1
|
Ipsen JA, Viberg B, Pedersen LT, Draborg E, Bruun IH. Informal care after hip fracture: prospective cohort. BMC Geriatr 2024; 24:436. [PMID: 38760708 PMCID: PMC11100116 DOI: 10.1186/s12877-024-05040-y] [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] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Hip fracture is very common and it has life-shattering consequences for older persons. After discharge the older persons need help with even basic everyday activities from formal and informal caregivers. In Scandinavia formal care are well-developed however the presence of informal caregivers likely reflect on the amount of formal care and wears on the informal caregivers. This study explore how often and how much informal care (IC) older persons receive after hip fracture. METHOD We contacted 244 community-dwelling older persons every two weeks the first twelve weeks after discharge after hip fracture and asked them if they received care from family and/or friends and how much. We used non-parametric statistics and level of significance was 95%. RESULTS The proportion of older persons receiving IC was 90% and the median amount of IC was 32 hours (IQR 14-66). The number of older persons who received IC was highest the first four weeks after discharge and so was the amount of hours of IC. The older persons that were high-dependence on IC received a median of 66 (IQR 46-107) hours compared to the low-dependent of 11 hours (IQR 2-20). CONCLUSION IC is very frequent, especially the first two to four weeks after discharge. The median IC was 32 hours from discharge to the 12-week follow-up. However, this figure tended to rise for persons with, among other, reduced functionality and those residing with a partner. IMPLICATIONS With respect to local differences, the findings in this study are likely applicable to other Scandinavian countries. We strongly suggest that the variation in older person need for informal caregiver be given consideration in the prioritisation of resources. TRIAL REGISTRATION This prospective cohort study of informal care, was part of a cluster-randomised stepped-wedge clinical controlled trial. Written consent was obtained required by regional ethics committee S-20200070. Data was collected in accordance with the Danish Data Protection Agency (20-21854).
Collapse
Affiliation(s)
- Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars T Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Health Education, University College South Denmark, Esbjerg, Denmark
| | - Eva Draborg
- Department of Public Health, DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Inge Hansen Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Risager SK, Arndt KB, Abrahamsen C, Viberg B, Odgaard A, Lindberg-Larsen M. Risk and Epidemiology of Periprosthetic Knee Fractures After Primary Total Knee Arthroplasty: A Nationwide Cohort Study. J Arthroplasty 2024:S0883-5403(24)00480-7. [PMID: 38759816 DOI: 10.1016/j.arth.2024.05.033] [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: 12/20/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Periprosthetic knee fractures (PPKF) following total knee arthroplasty (TKA) are uncommon, but potentially serious injuries. We analyze the risk and risk factors for a PPKF in standard primary TKA patients who have osteoarthritis (OA) and a minimally (cruciate-retaining TKAs without a femoral box cut) or posterior-stabilized TKA. In addition, we report the risk for patients who have other underlying knee disorders and/or a higher level of TKA constraint. METHODS All primary TKAs were identified from the Danish National Patient Register and the Danish Knee Arthroplasty Register using data between 1997 and 2022. Subsequent fractures were identified through the International Classifications of Disease (ICD) diagnosis code, Nordic Medico-Statistical Committee (NOMESCO) procedure code, or indication for revision TKA. RESULTS We included 120,642 standard primary TKA patients who had 1,434 PPKFs. The cumulated proportions were 0.3% (95% confidence interval (CI) 0.3 to 0.3) at 2 years 0.7% (0.6 to 0.7) at 5 years. At 10 years, the cumulated proportion was 1.5% (1.4 to 1.6), with 1.2% in the femur, 0.2% in the patella, and 0.1% in the tibia. Significant risk factors were (hazard ratio (HR) (95% CI)); ipsilateral hip arthroplasty (2.5 (2.1 to 2.8)); women (2.0 (1.8 to 2.3)), osteoporosis (1.4 (1.1 to 1.7)); age 80+ (1.4 (1.2 to 1.6)), and Charlson Comorbidity Index (CCI) score 3+ (1.4 (1.0 to 1.8)). An additional 22,624 primary TKA patients who had other underlying knee disorders and/or a higher level of implant constraint were included with 485 PPKFs. The 10-year cumulated proportions were 5.5% (95% CI 4.4 to 6.9) when the underlying disorder was a previous fracture, 2.3% (1.7 to 2.9) for rheumatic disorders, and 3.5% (1.4 to 8.8) for osteonecrosis. In patients who had condylar constrained knees, it was 4.3% (2.9 to 6.3), and 7.3% (4.1 to 13.1) for hinges. CONCLUSION In standard primary TKA patients, the 10-year cumulated proportion of PPKFs was 1.5%, and ipsilateral hip arthroplasty, women, osteoporosis, advanced age, and higher CCI increased the risk. Higher risks were observed in non-OA patients and/or patients who had a higher level of TKA constraint.
Collapse
Affiliation(s)
- S K Risager
- Department of Orthopaedic and traumatology, Odense University Hospital, Odense Denmark.
| | - K B Arndt
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding Denmark
| | - C Abrahamsen
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding Denmark
| | - B Viberg
- Department of Orthopaedic and traumatology, Odense University Hospital, Odense Denmark
| | - A Odgaard
- Department of Orthopaedic Surgery and Traumatology, Rigshospitalet, Copenhagen Denmark
| | - M Lindberg-Larsen
- Department of Orthopaedic and traumatology, Odense University Hospital, Odense Denmark
| |
Collapse
|
3
|
Pedersen LT, Ipsen JA, Bruun IH, Egebæk HK, Andersen PT, Viberg B. Association between patient activation level and functional outcomes in older adults with hip fractures. Arch Gerontol Geriatr 2024; 124:105472. [PMID: 38728823 DOI: 10.1016/j.archger.2024.105472] [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] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program. METHOD An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks. RESULTS The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds. CONCLUSION Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.
Collapse
Affiliation(s)
- Lars Tobiesen Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Health Education, University College South Denmark Esbjerg, Denmark.
| | - Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inge H Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Heidi Klakk Egebæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
4
|
Moos C, Abrahamsen C, Viberg B, Jensen CM. Adult patients' experiences after a distal radius fracture - A qualitative systematic review. Int J Orthop Trauma Nurs 2024; 54:101101. [PMID: 38640647 DOI: 10.1016/j.ijotn.2024.101101] [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] [Received: 02/01/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Distal radius fractures are a common presentation in emergency departments. Synthesis of qualitative research of treatment, care and rehabilitation this fracture presents from the patient perspective could improve clinical practice and care. The purpose of this systematic review was to synthesize the qualitative literature on patient experiences after sustaining a distal radius fracture. METHODS We searched Embase, MEDLINE, CINAHL, Psycinfo and CINAHL to identify qualitative studies published from database conception to May 2023. All studies were screened, extracted, analysed and quality assessed by two blinded reviewers. A thematic synthesis approach was used to analyse the findings from included studies. RESULTS A total of 9 studies interviewing 160 unique patients were included. We identified 3 themes in relation to patient experiences after sustaining a distal radius fracture: 1) Concerns about dependency, 2) Fear and pain and 3) Motivators for recovery. The themes did not exist as sharply demarcated topics but were intertwined with patients reflecting that more information and knowledge could assist in managing expectations and the recovery period. CONCLUSION Our synthesis highlighted that adult patients with DRF experience a lack of information about the care and treatment inhibiting independence and successful management of expectations due to pain, fear and lack of motivation. Our findings can inform orthopaedic units and assist in tailoring information to patient needs.
Collapse
Affiliation(s)
- Caroline Moos
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Charlotte Abrahamsen
- Department of Orthopaedic Surgery, Kolding Hospital, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Charlotte Myhre Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
| |
Collapse
|
5
|
Niebuhr D, Mattson T, Jensen NM, Viberg B, Steenstrup Jensen S. Risk factors for tibial infections following osteosynthesis - a systematic review and meta-analysis. J Clin Orthop Trauma 2024; 50:102376. [PMID: 38444773 PMCID: PMC10909754 DOI: 10.1016/j.jcot.2024.102376] [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: 07/31/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Aim This study aimed to quantitatively summarise risk factors associated with surgical site infection (SSI) following surgically managed tibial fractures. Method We searched the Embase/Medline, Cochrane Library, and Scopus databases for relevant studies in October 2023. We included original studies investigating risk factors for SSI following surgically managed traumatic tibial fractures that included ≥10 adult patients with SSIs. Meta-analysis was performed when >5 studies investigated the same risk factor. The risk of bias was assessed using the critical appraisal checklist from Joanna Briggs Institute for cohort studies. Results This study included 42 studies comprising 24,610 patients with surgically managed tibial fractures and 2,418 SSI cases. The following were identified as significant risk factors for SSI (p < 0.05): compartment syndrome (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 2.4-6.0), blood transfusion (OR = 3.8, 95% CI: 2.1-6.6), open fracture (OR = 3.6, 95% CI: 2.5-5.1), Gustilo-Anderson classification >2 (OR = 3.1, 95% CI: 2.1-4.6), external fixation (OR = 2.9, 95% CI: 2.3-3.8), American Society of Anesthesiologists classification >2 (OR = 2.5, 95% CI: 1.5-4.1), polytrauma (OR = 2.4, 95% CI: 1.5-4.0), dual incision approach (OR = 2.1, 95% CI: 1.5-3.0), smoking (OR = 1.8, 95% CI: 1.5-2.1), male sex (OR = 1.6, 95% CI: 1.3-1.8), high energy trauma (OR = 1.5, 95% CI: 1.1-2.1), and prolonged surgery time (OR = 0.62, 0.43-0.82). Other factors, including diabetes, hypertension, and time to surgery, were not identified as risk factors for SSI. However, the included studies were generally of poor quality and at risk of bias. Conclusions The review provides a basis for preoperatively assessing a patient's risk of developing an SSI, which could be used to initiate adjusted antibiotic regimes and more frequent postoperative controls. Furthermore, it indicates the risk factors future research should include when adjusting for confounding factors.
Collapse
Affiliation(s)
- Diana Niebuhr
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
| | - Thomas Mattson
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Martin Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Vejle, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Signe Steenstrup Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
6
|
Tobiesen Pedersen L, Ipsen JA, Egebæk HK, Bruun IH, Viberg B, Andersen PT. From fear to control: Older adults' thoughts and feelings about empowerment-oriented rehabilitation after a hip fracture. Int J Orthop Trauma Nurs 2023:101061. [PMID: 37907389 DOI: 10.1016/j.ijotn.2023.101061] [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] [Received: 04/25/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND It is essential to focus on how older adults remain active and regain control of their daily lives after hip fractures. 'Rehabilitation of Life' is an empowerment-orientated hip fracture intervention focused on continuous rehabilitation and care between sectors in Denmark. We aimed to understand and explore older adults' experience participating in the intervention 'Rehabilitation of Life' and how this relates to their sense of empowerment. METHOD Qualitative data were generated from 16 semi-structured interviews with patients experiencing a hip fracture and subsequent rehabilitation in the program "Rehabilitation of Life' The data was analysed using Graneheim and Lundman's concept-guided qualitative content analysis method. RESULTS The analysis revealed five themes that the participants emphasised as vital to their rehabilitation: getting information and care when hospitalised, early visits from healthcare professionals after returning to their homes, the social aspect of training together with others, rehabilitation provision by skilled and empathic staff, and acceptance of a new me. The five themes indicated that adults aged >65 years generally experienced rehabilitation after hip fractures as motivating and reassuring. CONCLUSION Social support and peer programs can significantly improve the rehabilitation of older adults with hip fractures. The Rehabilitation of Life intervention has shown that promoting successful rehabilitation requires patient-centred strategies that encourage collaboration between different sectors. To increase patients' empowerment and engagement in their health journey, it is important to consider changes in patients' behaviour, increase their autonomy and ensure their independence after rehabilitation.
