothenburg University, Gothenburg, Sweden
| | - Mattias Lorentzon
- Departments of Internal Medicine and Geriatrics, Gothenburg University, Gothenburg, Sweden
| | - PC Leung
- The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, Hong Kong
| | - Edith Lau
- The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, Hong Kong
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, USA
| | | | - Marcia L Stefanick
- Stanford Prevention Research Centre, Stanford University School of Medicine, Stanford, USA
| | - Eric Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, USA
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Abstract
AIMS Falls often result in soft tissue injuries, dislocations, fractures, longstanding pain and reduced quality of life. Therefore, fall preventive programmes have been developed. METHODS In this review, we evaluate programmes that in randomized controlled trials (RCT) have been shown with fall reducing effect. RESULTS Physical exercise that includes several training modalities, especially balance and strength training, is the only intervention programme that reduces both the number of fallers and the number of falls in community dwellers. Home hazards modification reduces the fall risk in community-living elderly but has the best effects in high risk groups when the programme is led by occupational therapists. Vitamin D supplement in those with low levels of vitamin D, adjustment of psychotropic medication and modification of multi-pharmacy are drug-related programmes that reduce the fall risk. Anti-slip shoe devices in elderly who walk outdoors during icy conditions and multifaceted podiatry to patients with specific foot disability are interventions targeted at the lower extremities with a fall-reducing effect. First eye cataract surgery and pacemakers in patients with cardio-inhibitory carotid sinus hypersensitivity are surgical procedures with fall-reducing effect. Multifactorial standardized preventive programmes that include an exercise component and individually-designed subject-specific programmes also reduce the number of falls. CONCLUSIONS Fall preventive interventions should be provided to elderly by a structured approach, especially to high risk groups, as to reduce the number of falls and fallers.
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Affiliation(s)
- Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
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Abstract
BACKGROUND AND PURPOSE A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused. PATIENTS AND METHODS The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman's correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach's alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37). RESULTS For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88-0.95), Cronbach's alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00. INTERPRETATION SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery.
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Affiliation(s)
| | - Magnus K Karlsson
- Department of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital in Malmö, Malmö, Sweden
| | - Jan-Åke Nilsson
- Department of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital in Malmö, Malmö, Sweden
| | - Åke Carlsson
- Department of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital in Malmö, Malmö, Sweden
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Dahlin LB, Cöster M, Ekerot L, Holmberg J. Bilateral congenital hypoplastic pulps of the little finger: reconstruction with a neurovascular step-advancement flap. Scand J Plast Reconstr Surg Hand Surg 2004; 38:125-7. [PMID: 15202672 DOI: 10.1080/02844310310019851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We describe a case of bilateral congenital hypoplastic finger pulps of the little finger in a 6-year-old girl in whom reconstruction with a neurovascular step-advancement flap was used to restore soft tissue padding of the pulps.
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Affiliation(s)
- Lars B Dahlin
- Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden.
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