Collapse
Affiliation(s)
- Lars Tobiesen Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Health Education, University College South Denmark, Esbjerg, Denmark.
| | - Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Heidi Klakk Egebæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inge H Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark
| |
Collapse
|
7
|
Karimi D, Qvistgaard SW, Gundtoft PH, Brorson S, Viberg B. Unchanged incidence but change in treatment trends from 1996 to 2018: 23,718 humeral shaft fractures from the Danish National Patient Registry. Acta Orthop 2023; 94:523-529. [PMID: 37831408 PMCID: PMC10574250 DOI: 10.2340/17453674.2023.21125] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND PURPOSE Humeral shaft fractures (HSF) can be treated surgically or non-surgically. National trends and distributions are sparsely reported. We present the temporal trends in epidemiology of adult HSF in Denmark, with the primary aim of reporting HSF incidences, and the secondary aim of reporting on the primary treatment management. PATIENTS AND METHODS The diagnosis (International Classification of Diseases Version 10 [ICD-10]: S42.3) and surgical procedure codes for HSF were obtained from the Danish National Patient Registry (DNPR) covering 1996-2018. The diagnosis code for HSF is validated in the DNPR with a positive predictive value of 89%. Patients aged 18 years and above were included. Surgical treatment was defined as a diagnosis of HSF combined with a surgical procedure within 3 weeks of injury. Cases without relevant registered procedures within 3 weeks were defined as nonsurgical treatment cases. RESULTS 23,718 HSF (62% female) were identified in the DNPR. The overall mean incidence was 25/100,000/year and was stable over 23 years. The population above 50 years accounted for 78% of all HSF. Non-surgical treatment accounted for 87% of treatments and was stable during the study period. Temporal changes were observed regarding surgical procedures; intramedullary nailing decreased from 57% to 26% and plate osteosynthesis increased from 12% to 69%. CONCLUSION The overall incidence for HSF remained stable from 1996 to 2018. Most cases were females aged 50 years and above. The preferred primary treatment for HSF was non-surgical for all ages. Plate osteosynthesis became more popular than intramedullary nailing over the study period.
Collapse
Affiliation(s)
- Dennis Karimi
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark.
| | - Søren Wacher Qvistgaard
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark
| | - Per Hviid Gundtoft
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopedic Surgery and Traumatology, Aarhus University Hospital
| | - Stig Brorson
- Centre for Evidence-Based Orthopedics, Zealand University Hospital and Department of Clinical Medicine, University of Copenhagen
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark
| |
Collapse
|
8
|
Roennegaard AB, Gundtoft PH, Tengberg PT, Viberg B. Completeness and validity of the Danish fracture database. Injury 2023; 54:110769. [PMID: 37179202 DOI: 10.1016/j.injury.2023.05.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To calculate completeness of the Danish Fracture Database (DFDB) overall and stratified by hospital volume and to calculate the validity of independently assessed variables in the DFDB. STUDY DESIGN AND SETTING In this completeness and validation study, cases registered in the DFDB with fracture-related surgery in 2016 were retrospectively reviewed. All cases had undergone fracture-related surgery at a Danish hospital reporting to the DFDB in 2016. The Danish health care system is fully tax-funded providing equal and free access to all residents. Completeness was calculated as sensitivity and validity was calculated as positive predictive values (PPVs). RESULTS OVERALL COMPLETENESS WAS 55.4% (95% CI: : 54.7-56.0). For small-volume hospitals it was 60% (95% CI: 58.9-61.1), and for large-volume hospitals, it was 52.9% (95% CI: 52.0-53.7). The PPV for variables of interest ranged from 81% to 100%. The PPV of key variables was 98% (95% CI: 95-98) for operated side, 98% (95% CI: 96-98) for date of surgery, and 98% (95% CI: 98-100) for surgery type. CONCLUSION We found low completeness of data reported to the DFDB in 2016; however, in the same period, the validity of data in the DFDB was high.
Collapse
Affiliation(s)
- Anders Bo Roennegaard
- Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark.
| | - Per Hviid Gundtoft
- Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark; Department of Orthopedic Surgery, Aarhus University Hospital, Denmark
| | | | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital
| |
Collapse
|
9
|
Lazarow J, Jensen SS, Viberg B. Early versus late weight-bearing in operatively treated ankle fractures with syndesmotic injury: A systematic review. Foot (Edinb) 2023; 56:101967. [PMID: 37352790 DOI: 10.1016/j.foot.2023.101967] [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: 05/17/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Over the past 30 years, several studies have compared early weight-bearing versus late weight-bearing following open reduction and internal fixation of ankle fractures; however, no review strictly including patients with ankle fractures and complete syndesmotic disruption has been performed. OBJECTIVE The objective of this systematic review was to compare early versus late weight-bearing following surgery for ankle fracture with syndesmotic injury regarding clinical and patient-reported outcomes. METHODS A comprehensive search strategy was applied to the Cochrane Library, MEDLINE, Embase, CINAHL and PubMed databases from their inception to the 17th of January 2022. The articles were screened independently by two blinded reviewers. Data were extracted by one author, then cross-checked and approved by the other. RESULTS No comparative studies were found; therefore, studies describing either early or late weight-bearing were included. It was thus not possible to perform a meta-analysis. 11 studies and 751 patients were included. An early partial weight-bearing protocol was used in three studies (253 patients) and late in eight studies (498 patients). Functional outcomes suggested that there were no clear differences between early partial weight-bearing and late weight-bearing. The reoperation rate was 9-31% in the early group and 0-11% in the late. Similar results were seen for loss of syndesmotic reduction, malreduction, infection, and fixation failure. CONCLUSION Pros and cons were reported for early partial weight-bearing and late weight-bearing, but the evidence was very limited as our results were based on noncomparative studies. In the future, high-quality comparative studies focusing on functional outcomes within 6 months postoperatively are needed. LEVEL OF CLINICAL EVIDENCE 1.
Collapse
Affiliation(s)
- Julia Lazarow
- Faculty of Health Sciences, University of Southern Denmark, Denmark; Dept. of Orthopedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding, Denmark.
| | - Signe Steenstrup Jensen
- Faculty of Health Sciences, University of Southern Denmark, Denmark; Dept. of Orthopedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding, Denmark
| | - Bjarke Viberg
- Dept. of Orthopedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding, Denmark; Dept. of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
10
|
Abrahamsen C, Jensen CM, Elkjaer M, Østervang C, Knudsen BM, Jensen SS, Moos C, Viberg B, Mogensen CB. Translation and cultural adaption of the emergency department-consumer assessment of healthcare providers and systems (ED CAPHS)-A questionnaire to measure patient experience in Denmark. Scand J Caring Sci 2023; 37:872-879. [PMID: 36710584 DOI: 10.1111/scs.13146] [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] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
AIM The aim of this study was to translate and culturally adapt The Emergency Department-Consumer Assessment of Healthcare Providers and Systems (ED CAPHS) to the Danish ED context. BACKGROUND In Denmark, a large number of patients attend emergency departments (ED) every year. During their ED visits, examinations, tests and encounters with different healthcare professionals occur frequently. Moreover, patients receive much information. Patients' direct experiences of care can provide valuable insights into what works and what does not in health care. The emergency department-consumer assessment of healthcare providers and systems (ED CAPHS) is a valid questionnaire designed to measure patients' experiences with ED care and is intended for patients discharged home following their ED visit. METHOD The translation process was systematically planned and executed using the principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) guidelines by the ISPOR. RESULTS The translation and cultural adaption process were successfully conducted. Three items concerning language and race were omitted as they are not distinct in Danish ED context. Furthermore, a few conceptual factors and linguistic challenges were discussed and harmonised during the reconciliation and harmonisation process respectively. The Danish survey ED CAPHS DK containing 32 items was proofread and finalised. CONCLUSION Overall, patients reported that the survey was relevant and comprehensive, as it focused on essential factors when discharged directly home after an ED admission. ED CAPHS DK is found to be content valid and ready for use. However, a future study testing the Danish version using confirmative factor analysis and internal consistency reliability is needed to ensure construct validity and reliability.
Collapse
Affiliation(s)
- Charlotte Abrahamsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Emergency Department, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Charlotte Myhre Jensen
- Department of Orthopaedic Surgery and Traumatology, University Hospital Odense, Odense, Denmark
| | - Mette Elkjaer
- Emergency Department, Hospital Southern Jutland, Aabenraa, Denmark
- Emergency Department, University Hospital Odense, Odense, Denmark
| | - Christina Østervang
- Department of Clinical Research, Hospital Southern Jutland, Aabenraa, Denmark
| | - Bettina Mølri Knudsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Administration, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Signe Steenstrup Jensen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Caroline Moos
- Emergency Department, University Hospital Odense, Odense, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Orthopaedic Surgery and Traumatology, University Hospital Odense, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Emergency Department, University Hospital Odense, Odense, Denmark
| |
Collapse
|
11
|
Thorlund JB, Lundberg M, Petersen JD, Englund M, Viberg B, Waldorff FB, Søndergaard J. Opioid dispensing in relation to arthroscopic knee surgery in Denmark from 2006 to 2018. Dan Med J 2023; 70:A01230032. [PMID: 37622647] [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: 08/26/2023]
Abstract
INTRODUCTION In the US, opioids are commonly prescribed after arthroscopic knee surgery. We aimed to investigate opioid dispensing in relation to arthroscopic knee surgeries from 2006 to 2018 in Denmark. METHODS In Danish registries, we identified patients (≥ 15 years old) having arthroscopic knee surgery (anterior cruciate ligament (ACL) reconstruction; meniscal surgery; cartilage resection; synovectomy and diagnostic arthroscopy) between 1 January 2006 and 31 December 2018 and opioid dispensing (oral morphine equivalents (OMEQ)) within seven days after discharge from surgery. RESULTS Among 218,940 patients, 15,263 (7%) had an opioid dispensed within seven days after being discharged following surgery. The opioid dispensing incidence (per 1,000 persons/year) increased during the study period for all procedures. This trend was more pronounced for ACL reconstruction, which recorded an increase from 86 (95% confidence interval (CI): 75-99) in 2006 to 278 (95% CI: 255-301) in 2018, corresponding to 9% and 28% of ACL patients, respectively. In the same period, the average amount of opioids dispensed within the first seven days after discharge decreased (change: 70.0 OMEQ (95% CI: 12.4-127.5)). Tramadol and oxycodone were the most commonly dispensed opioids. CONCLUSION About 7% of patients had an opioid dispensed within the first seven days after discharge following arthroscopic knee surgery. The incidence of opioids dispensed increased for all investigated procedures from 2006 to 2018. In the same period, the average amount of opioids dispensed within the first seven days after discharge decreased. FUNDING None. TRIAL REGISTRATION Not relevant.
Collapse
Affiliation(s)
- Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark
| | - Matilde Lundberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark
| | - Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark
- International School of Public Health and One Health, Hainan Medical University, China
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Sweden
| | - Bjarke Viberg
- epartment of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark
| |
Collapse
|
12
|
Viberg B, Tofte S, Rønnegaard AB, Jensen SS, Karimi D, Gundtoft PH. Changes in the incidence and treatment of distal radius fractures in adults - a 22-year nationwide register study of 276,145 fractures. Injury 2023:110802. [PMID: 37211473 DOI: 10.1016/j.injury.2023.05.033] [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: 02/21/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The incidence of distal radius fractures (DRFs) is reported, with conflicting results. To ensure evidence-based practice, the variation in treatment over time should be monitored. Treatment in the elderly population is particularly interesting because newer guidelines find little indication for surgery. Our primary aim was to assess the incidence and treatment of DRFs in the adult population. Secondly, we assessed the treatment stratified on non-elderly (aged 18-64 years) and elderly (aged 65+ years) patients. METHODS This is a population-based register study comprising all adult patients (i.e. aged over 18 years) with DRFs in the Danish National Patient Register from 1997 to 2018. Data were extracted using the ICD-10 code for DRF (DS52.5), and the incidence was calculated using data from Statistics Denmark. We defined a case as surgically treated if a relevant procedure was performed within three weeks of the DRF diagnosis. Nordic procedure codes were used to define surgical treatments as either plate (KNCJ65), external fixation (KNCJ25), k-wire (KNCJ45), or 'other' (KNCJ35,55,75,85,95). RESULTS A total of 276,145 fractures were included, with an overall increase in DRFs of 31% during the study period. The overall incidence was 228/100,000/year, which increased by 20% during the study period. The increased incidence was especially notable among women and those aged 50-69 years. Surgical treatment steadily increased from 8% in 1997 to 22% in 2010, thereafter reaching a plateau at 24% in 2018. The surgical rate in the elderly group was as high as in the non-elderly group. In 1997, the treatment distribution of DRFs was as follows: 59% external fixation, 20% plate fixation, and 18% k-wire fixation. From 2007 and onwards, plating was the primary choice of surgery, and in 2018, 96% of patients were treated with a plate. CONCLUSION We found a 31% increase in DRFs over a 22-year period, mostly driven by an increase in the size of the elderly population. The surgical rate increased markedly even in the elderly group. There is a lack of evidence on how beneficial surgery is for elderly patients, and similar surgical rate between the elderly and non-elderly calls for hospitals to re-evaluate their treatment strategies.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
| | - Søren Tofte
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - Anders Bo Rønnegaard
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Signe Steenstrup Jensen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Dennis Karimi
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Denmark
| |
Collapse
|
13
|
Viberg B, Kristensen EQ, Gaarsdal T, Petersen CD, Jensen TG, Overgaard S, Palm H. A piriformis-preserving posterior approach reduces dislocation rate of the hemiarthroplasty in patients with femoral neck fracture. Injury 2023:S0020-1383(23)00382-0. [PMID: 37100693 DOI: 10.1016/j.injury.2023.04.040] [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: 12/30/2022] [Revised: 03/31/2023] [Accepted: 04/22/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION The posterior approach (PA) for hemiarthroplasty (HA) in patients with femoral neck fracture (FFN) has a high risk of dislocation; however, by preserving the piriformis muscle, the dislocation rate could be lowered considerably. The aim of this study was to compare the surgical complications of the piriformis-preserving posterior approach (PPPA) and the PA in patients with FNF treated with HA. METHODS On 1 January 2019, the PPPA was introduced at two hospitals as the new treatment standard. The sample size was calculated based on a 5 percentage point dislocation reduction and 25% censoring; a sample of 264 patients per group was determined. An approximately 2-year inclusion period with 1-year follow-up was estimated, including a historical cohort from 2 years before the PPPA introduction. Data were retrieved from health care records and X-ray images from the hospitals' administrative databases. Relative risk (RR) and 95% confidence intervals were calculated using Cox regression and adjusted for age, sex, comorbidity, smoking, surgeon experience and implant type. RESULTS There were 527 patients included in the study, of which 72% were women and 43% were above 85 years old. There were no baseline differences between the PPPA and PA groups in sex, age, comorbidity, body mass index, smoking, alcohol, mobility, length of surgery, blood loss or implant positioning, but there were differences in 30-day mortality, surgeon experience and implant type. The dislocation rate reduced from 11.6% in the PA group to 4.7% in the PPPA group (p = 0.004), with an RR of 2.5 (1.2; 5.1). The reoperation rate reduced from 6.8% with the PA to 3.3% with the PPPA (p = 0.022), with an RR of 2.1 (0.9; 5.2), and total surgery-related complications reduced from 14.7% with the PA to 6.9% with the PPPA (p = 0.003), with an RR of 2.4 (1.3; 4.4). INTERPRETATION Changing from PA to PPPA in patients with FNF treated with HA resulted in a more than 50% reduction in dislocation and reoperation rates. This approach was easily introduced and may enable further lowering of dislocation rates through the sparing of all short external rotators.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital Kolding, University Hospital of Southern Denmark, Denmark.
| | - Erik Qvist Kristensen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital Kolding, University Hospital of Southern Denmark, Denmark
| | - Thomas Gaarsdal
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | | | - Thomas Giver Jensen
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
14
|
Lindestrand AG, Rönnquist SS, Viberg B, Overgaard S, Palm H, Rogmark C, Kristensen MT. Physical activity in young hip fracture patients is associated with health-related quality of life and strength; results from a multicenter study. Injury 2023; 54:1191-1197. [PMID: 36759311 DOI: 10.1016/j.injury.2023.01.037] [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: 09/20/2022] [Revised: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The World Health Organization recommends a minimum of 150 min of moderate intensity exercise per week or 75 min of strenuous activity weekly for adults. Younger hip fracture patients are often assumed less active than the general population, however, knowledge on physical activity (PA) and health-related quality of life (HRQoL) in younger hip fracture patients is limited. OBJECTIVES We aimed to 1) investigate the variation in pre-fracture PA for adult patients with hip fractures under the age of 60; and 2) to quantify the association with patient characteristics, including outcomes of HRQOL and handgrip strength. DESIGN AND METHODS A prospective multicenter cohort study of 207 adult hip fracture patients under 60 years admitted to four study hospitals from July 2015 to December 2018. Data was collected through medical records, questionnaires, physical tests and interviews. PA level was assessed using a validated questionnaire from the Swedish National Board of Health and Welfare, providing a total score from 3 to 19. A score ≥11 corresponds to fulfillment of the WHO recommendation for weekly PA. Handgrip strength was measured in kilograms using a handheld dynamometer following a standardized protocol. Recall pre-fracture HRQoL was assessed using the EQ-5D-3L questionnaire. RESULTS Fifty-nine percent had a PA score ≤10 out of these 46% had an ASA grade of 3 or 4, 38% had a BMI over 25 and 81% had a low energy fracture. A PA score ≤10 was associated with a lower HRQoL compared to those who had a PA score ≥11. PA score ≤10 points was associated with weaker hand grip strength and a worse health status (higher ASA-grade) p<0.001. CONCLUSION We found that close to two-thirds of the patients had a pre-fracture PA level below WHO recommendations. Being more active was associated with better handgrip strength, HRQoL, and ASA score. Our findings indicate that individuals under 60 years who sustain a hip fracture form a heterogeneous group, some severely comorbid and others highly active and seemingly healthy. This suggests a more nuanced approach to rehabilitation, as the more active patient might need a more individualized plan than the standard program can offer.
Collapse
Affiliation(s)
- Anna Gaki Lindestrand
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
| | - Sebastian Strøm Rönnquist
- Department of Orthopedics, Lund University, Skåne University Hospital, Carl-Bertil Laurells gata 9, 21428 Malmö, Sweden; Department of Orthopaedic Surgery and Traumatology, J.B. Winsløws Vej 4 5000 Odense University Hospital, Odense, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, J.B. Winsløws Vej 4 5000 Odense University Hospital, Odense, Denmark; Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Cecilia Rogmark
- Department of Orthopedics, Lund University, Skåne University Hospital, Carl-Bertil Laurells gata 9, 21428 Malmö, Sweden
| | - Morten Tange Kristensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| |
Collapse
|
15
|
Kindt M, Jönsson ML, Torfing T, Strøm Rönnquist S, Viberg B, Overgaard S, Rogmark C. Assessing osteonecrosis of the femoral head after internal fixation of femoral neck fractures in young patients with fixation implants in situ: the value of MARS MRI in relation to conventional radiography and patient-reported outcomes. Acta Orthop 2023; 94:135-140. [PMID: 36999919 PMCID: PMC10065120 DOI: 10.2340/17453674.2023.11658] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Little is known on the use of metal artifact reduction sequence (MARS) MRI to diagnose osteonecrosis of the femoral head (ONFH) after fixation of femoral neck fractures (FNF) with conventional metal implants present. We compared MARS MRI with radiography in diagnosing ONFH. Secondarily, we determined whether signs of ONFH on MARS MRI correlate with patient-reported outcomes (PROs) via Oxford Hip Score (OHS) and pain (VAS). PATIENTS AND METHODS 30 adults under 60 years treated with internal fixation after FNF were prospectively included (2015-2018) at 2 hospitals. They were followed up with radiography and PROs at 4, 12, and 24 months and MARS MRI at 4 and 12 months. OHS < 34 or VAS pain > 20 was considered significant. RESULTS At 12 months, 14 patients had a pathological MRI. 3 of 14 had ONFH on radiographs at 12 months, increasing to 5 at 24 months, and 4 had unfavorable PROs. 2 of 5 patients with ONFH signs on both MRI and radiography had unfavorable PROs. 1 of 10 patients with normal MRI and radiography had unfavorable 2-year PROs. 4 patients had inconsistent MRI results, of which 1 developed ONFH. 1 patient dropped out. CONCLUSION Information from a pathological MRI was not useful, as a majority remained free from symptoms and ONFH signs on radiographs. Furthermore, PROs did not correlate with imaging results. MARS MRI findings must be better understood before being taken into clinical practice. However, a normal MARS MRI seems to be a good prognostic finding.
Collapse
Affiliation(s)
- Mikael Kindt
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Maria L Jönsson
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg
| | - Trine Torfing
- Department of Radiology, Odense University Hospital, Odense
| | - Sebastian Strøm Rönnquist
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
16
|
Karimi D, Houkjær L, Gundtoft P, Brorson S, Viberg B. Positive predictive value of humeral fractures in the Danish National Patient Registry. Dan Med J 2023; 70:A10220612. [PMID: 36999816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
INTRODUCTION The purpose of this study was to validate the humeral fracture diagnoses for adults in the Danish National Patient Registry (DNPR). METHODS This was a population-based validity study, including adult patients (≥ 18 years) with a humeral fracture referred to the emergency department of hospitals in three Danish regions from March 2017 to February 2020. Administrative data were retrieved on 12,912 patients from the databases of the involved hospitals. These databases hold information on discharge and admission diagnoses, which is based on the International Classification of Diseases, tent version. Data of 100 cases were randomly sampled from each of the specific humeral fracture diagnoses (S42.2-S42.9). The positive predictive value (PPV) was estimated for each diagnosis to study the recorded accuracy. Radiographic images from the emergency departments were reviewed and assessed as the gold standard. The PPVs with 95% confidence intervals (CI) were estimated according to the Wilson method. RESULTS In total, 661 patients were sampled between all available diagnosis codes. Overall, the PPV for humeral fracture was 89.3% (95% CI: 86.6-91.4%). PPVs for the subdivision codes were 91.0% (95% CI: 84.0-95.0%) for proximal humeral fractures, 89.0% (95% CI: 81.0-94.0%) for humeral diaphyseal fractures and 78.0% (95% CI: 68.9-84.9%) for distal humeral fractures. CONCLUSION The validity of the humeral fracture diagnosis and the classifications of proximal and diaphyseal fractures in the DNPR is high, and the DNPR may therefore be used in registry research. Diagnosis of distal humeral fractures has a lower validity and should be used with caution. FUNDING none. TRIAL REGISTRATION not relevant.
Collapse
Affiliation(s)
- Dennis Karimi
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Southern Denmark - Hospital Lillebaelt
| | - Line Houkjær
- Centre for Evidence-Based Orthopaedics, Zealand University Hospital
| | - Per Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital
| | - Stig Brorson
- Centre for Evidence-Based Orthopaedics, Zealand University Hospital
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Southern Denmark - Hospital Lillebaelt
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| |
Collapse
|
17
|
Valen AK, Viberg B, Gundtoft PH, Wæver D, Thorninger R. Mortality in patients with trochanteric hip fractures (AO/OTA 31-A) treated with sliding hip screw versus intramedullary nail: A retrospective national registry study of 9547 patients from the Danish Fracture Database. Injury 2023:S0020-1383(23)00249-8. [PMID: 36925374 DOI: 10.1016/j.injury.2023.03.008] [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: 11/26/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Whether trochanteric hip fractures (AO/OTA 31-A) should be treated with an intramedullary nail (IMN) or sliding hip screw (SHS) is debated. Recent studies suggest an association between IMN and excess mortality rates compared to SHS, but higher quality studies fail to show this association. Furthermore, there is an increased usage of IMN with sparse evidence supporting this rise. Our aim was to compare mortality rates between IMN and SHS in patients with AO/OTA 31-A fractures. Secondarily, to investigate choice of implant in relation to fracture subtype. METHODS This national registry study is based on data from the Danish Fracture Database (DFDB). Data were retrieved on patients aged ≥65 years treated for a non-pathological AO/OTA type 31-A fracture with IMN or SHS from January 1, 2012 to December 31, 2018. Data from DFDB were merged with data from the Danish Civil Registration System (CRS) for time of death. Mortality rates were recorded at 30 days, 90 days, and 1 year and presented as crude mortality and adjusted for age, gender, ASA-class, and AO/OTA-subtype. RESULTS A total of 9,547 patients were included. The mean age was 83 years, 69% were female, and 55% were ASA-class 3-5. We found higher mortality rates for IMN-patients at 30 days, 90 days, and 1 year. The crude relative mortality risk for IMN was also significantly higher at both 30 days (1.20) and 90 days (1.11). Adjusted relative mortality risk for IMN was 1.12 [0.96; 1.31] at 30-days, 1.03 [0.91; 1.17] at 90-days, and 1.01 [0.92; 1.11] at 1 year. Most patients suffered a 31-A2 fracture (56%) and, overall, 74% of patients were treated with IMN. CONCLUSION We found significantly increased crude relative mortality risk at 30 days and 90 days in patients treated with IMN. However, when adjusting for confounders the two groups had similar mortality risks. In total, 74% of all patients in this cohort were treated with IMN. LEVEL OF EVIDENCE This study has level of evidence: III.
Collapse
Affiliation(s)
- Anders Kjærsgaard Valen
- Department of Orthopaedic Surgery and Traumatology, Regional Hospital Randers, Skovlyvej 15, 8930 Randers, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Denmark
| | - Daniel Wæver
- Department of Orthopaedic Surgery and Traumatology, Regional Hospital Randers, Skovlyvej 15, 8930 Randers, Denmark.
| | - Rikke Thorninger
- Department of Orthopaedic Surgery and Traumatology, Regional Hospital Randers, Skovlyvej 15, 8930 Randers, Denmark
| |
Collapse
|
18
|
Nielsen LL, Smidt NS, Erichsen JL, Palm H, Viberg B. Reply to Letter to the editor regarding "Posterior tilt in nondisplaced femoral neck fractures increases the risk of reoperations after osteosynthesis. A systematic review and meta-analysis". Injury 2023; 54:S0020-1383(23)00177-8. [PMID: 36858894 DOI: 10.1016/j.injury.2023.02.044] [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] [Indexed: 03/03/2023]
Affiliation(s)
- Line L Nielsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Nanna S Smidt
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Julie L Erichsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, DK
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK.
| |
Collapse
|
19
|
Gundtoft PH, Danielsson FB, Houlind M, Mortensen SO, Corap Y, Bonde N, Brix M, Barckman J, Terndrup M, Viberg B. The positive predictive value of ankle fracture diagnosis in the Danish National Patient Registry. Dan Med J 2022; 69:A01220032. [PMID: 36458605] [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: 06/17/2023]
Abstract
INTRODUCTION Information on data validity is essential for understanding the precision of studies based on data from the Danish National Patient Registry (DNPR). Thus, the aim of this study was to validate the quality of ankle fracture data in the DNPR. METHODS We identified all patients from four hospitals with a surgically treated ankle fracture between 1 January 2018 and 31 December 2018. The positive predictive value (PPV) was estimated for a random sample of 10% of patients with both a relevant ankle fracture diagnosis code and a relevant procedure code, as well as for patients with only a relevant ankle fracture diagnosis code or a relevant ankle fracture procedure code. We collected data from medical records and X-rays. Two consultants independently validated the ankle fracture diagnosis and procedure codes reported to the DNPR. RESULTS Among the four centres, 651 patients were identified with both an ankle fracture diagnosis and a procedure code. Among these, data from 65 (10%) patients were extracted for validation. For these patients, the PPV for an ankle fracture was 0.95 (95% confidence interval (CI): 0.88-0.99). The PPV for the diagnosis code was 0.89 (95% CI: 0.79-0.95), and for the procedure code, the PPV was 0.82 (95% CI: 0.70-0.90). For patients with only an ankle fracture diagnosis code or only a surgical procedure code, the PPV for an ankle fracture was 0.77 (95% CI: 0.64-0.87). CONCLUSION This study showed that ankle fracture diagnosis and procedure codes registered in the DNPR are of a high quality and thus constitute a valuable data source for research on ankle fractures. FUNDING none. TRIAL REGISTRATION The Danish Data Protection Agency approved the study (journal number 2015-18/62866).
Collapse
Affiliation(s)
- Per Hviid Gundtoft
- Orthopaedic Department, Aarhus University Hospital
- Orthopaedic Department, Kolding Hospital
| | | | | | | | | | - Nicholas Bonde
- Orthopaedic Department, Copenhagen University Hospital - Hvidovre Hospital, Denmark
| | - Michael Brix
- Orthopaedic Department, Odense University Hospital
| | | | - Mads Terndrup
- Orthopaedic Department, Copenhagen University Hospital - Hvidovre Hospital, Denmark
| | | |
Collapse
|
20
|
Viberg B, Barat S, Rotwitt L, Gundtoft PH. Reoperation for sliding hip screws vs cannulated cancellous screws in femoral neck fractures: A study from the Danish Fracture Database Collaborators. Injury 2022; 53:3805-3809. [PMID: 36167688 DOI: 10.1016/j.injury.2022.09.029] [Citation(s) in RCA: 2] [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: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION It is still debated whether to use cannulated cancellous screw (CCS) or sliding hip screw (SHS) implants for femoral neck fracture (FNF) patients but there are no studies large enough to evaluate on smaller differences. The aim were to compare the reoperation and mortality rates of a large cohort of FNF patients above 60 years of age with internal fixation using CCS and SHS implants, with stratification by fracture classification. METHODS This register study employed prospectively collected data from 2014 to 2018 from the Danish Fracture Database, including 2-year follow-up and data on age, sex, surgery, comorbidity and fracture classification. Reoperation data was retrieved from the Danish National Patient Register. The primary outcome was major reoperation, defined as re-osteosynthesis, conversion to arthroplasty, non-union surgery, Girdlestone procedure or deep infection 1-year post-surgery. Relative risk (RR) for the CCS group compared with the SHS group was estimated using Cox proportional hazards modelling, adjusted for age, sex and comorbidity (including 95% confidence intervals). RESULTS A total of 2,598 FNFs were included, 1,731 with CCS (67%) and 867 with SHS (33%). The overall 1-year major reoperation rate was 15% with CCS and 13% with SHS, yielding an adjusted RR of 1.10 (0.88; 1.37) for CCS compared to SHS. The adjusted RR was 1.15 (0.77; 1.69) for undisplaced FNF, 1.09 (0.68; 1.75) for displaced FNF and 1.35 (0.94; 1.94) for transcervical FNF, which increased to 1.42 (1.01; 2.00) after 2 years. The minor reoperation rate was higher for CCS (3%) than SHS (1%), yielding an adjusted RR of 2.28 (1.14; 4.51). The adjusted RR for CCS compared to SHS was 0.83 (0.62; 1.12) for 30-day mortality and 0.96 (0.82; 1.14) for 1-year mortality. CONCLUSIONS We found no difference between CCS and SHS in major reoperation rates; however, for transcervical FNF, CCS was associated with higher reoperation rates. Furthermore, CCS was associated with a higher risk of minor reoperation than SHS. There were no differences in mortality rates.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
| | - Siar Barat
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
| | - Lars Rotwitt
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
21
|
Ipsen JA, Pedersen LT, Draborg E, Bruun IH, Abrahamsen C, Viberg B. Cost-Effectiveness of Physical Rehabilitation and Care of Older Home-Dwelling Persons After Hip Fracture: a Systematic Review and Narrative Synthesis. J Rehabil Med 2022; 54:jrm00351. [DOI: 10.2340/jrm.v54.3421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective: To provide a systematic review of the literature and knowledge base of cost per quality-adjusted life year of physical rehabilitation and care of older persons after hip fracture.Material and methods: A research librarian assisted in searching 9 databases (14 May to 27 May 2021), with exclusion of studies on cognitively impaired or institutionalized individuals. A stepwise selection process was conducted by 2 authors, study quality was assessed using Drummond et al.’s checklist, and correspondence between different countries was assessed using Welte et al.’s checklist.Results: Three studies were included, which employed 3 different interventions initiated at 3 different postoperative time-points. One high-quality study demonstrated that comprehensive geriatric assessment was cost-effective compared with coordinated care. The other 2 studies did not find the interventions studied to be cost-effective, and both studies were deemed to be of moderate quality.Conclusion: The body of evidence on the cost-effectiveness of physical rehabilitation and care after hip fracture is limited and heterogeneous, with only 1 high-quality study. Thus, stakeholders perform decision-making with a limited knowledge base of the cost-effectiveness of physical rehabilitation and care.
Collapse
|
22
|
Viberg B, Palm H. [Not Available]. Ugeskr Laeger 2022; 184:V205117. [PMID: 36331324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Bjarke Viberg
- Ortopædkirurgisk Afdeling, Odense Universitetshospital
| | - Henrik Palm
- Ortopædkirurgisk Afdeling, Bispebjerg og Frederiksberg Hospital
| |
Collapse
|
23
|
Varming A, Nymark T, Pedersen L, Viberg B. [Not Available]. Ugeskr Laeger 2022; 184:V05220334. [PMID: 36331168] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this case report a 37-year-old women, 38 weeks and four days pregnant, presented with an occult hip fracture. Before surgery, it was important to investigate the nature of the fracture as the treatment differed accordingly. The patient was investigated with MRI and following acute caesarean section a PET-CT scan was performed with no proof of malignancy. An undetectable low level of vitamin D and the pathology report determined the cause of the fracture to be transient osteoporosis of pregnancy. The patient received a total hip arthroplasty and was referred to further treatment at a department of endocrinology.
Collapse
Affiliation(s)
- Adam Varming
- Ortopædkirurgisk Afdeling, Odense Universitetshospital
| | - Tine Nymark
- Ortopædkirurgisk Afdeling, Odense Universitetshospital
| | | | - Bjarke Viberg
- Ortopædkirurgisk Afdeling, Odense Universitetshospital
| |
Collapse
|
24
|
Møller S, Riel H, Wester J, Simony A, Viberg B, Jensen C. Surgical or non-surgical treatment of plantar fasciopathy (SOFT): study protocol for a randomized controlled trial. Trials 2022; 23:845. [PMID: 36195936 PMCID: PMC9531425 DOI: 10.1186/s13063-022-06785-w] [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] [Received: 04/11/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Plantar fasciopathy is the most common reason for complaints of plantar heel pain and one of the most prevalent musculoskeletal conditions with a reported lifetime incidence of 10%. The condition is normally considered self-limiting with persistent symptoms that often last for several months or years. Multiple treatments are available, but no single treatment appears superior to the others. Heavy-slow resistance training and radiofrequency microtenotomy for the treatment of plantar fasciopathy have shown potentially positive effects on short- and long-term outcomes (> 3 months). However, the effect of heavy-slow resistance training compared with a radiofrequency microtenotomy treatment is currently unknown. This trial compares the efficacy of heavy-slow resistance training and radiofrequency microtenotomy treatment with supplemental standardized patient education and heel inserts in improving the Foot Health Status Questionnaire pain score after 6 months in patients with plantar fasciopathy. Methods In this randomized superiority trial, we will recruit 70 patients with ultrasound-confirmed plantar fasciopathy and randomly allocate them to one of two groups: (1) heavy-slow resistance training, patient education and a heel insert (n = 35), and (2) radiofrequency microtenotomy treatment, patient education and a heel insert (n = 35). All participants will be followed for 1 year, with the 6-month follow-up considered the primary endpoint. The primary outcome is the Foot Health Status Questionnaire pain domain score. Secondary outcomes include the remaining three domains of the Foot Health Status Questionnaire, a Global Perceived Effect scale, the physical activity level, and Patient Acceptable Symptom State, which is the point at which participants feel no further need for treatment. Discussion By comparing the two treatment options, we should be able to answer if radiofrequency microtenotomy compared with heavy-slow resistance training is superior in patients with plantar fasciopathy. Trial registration ClinicalTrials.gov NCT03854682. Prospectively registered on February 26, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06785-w.
Collapse
Affiliation(s)
- Stefan Møller
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark.
| | - Henrik Riel
- Center for General Practice at Aalborg University, Fyrkildevej 7, 9220, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Jens Wester
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark
| | - Ane Simony
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark
| | - Carsten Jensen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark
| |
Collapse
|
25
|
Karimi D, Houkjær L, Skive A, Holmenlund C, Brorson S, Viberg B, Abrahamsen C. Exploring patient experiences after treatment of humeral shaft fractures: A qualitative study. Int J Orthop Trauma Nurs 2022; 46:100957. [PMID: 35921741 DOI: 10.1016/j.ijotn.2022.100957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Humeral shaft fracture treatment can induce serious morbidities, and it is unclear how these morbidities impact patients. To gain in-depth knowledge, we explored how patients experience humeral shaft fractures and the subsequent treatment course. METHOD A qualitative study was performed using semi-structured individual interviews. A purposive sampling approach was conducted to recruit patients with traumatic isolated humeral shaft fractures; the patients' ages, genders, primary treatments, and complications varied. Data saturation was met after the data of 12 patients were analyzed using Malterud Systematic Text Condensation. RESULTS Eight women and four men with a median age of 48.5 years (range: 22-83 years) were interviewed. The median time from injury to interview was 12.5 months (range: 8-18 months). Ten out of twelve patients were treated non-surgically; of those ten, four patients experienced major complications from the primary treatment. During the analysis, five overarching themes appeared: expectations, physical changes, support and independence, psychological impact, and the specific treatment and recovery. CONCLUSION First, patients with humeral shaft fractures expressed frustration with treatment in the emergency department. Second, gross fracture movement and pain were central symptoms that led to the loss of basic capabilities. Third, patient preferences were included in the treatment decision-making process and could change throughout the treatment course. Fourth, patients required massive support to perform basic activities of daily living.
Collapse
Affiliation(s)
- Dennis Karimi
- Department of Orthopedic Surgery, Lillebaelt Hospital, Kolding Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark Campusvej 55, 5230, Odense, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | - Line Houkjær
- Department of Orthopedic Surgery, Zealand University Hospital, Køge Lykkebækvej 1, 4600 Køge, Denmark
| | - Anders Skive
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Camilla Holmenlund
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Stig Brorson
- Department of Orthopedic Surgery, Zealand University Hospital, Køge Lykkebækvej 1, 4600 Køge, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery, Lillebaelt Hospital, Kolding Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark Campusvej 55, 5230, Odense, Denmark
| | - Charlotte Abrahamsen
- Department of Orthopedic Surgery, Lillebaelt Hospital, Kolding Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark Campusvej 55, 5230, Odense, Denmark
| |
Collapse
|
26
|
Jensen SS, Jensen NM, Gundtoft PH, Kold S, Zura R, Viberg B. Risk factors for nonunion following surgically managed, traumatic, diaphyseal fractures: a systematic review and meta-analysis. EFORT Open Rev 2022; 7:516-525. [PMID: 35900220 PMCID: PMC9297052 DOI: 10.1530/eor-21-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 12/01/2022] Open
Abstract
Background Methods Results Conclusion
Collapse
Affiliation(s)
- Signe Steenstrup Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Niels Martin Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Robert Zura
- Department of Orthopedic Surgery, Louisiana State University Medical Center, New Orleans, Louisiana, USA
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
27
|
Karimi D, Brorson S, Midtgaard KS, Fjalestad T, Paulsen A, Olerud P, Ekholm C, Wolf O, Viberg B. Surgical versus non-surgical treatment of humeral SHAFT fractures compared by a patient-reported outcome: the Scandinavian Humeral diAphyseal Fracture Trial (SHAFT)-a study protocol for a pragmatic randomized controlled trial. Trials 2022; 23:453. [PMID: 35655280 PMCID: PMC9161482 DOI: 10.1186/s13063-022-06317-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 09/06/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcome of non-surgical treatment is generally good, but the treatment course can be long and painful with approximately a quarter of the patients acquiring a nonunion. Both surgical and non-surgical treatment can have disabling consequences such as nerve injury, infection, and nonunion. The purpose of the study is to compare patient-reported outcomes after surgical and non-surgical treatment for humeral shaft fractures. METHODS A pragmatic randomized controlled trial (RCT) is planned with two study groups (SHAFT-Young and SHAFT-Elderly). A total of 287 eligible acute humeral shaft fractures are scheduled to be recruited and randomly allocated to surgical or non-surgical treatment with the option of early crossover due to delayed union. The surgical method within the allocation is decided by the surgeon. The primary outcome is the Disability of Arm, Shoulder, and Hand (DASH) score at 52 weeks, and is assessor blinded. The secondary outcomes are DASH score, EQ-5D-5L, pain assessed by visual analog score, Constant-Murley score including elbow range of motion, and anchor questions collected at all timepoints throughout the trial. All complications will be reported including; infection, nerve or vascular injury, surgical revisions (implant malpositioning, hardware failure, aseptic loosening, and peri-implant fracture), major adverse cardiovascular events, and mortality. DISCUSSION The SHAFT trial is a pragmatic multicenter RCT, that will compare the effectiveness of the main strategies in humeral shaft fracture treatment. This will include a variety of fracture morphologies, while taking the dilemmas within the population into account by splitting the population by age and providing the orthopedic society with an interval for early crossover surgery. TRIAL REGISTRATION Clinicaltrials.gov NCT04574336 . Registered on 5 October 2020.
Collapse
Affiliation(s)
- Dennis Karimi
- Department of Orthopedic Surgery, Kolding Hospital, Kolding, Denmark.
| | - Stig Brorson
- Department of Orthopedic Surgery, Centre for Evidence-Based Orthopaedics, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kaare S Midtgaard
- Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Tore Fjalestad
- Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Aksel Paulsen
- Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Per Olerud
- Department of Orthopedic Surgery, Stockholm South General Hospital, Stockholm, Sweden
| | - Carl Ekholm
- Department of Orthopedic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Bjarke Viberg
- Department of Orthopedic Surgery, Kolding Hospital, Kolding, Denmark
| | | |
Collapse
|
28
|
Hermansen LL, Viberg B, Overgaard S. Large hospital variation in the risk of dislocation after primary total hip arthroplasty for primary osteoarthritis: 31,105 patients in 59 hospitals from the Danish Hip Arthroplasty Register. Acta Orthop 2022; 93:503-508. [PMID: 35642500 DOI: 10.2340/17453674.2022.2754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/18/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The risk of dislocation after primary total hip arthroplasty (THA) is affected by several factors, which increases the possibility of substantial differences among hospitals. We compared cumulative incidences of dislocation between regions and hospitals after primary THA surgery in osteoarthritis (OA) patients. PATIENTS AND METHODS From the Danish Hip Arthroplasty Register, we included 31,105 THAs performed from 2010 to 2014 with 2 years' follow-up. Dislocations treated by closed reduction were identified in the Danish National Patient Register combined with patient file review. The results are presented as 2-year cumulative incidence on national, regional, and hospital level as proportions with 95% confidence intervals (CI) and as adjusted odds ratios (OR) analyzed by multiple logistic regression. RESULTS 1,861 dislocations in 1,079 THAs were identified from 59 orthopedic departments. The 2-year cumulative incidence ranged from 2.2% to 4.3% between the 5 regions in Denmark. Hospital variation was 0-12%. For hospitals with a 5-year volume of more than 100 procedures, the incidence was 0.9-7.4%. Using the highest volume hospital as the reference, ORs for dislocation for the remaining hospitals were between 0.3 (CI 0.1-0.6) and 2.7 (1.9-4.0) after adjusting for age, sex, head size, and fixation method. Low-volume hospitals showed a higher dislocation risk than high-volume units with an adjusted OR of 1.2 (1.1-1.4). INTERPRETATION We found substantial variation in the incidence of dislocation between hospitals within Denmark, which can be explained by a combination of patient-, component-, and surgery-related factors. There is a need for continuous monitoring of THA dislocation on regional and hospital levels to reduce overall and local dislocation risk for future patients.
Collapse
Affiliation(s)
- Lars L Hermansen
- The Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense; Department of Orthopedics, Hospital of South West Jutland, Esbjerg; Department of Clinical Research, University of Southern Denmark, Odense.
| | - Bjarke Viberg
- The Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense; Department of Orthopedics, Hospital of South West Jutland, Esbjerg; Department of Clinical Research, University of Southern Denmark, Odense; Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding
| | - Soeren Overgaard
- Department of Orthopedic Surgery and Traumatology, Bispebjerg Hospital; Department of Clinical Research, University of Copenhagen, Denmark
| |
Collapse
|
29
|
Jacobsen GH, Gude MH, Viberg B, Gundtoft PH. Risk of Reoperation in Simple Ankle Fracture Surgery When Comparing Locking Plate With Nonlocking Plate. J Foot Ankle Surg 2022; 61:567-571. [PMID: 34838457 DOI: 10.1053/j.jfas.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/12/2021] [Revised: 07/12/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Locking plates were initially designed to provide improved stability to ankle fractures with poor bone quality but are currently widely used. The aim of this study was to compare the reoperation risk when using locking plates compared with nonlocking plates in patients with simple ankle fractures. This study was a population-based register study. Data regarding patients with AO type 44A1/2 and 44B1/2 injuries who were treated with either locking or nonlocking plates were obtained from the Danish Fracture Database. The follow-up period was 24 months. Major complications were defined as complications requiring surgical intervention, with the exception of simple hardware removal 6 weeks after primary surgery, which was defined as a minor complication. Multivariate regression analysis was performed to determine relative risk (RR), adjusted for age, sex, American Society of Anesthesiologists physical status classification (ASA)-score, and level of the surgeon's experience. A total of 2177 ankle fractures were included, among which 718 (33%) were treated with locking plates, and 1459 (67%) were treated with nonlocking plates. Data were linked with the Danish National Patient Registry to ensure complete information was obtained regarding reoperations, which were divided into major and minor complications. In both groups, the risks for major and minor complications were 3% and 22%, respectively, resulting in adjusted RRs of 1.00 (0.66; 1.66) for major reoperation comparing locking with nonlocking plates and 0.92 (0.76; 1.11) for minor reoperations. We conclude that no significant association with reoperation exists for locking compared with nonlocking plates among patients with surgically treated simple ankle fractures.
Collapse
Affiliation(s)
- Gudrun Holm Jacobsen
- Resident, Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.
| | - Mads Holm Gude
- Resident, Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Bjarke Viberg
- Consultant Associate Professor and Head of Research, Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Per Hviid Gundtoft
- Consultant, Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| |
Collapse
|
30
|
Ipsen JA, Pedersen LT, Viberg B, Nørgaard B, Suetta C, Bruun IH. Rehabilitation for life: the effect on physical function of rehabilitation and care in older adults after hip fracture-study protocol for a cluster-randomised stepped-wedge trial. Trials 2022; 23:375. [PMID: 35526010 PMCID: PMC9077959 DOI: 10.1186/s13063-022-06321-w] [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] [Received: 11/10/2020] [Accepted: 04/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background A hip fracture is a serious event for older adults, given that approximately 50% do not regain their habitual level of physical function, and the mortality rate is high, as is the number of readmissions. The gap in healthcare delivery, as separated into two financial and self-governing sectors, might be a contributing cause of inferior rehabilitation and care for these patients. Therefore, we aim to assess the effect of continuous and progressive rehabilitation and care across sectors for older adults after hip fracture. Methods/design The project is designed as a stepped-wedge cluster randomised controlled trial. The study population of patients are older adults 65 years of age and above discharged after a hip fracture and healthcare professionals in primary and secondary care (municipalities and hospitals). Healthcare professionals from different sectors (hospital and municipalities) will be engaged in the empowerment-orientated praxis, through a workshop for healthcare professionals with knowledge sharing to the older adults using a digital health application (app). The rehabilitation intervention consists of 12 weeks of progressive resistance exercises initiated 1–2 days after discharge. To improve communication across sectors, a videoconference involving the patient and physiotherapists from both sectors will be conducted. On day, 3 after discharge, an outreach nurse performs a thorough assessment including measurement of vital signs. A hotline to the hospital for medical advice is a part of the intervention. The intervention is delivered as an add-on to the usual rehabilitation and care, and it involves one regional hospital and the municipalities within the catchment area of the hospital. The primary outcome is a Timed Up and Go Test 8 weeks post-surgery. Discussion Using a stepped-wedge design, the intervention will be assessed as well as implemented in hospital and municipalities, hopefully for the benefit of older adults after hip fracture. Furthermore, the collaboration between the sectors is expected to improve. Trial registration The study is approved by the Regional Scientific Ethics Committees of Southern Denmark (S-20200070) and the Danish Data Protection Agency (20-21854). Registered 9 of June 2020 at ClinicalTrials.gov, NCT04424186. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06321-w.
Collapse
Affiliation(s)
- Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Lars T Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Health Education, University College South Denmark, Odense, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Charlotte Suetta
- Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark.,Department of Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Inge H Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
31
|
Strøm Rönnquist S, Viberg B, Kristensen MT, Palm H, Jensen JEB, Madsen CF, Åkesson KE, Overgaard S, Rogmark C. Frailty and osteoporosis in patients with hip fractures under the age of 60-a prospective cohort of 218 individuals. Osteoporos Int 2022; 33:1037-1055. [PMID: 35029719 PMCID: PMC9007814 DOI: 10.1007/s00198-021-06281-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
UNLABELLED Research on younger patients with hip fractures is limited. This study adds knowledge on patient and injury characteristics, and DXA was investigated at the time of the fracture. Risk factors for osteoporosis and fractures were numerous among young patients, and osteoporosis was markedly more prevalent than in the general population. INTRODUCTION Knowledge on younger patients with hip fractures is limited. Common preconceptions are that they suffer fractures due to high-energy trauma, alcohol or substance use disorder but not associated to osteoporosis. We aimed to descriptively analyze the characteristics of young and middle-aged patients with hip fractures and examine bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) at the time of the fracture. METHODS A prospective multicenter cohort study on adult patients with hip fractures below age 60 collected detailed information on patient characteristics regarding demographics, trauma mechanism, previous fractures, comorbidity and medication, and lifestyle factors. DXA results were compared to population-based reference data. RESULTS The cohort contains 91 women and 127 men, median age 53 (IQR 47-57). Most fractures, 83%, occurred in patients aged 45-59. Two-thirds of all fractures resulted from low-energy trauma. Half of the patients had prior fractures after age 20. Thirty-four percent were healthy, 31% had one previous disease, and 35% had multiple comorbidities. Use of medication associated with increased fracture risk was 32%. Smoking was prevalent in 42%, harmful alcohol use reported by 29%, and signs of drug-related problems by 8%. Osteoporosis according to WHO criteria was found in 31%, osteopenia in 57%, and normal BMD in 12%. CONCLUSION In patients with hip fractures below age 60, risk factors for osteoporosis and fractures were numerous. Moreover, the prevalence of osteoporosis was markedly higher than in the general population. We suggest that young and middle-aged patients with hip fractures undergo a thorough health investigation including DXA, regardless of trauma mechanism.
Collapse
Affiliation(s)
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Morten Tange Kristensen
- Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Physio- and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Erik Beck Jensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Endocrine Department, Hvidovre University Hospital, Copenhagen, Denmark
| | - Carsten Fladmose Madsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Kristina E Åkesson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö and Lund, Sweden
| |
Collapse
|
32
|
Melbye P, Gundtoft P, Lien-Iversen T, Barklin Morgan D, Pörneki JC, Viberg B. Secondary surgeries 20 years after surgical and non-surgical treatment of ACL rupture: A population-based cohort study. Knee 2022; 35:1-7. [PMID: 35144195 DOI: 10.1016/j.knee.2022.01.007] [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: 04/16/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies with less than 10 years of follow-up have demonstrated no difference between surgical and non-surgical treatment after an anterior cruciate ligament (ACL) rupture; however, long-term effects remain unclear. The aim of this study was to compare the risk of long-term secondary surgical procedures after primary surgical and non-surgical treatment for ACL ruptures. METHODS Patients aged 18-35, registered in the Danish National Patient Registry with an ACL rupture between January 1, 1996 and December 31, 2000 with a minimum of 20 years follow-up were included. The surgically treated group was defined as receiving an ACL reconstruction within 1 year after diagnosis. Major secondary surgical procedures were defined as subsequent ACL surgeries (reconstruction/revision), arthroplasty, deep infection, arthrodesis, or amputation. Minor secondary surgical procedures were defined as meniscal surgery, synovectomy, and manipulation under anesthesia (MUA). Multivariate regression analysis was performed to assess relative risk (RR), adjusted for age and sex. The results are reported with 95% confidence intervals. RESULTS 7,539 patients had an ACL rupture; 1,970 patients were surgically treated. In the surgically treated group, 5.9% of patients underwent major secondary surgeries; this was 6.1% in the non-surgically treated group, yielding an adjusted RR of 1.05 (0.85;1.30). There were 43.9% minor secondary surgeries in the surgically treated group and 49.1% in the non-surgically treated group, yielding an adjusted RR of 1.29 (1.20;1.39). CONCLUSIONS No significant differences in the rate of major secondary surgical procedures between the groups, the non-surgical group was associated with a higher risk of minor secondary surgeries.
Collapse
Affiliation(s)
- Pernille Melbye
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark.
| | - Per Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Teodor Lien-Iversen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Daniel Barklin Morgan
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Jens Christian Pörneki
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| |
Collapse
|
33
|
Wessels JO, Bjarnesen MP, Erichsen JL, Palm H, Gundtoft PH, Viberg B. Sliding hip screw vs intramedullary nail for AO/OTA31A1-A3: a systematic review and meta-analysis. Injury 2022; 53:1149-1159. [PMID: 35027220 DOI: 10.1016/j.injury.2021.12.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/01/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE to conduct a systematic review with consequent meta-analysis evaluating the best treatment for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31A1-A3 trochanteric fractures when comparing the sliding hip screw (SHS) to the intramedullary nail (IMN). The outcomes used for comparison are major complications (in total, as well as nonunion and infection specifically), mortality rates, functional outcomes and patient-reported outcome measures (PROM). MATERIALS AND METHODS Search strings for the Cochrane Library, CINAHL, Medline and Embase databases were developed with the help of a scientific librarian. Two authors screened the studies from the search string independently using Covidence.org and data extraction was performed similarly. Quality assessment was performed using the Cochrane Risk of Bias tool for randomised trials (ROB2) for RCT studies, and Cochrane Risk of Bias in Non-Randomised Studies - of Interventions (ROBINS-I) for non-RCT studies. Meta-analyses were performed using Log Risk Ratio as the primary effect estimate. RESULTS Of the 2,051 studies screened by the two authors, six RCTs and six non-RCTs were included in this meta-analysis, with a total of 10,402 patients. The results indicated no significant differences in total major complications, nonunion, infection or mortality between SHS and IMN treatments for AO/OTA 31A1, 31A2 and 31A3 trochanteric fractures. Due to a lack of compatible data, we were unable to perform a meta-analysis on function scores and PROM. However, there are trends that favour IMN for 31A1 and 31A2 fractures. CONCLUSION No significant difference between SHS and IMN was found in the meta-analysis in any of the examined AO/OTA fracture subtypes in terms of primary and secondary outcomes. When assessing function scores and PROM, we found trends favouring IMN for 31A1 and 31A2 fractures that should be explored further.
Collapse
Affiliation(s)
- Johanne Overgaard Wessels
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Mie Pilegaard Bjarnesen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Julie Ladeby Erichsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, DK
| | - Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK.
| |
Collapse
|
34
|
Abrahamsen C, Viberg B, Nørgaard B. Patients’ perspectives on everyday life after hip fracture: A longitudinal interview study. Int J Orthop Trauma Nurs 2022; 44:100918. [DOI: 10.1016/j.ijotn.2021.100918] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
|
35
|
Rowling SC, Fløjstrup M, Henriksen DP, Viberg B, Hallenberg C, Lindholt JS, Alberg-Fløjborg A, Nanayakkara PWB, Brabrand M. Arterial Blood Gas Analysis: as safe as we think? A multicentre historical cohort study. ERJ Open Res 2022; 8:00535-2021. [PMID: 35237684 PMCID: PMC8883174 DOI: 10.1183/23120541.00535-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Methods Results Conclusion Arterial punctures for arterial blood gas analysis are safe procedures with a major complication rate within 7 days of 0.14% (95% CI 0.13–0.15%). Patients on antithrombotic medication have an increased risk of developing major complications.https://bit.ly/3FaPOwk
Collapse
|
36
|
Viberg B, Pedersen AB, Kjærsgaard A, Lauritsen J, Overgaard S. Risk of mortality and reoperation in hip fracture patients undergoing cemented versus uncemented hemiarthroplasty : a population-based study from Danish National Registries. Bone Joint J 2022; 104-B:127-133. [PMID: 34969285 DOI: 10.1302/0301-620x.104b1.bjj-2021-0523.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the association of mortality and reoperation when comparing cemented and uncemented hemiarthroplasty (HA) in hip fracture patients aged over 65 years. METHODS This was a population-based cohort study on hip fracture patients using prospectively gathered data from several national registries in Denmark from 2004 to 2015 with up to five years follow-up. The primary outcome was mortality and the secondary outcome was reoperation. Hazard ratios (HRs) for mortality and subdistributional hazard ratios (sHRs) for reoperations are shown with 95% confidence intervals (CIs). RESULTS A total of 17,671 patients with primary HA were identified (9,484 uncemented and 8,187 cemented HAs). Compared to uncemented HA, surgery with cemented HA was associated with an absolute risk difference of 0.4% for mortality within the period zero to one day after surgery and an adjusted HR of 1.70 (95% CI 1.22 to 2.38). After seven days, there was no longer any association, with an adjusted HR of 1.07 (95% CI 0.90 to 1.28). This continued until five years after surgery with a HR of 1.01 (95% CI 0.96 to 1.06). There was a higher proportion of reoperations due to any reason after five years in the uncemented group with 10.2% compared to the cemented group with 6.1%. This yielded an adjusted sHR of 0.65 (95% CI 0.57 to 0.75) and difference continued up until five years after the surgery, demonstrating a sHR of 0.70 (95% CI 0.59 to 0.83). CONCLUSION In a non-selected cohort of hip fracture patients, surgery with cemented HA was associated with a higher relative mortality during the first postoperative day compared to surgery with uncemented HA, but there was no difference after seven days up until five years after. In contrast, surgery with cemented HA was associated with lower risk of reoperation up to five years postoperatively compared with surgery with uncemented HA. There was a higher relative mortality on the first postoperative day for cemented HA versus uncemented HA. There was no difference in mortality after seven days up until five years after surgery. There were 6.1% reoperations for cemented HA compared to 10.2% for uncemented HA after five years. Cite this article: Bone Joint J 2022;104-B(1):127-133.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
37
|
Viberg B, Eriksen L, Højsager KD, Højsager FD, Lauritsen J, Palm H, Overgaard S. Should Pertrochanteric and Subtrochanteric Fractures Be Treated with a Short or Long Intramedullary Nail?: A Multicenter Cohort Study. J Bone Joint Surg Am 2021; 103:2291-2298. [PMID: 34546997 DOI: 10.2106/jbjs.20.01904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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 The purpose of the present multicenter cohort study was to compare the rates of reoperation in elderly patients with pertrochanteric and subtrochanteric fractures that had been treated with a short or long intramedullary nail. METHODS Eleven orthopaedic departments across Denmark delivered data that had been obtained from the Danish Multidisciplinary Hip Fracture Registry (DMHFR) and a review of health-care records. With use of surgical procedure codes for pertrochanteric and subtrochanteric fractures that had been treated with an intramedullary nail, the DMRHF was searched to identify patients who had been ≥65 years of age between 2008 and 2013. The health-care records for patients who had had major reoperations, defined as any reoperation with the exclusion of simple hardware removal, were retrieved from the DMHFR, were reviewed for the type of intramedullary nail and missed reoperations, including peri-implant fractures, within 2 years of follow-up. Crude logistic regression analysis with adjustment for age, sex, and comorbidity was performed, yielding odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Of 2,245 pertrochanteric fractures, 1,867 were treated with a short intramedullary nail and 378 were treated with a long intramedullary nail. The rate of major reoperations was 4.0% in the short intramedullary nail group and 6.3% in the long intramedullary nail group. This yielded a crude OR of 1.61 (1.01 to 2.60) and an adjusted OR of 1.67 (1.04 to 2.70). Of 909 subtrochanteric fractures, 308 were treated with a short intramedullary nail and 601 were treated with a long intramedullary nail. The rate of major reoperations was 8.4% in the short intramedullary nail group and 4.0% in the long intramedullary nail group, yielding a crude OR of 0.45 (0.25 to 0.80) and an adjusted OR of 0.45 (0.25 to 0.81). CONCLUSIONS This is the first study confirming the theory that, for subtrochanteric fractures, a long intramedullary nail has a lower rate of major reoperations compared with a short intramedullary nail. In contrast, a short intramedullary nail has a lower rate of major reoperations compared with a long intramedullary nail for pertrochanteric fractures but with a lower absolute risk reduction compared with the results for subtrochanteric intramedullary nailing. There is a need for validation of these results in other large studies, especially for pertrochanteric fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lasse Eriksen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark
| | - Katia D Højsager
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Frederik D Højsager
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
38
|
Viberg B. Tranexamic Acid: When is It Indicated in Orthopaedic Surgery? Z Orthop Unfall 2021. [PMID: 34902870 DOI: 10.1055/a-1666-9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tranexamic acid (TXA) has been studied extensively during the last 5-8 years. It inhibits clot dissolution during surgery and can therefore reduce blood loss. However, there has been concern that this could result in more frequent complications, specifically in terms of thromboembolic events. The indications for TXA are widespread, and this review covers the literature on orthopaedic indications such as joint replacement, fracture surgery, and arthroscopic procedures. In general, TXA is safe and can be used in a wide variety of orthopaedic procedures, lowering blood loss without increasing the risk of complications.
Collapse
Affiliation(s)
- Bjarke Viberg
- Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding, Denmark.,Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
39
|
Viberg B, Erlandsen Claville LU, Andersen LR, Fredholm L, Dall-Hansen D, Grejsen H. Standardized, Coordinated Care in Nursing Homes Lowers Rehospitalization After Hip Fracture. J Am Med Dir Assoc 2021; 23:596-600. [PMID: 34861227 DOI: 10.1016/j.jamda.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess the effect of enhanced standardized interdisciplinary cooperation between the orthogeriatric ward, municipality, and nursing home facility (NHF) on readmission rates in patients with hip fracture. DESIGN Quasi-experimental design with a nonequivalent control group. SETTING AND PARTICIPANTS From January 2018 to July 2020, patients with hip fracture who were admitted to the department of orthopedic surgery and traumatology at Lillebaelt Hospital, and later discharged to NHF were included. INTERVENTION The intervention consisted of a safety program to the NHF for the first 14 days postdischarge and included assessment of vital signs, weight, pain, signs of constipation, hours of mobilization, and daily intake of fluids and high-protein beverages. Acute team nurses undertook visits (planned and unplanned) and could take blood samples and administer intravenous fluids or antibiotics at the NHF. Control participants received usual care. METHODS The intervention was performed in 2 municipalities with an acute team; the remaining 3 municipalities comprised the control group. The primary outcome was 30-day readmission, and secondary outcomes were mortality, mobility, and quality of life. RESULTS There were 100 patients in the intervention group and 152 in the control group. The median age was 86 years, 68% were female, and more than 60% had a low mental score; there were no statistical differences between groups in baseline variables. The 30-day readmission rate was 14% in the intervention group and 30% in the control group (P = .004). The 30-day mortality rate was 6% in the intervention group and 13% in the control group (P = .07). There was no statistically significant difference in mobility between the 2 groups but there was a higher health-related quality of life score in the intervention group (P = .045). CONCLUSIONS AND IMPLICATIONS Enhanced standardized interdisciplinary cooperation between hospital, NHF teams, and visiting acute team nurses can lower readmissions and potentially mortality.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Research, University of Southern Denmark, Odense, Denmark.
| | - Lars Uldum Erlandsen Claville
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Lis R Andersen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Lisbeth Fredholm
- Department of Geriatrics, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Dorte Dall-Hansen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Heidi Grejsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| |
Collapse
|
40
|
Jensen NM, Steenstrup S, Ravn C, Schmal H, Viberg B. The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review. J Clin Orthop Trauma 2021; 24:101710. [PMID: 34881170 PMCID: PMC8627993 DOI: 10.1016/j.jcot.2021.101710] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/22/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022] Open
Abstract
This study aimed to systematically review the current literature on studies using negative pressure wound therapy (NPWT) or dressings following fracture-related infection (FRI) in internal osteosynthesis of the extremity. Articles were analyzed on fracture and wound healing and included when comparing or describing the use of either NPWT or dressings in FRI. We conducted a systematic literature search in four electronic databases: Embase, Medline, the Cochrane Library, and Scopus. The studies were screened by two authors using Covidence.org and evaluated for risk of bias. A total of 8576 records were identified. No articles compared NPWT to dressings. Seven case reports and three case series included a total of 115 patients treated for FRI. Fracture healing was achieved in 21 out of 67 patients treated with NPWT (4 amputations and 46 not described) and all 48 patients in the dressing group (4 patients needed additional sequestrectomy procedures). Five studies did not describe fracture healing. In 57 out of 67 patients treated with NPWT, the wounds were described as healed, closed, or requiring soft tissue reconstruction (4 amputations and six lacking description). The dressing group had complete wound coverage in 18 patients and partial coverage in 30 patients. Studies were generally at high risk of bias because of insufficient descriptions of both patient demographics and outcomes. No studies compared NPWT to dressings, and the existing literature is at high risk of bias. The included studies were of low-level evidence. NPWT can be neither recommended nor advised against to cover infected osteosynthesis.
Collapse
Affiliation(s)
- Niels Martin Jensen
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital Part of Lillebaelt Hospital, Sygehusvej 22, 6000, Kolding, Denmark,Corresponding author. Pilevangen 15, 5450, Otterup, Denmark.
| | - Signe Steenstrup
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital Part of Lillebaelt Hospital, Sygehusvej 22, 6000, Kolding, Denmark
| | - Christen Ravn
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital Part of Lillebaelt Hospital, Sygehusvej 22, 6000, Kolding, Denmark
| | - Hagen Schmal
- Department of Orthopaedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B. Winsloewsvej 4, 5000, Odense C, Denmark
| |
Collapse
|
41
|
Pihl K, Englund M, Christensen R, Lohmander LS, Jørgensen U, Viberg B, Fristed JV, Thorlund JB. Less improvement following meniscal repair compared with arthroscopic partial meniscectomy: a prospective cohort study of patient-reported outcomes in 150 young adults at 1- and 5-years' follow-up. Acta Orthop 2021; 92:589-596. [PMID: 33929284 PMCID: PMC8519526 DOI: 10.1080/17453674.2021.1917826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Meniscal repair may reduce long-term risk of knee osteoarthritis compared with arthroscopic partial meniscectomy (APM), whereas patient-reported outcomes may be poorer at short term than for APM. We compared patient-reported outcomes in young adults undergoing meniscal repair or APM up to ∼5 years after surgery.Patients and methods - We included 150 patients aged 18-40 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing meniscal repair or APM. Between-group differences in change in a composite of 4 of 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, sport and recreation, and quality of life-KOOS4) from baseline, 12, and 52 weeks, and a median of 5 years (range 4-6 years) were analyzed using adjusted mixed linear models, with 52 weeks being the primary endpoint.Results - 32 patients had meniscal repair (mean age 26 [SD 6]), and 118 patients underwent APM (mean age 32 [SD 7]). The repair and APM groups improved in KOOS4 from before to 52 weeks after surgery (least square means 7 and 19, respectively; adjusted mean difference -12, [95% CI -19 to -4] in favor of APM). Both groups improved further from 52 weeks to 5 years after surgery with the difference in KOOS4 scores between the groups remaining similar.Interpretation - Patients having meniscal repair experienced less improvements in patient-reported outcomes from baseline to 52 weeks and 5 years post-surgery. The findings highlight the need for randomized trials comparing these interventions in terms of patient-reported outcomes and knee OA development.
Collapse
Affiliation(s)
- Kenneth Pihl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden;
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; ,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark;
| | - L Stefan Lohmander
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
| | - Uffe Jørgensen
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark;
| | - Bjarke Viberg
- Department of Orthopedics, Lillebaelt Hospital, Kolding, Denmark;
| | | | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; ,Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark,Correspondence:
| |
Collapse
|
42
|
Gundtoft PH, Jørstad M, Erichsen JL, Schmal H, Viberg B. The ability of comorbidity indices to predict mortality in an orthopedic setting: a systematic review. Syst Rev 2021; 10:234. [PMID: 34407872 PMCID: PMC8375166 DOI: 10.1186/s13643-021-01785-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Several comorbidity indices have been created to estimate and adjust for the burden of comorbidity. The objective of this systematic review was to evaluate and compare the ability of different comorbidity indices to predict mortality in an orthopedic setting. METHODS A systematic search was conducted in Embase, MEDLINE, and Cochrane Library. The search were constructed around two primary focal points: a comorbidity index and orthopedics. The last search were performed on 13 June 2019. Eligibility criteria were participants with orthopedic conditions or who underwent an orthopedic procedure, a comparison between comorbidity indices that used administrative data, and reported mortality as outcome. Two independent reviewers screened the studies using Covidence. The area under the curve (AUC) was chosen as the primary effect estimate. RESULTS Of the 5338 studies identified, 16 met the eligibility criteria. The predictive ability of the different comorbidity indices ranged from poor (AUC < 0.70) to excellent (AUC ≥ 0.90). The majority of the included studies compared the Elixhauser Comorbidity Index (ECI) and the Charlson Comorbidity Index (CCI). In-hospital mortality was reported in eight studies reporting AUC values ranging from 0.70 to 0.92 for ECI and 0.68 to 0.89 for CCI. AUC values were generally lower for all other time points ranging from 0.67 to 0.78. For 1-year mortality the overall effect size ranging from 0.67 to 0.77 for ECI and 0.69 to 0.77 for CCI. CONCLUSION The results of this review indicate that the ECI and CCI can equally be used to adjust for comorbidities when analyzing mortality in an orthopedic setting. TRIAL REGISTRATION The protocol for this systematic review was registered on PROSPERO, the International Prospective Register of Systematic Reviews on 13 June 2019 and can be accessed through record ID 133,871.
Collapse
Affiliation(s)
- Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mari Jørstad
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark
| | - Julie Ladeby Erichsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark
| | - Hagen Schmal
- Clinic of Orthopaedic Surgery Medical Center, Faculty of Medicine, University of Freiburg, Breisacher Straße 86b, 79110, Freiburg, Germany
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark.
| |
Collapse
|
43
|
Nielsen LL, Smidt NS, Erichsen JL, Palm H, Viberg B. Response to the letter to the editor regarding "posterior tilt in nondisplaced femoral neck fractures increases the risk of reoperations after osteosynthesis. A systematic review and meta-analysis.". Injury 2021; 52:2488. [PMID: 33906743 DOI: 10.1016/j.injury.2021.04.024] [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: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Line L Nielsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Nanna S Smidt
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Julie L Erichsen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, DK
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, DK.
| |
Collapse
|
44
|
Erichsen JL, Jensen C, Larsen MS, Damborg F, Viberg B. Danish translation and validation of the Self-reported foot and ankle score (SEFAS) in patients with ankle related fractures. Foot Ankle Surg 2021; 27:521-527. [PMID: 32980265 DOI: 10.1016/j.fas.2020.06.014] [Citation(s) in RCA: 3] [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: 05/11/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure used to evaluate foot and ankle disorders. The purpose of this study was to translate, cross-culturally adapt and validate the Danish language version of the SEFAS in patients with ankle-related fractures. METHODS Forward-backward translation, cross-cultural adaption and validation were performed. In total, 125 patients completed the SEFAS-DK and the Danish version of American Orthopaedic Foot and Ankle Score (AOFAS-DK) at three time points after the date of fracture. The evaluation was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. RESULTS The intra-class correlation coefficient (ICC) level of the SEFAS-DK total score was 0.93 (95% confidence interval [CI]: 0.88-0.96). Cronbach's alpha (CA) for the SEFAS-DK was 0.93, while the floor and ceiling effect at week 6 post-injury was 22.4%. Construct validity was correlated with the AOFAS, and >75% of the pre-defined hypotheses could be confirmed. Responsiveness was analysed using longitudinal data. The minimal clinical important change (MCIC) showed that the SEFAS-DK detects changes in physical function over time. CONCLUSION The Danish version of the SEFAS showed overall good reliability, validity and responsiveness. SEFAS-DK can be used to evaluate physical function in patients with ankle-related fractures. LEVEL OF EVIDENCE level II, prospective cohort study.
Collapse
Affiliation(s)
- J L Erichsen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B Winsløvvej 15, 5000, Odense, Denmark; Institute of Clinical Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark.
| | - C Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark; Institute of Regional Health Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark
| | - M S Larsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B Winsløvvej 15, 5000, Odense, Denmark; Institute of Clinical Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark
| | - F Damborg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark
| | - B Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B Winsløvvej 15, 5000, Odense, Denmark; Institute of Regional Health Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark
| |
Collapse
|
45
|
Erichsen J, Froberg L, Viberg B, Damborg F, Jensen C. Danish Language Version of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) in Patients with Ankle-Related Fractures. J Foot Ankle Surg 2021; 59:657-663. [PMID: 32307287 DOI: 10.1053/j.jfas.2019.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/27/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 02/03/2023]
Abstract
The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) is, to date, the most widely used scale for evaluating foot and ankle disorders. We translated it into Danish and evaluated the reliability, validity and responsiveness of the Danish version of the AOFAS-AHS (AOFAS-DK) in patients aged >18 years with isolated ankle-related fractures. Forward-backward translation, cross-cultural adaption, and validation study were performed. In total, 125 patients completed the AOFAS-DK and the Self-reported Foot and Ankle Score (SEFAS) at 3 time points after the date of fracture. The evaluation was performed according to the Consensus-based Standards for the selection of health Measurement Instruments guidelines. The intra-class correlation coefficient level of the AOFAS-DK total score was 0.87 (95% confidence interval: 0.80-0.91). Cronbach's alpha (CA) for the AOFAS-DK function subscale was 0.62, whereas the floor and ceiling effect of the function subscale was 32% (T1) and 19% (T2), respectively. Construct validity was correlated with the SEFAS, and >75% of the predefined hypotheses could be confirmed. Responsiveness was analyzed using longitudinal data, and showed that the AOFAS-DK can detect changes in scores. The Danish version of the self-administered section of the AOFAS-AHS showed overall good reliability, validity, and responsiveness. The low CA values and the presence of the floor effect might be due to the low number of items and response options available in the scale. The AOFAS-DK can be used to evaluate physical function in patients with ankle-related fractures.
Collapse
Affiliation(s)
- Julie Erichsen
- Senior Registrar, Department of Orthopedic Surgery and Traumatology, Kolding Hospital, a part of Lillebaelt Hospital, Kolding, Denmark; Consultant and Associate Professor, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lonnie Froberg
- Consultant and Associate Professor, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Consultant and Associate Professor, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bjarke Viberg
- Senior Registrar, Department of Orthopedic Surgery and Traumatology, Kolding Hospital, a part of Lillebaelt Hospital, Kolding, Denmark; Associate Professor, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Frank Damborg
- Consultant, Department of Orthopedic Surgery and Traumatology, Kolding Hospital, a part of Lillebaelt Hospital, Kolding, Denmark
| | - Carsten Jensen
- Senior Registrar, Department of Orthopedic Surgery and Traumatology, Kolding Hospital, a part of Lillebaelt Hospital, Kolding, Denmark; Associate Professor, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
46
|
Abrahamsen C, Stork-Hansen J, Joanroy R, Arndt KB, Jordy A, Viberg B. Impact of compression stockings on wound healing and complications in ankle fractures: A retrospective cohort study. Int J Orthop Trauma Nurs 2021; 43:100866. [PMID: 34333325 DOI: 10.1016/j.ijotn.2021.100866] [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] [Received: 11/20/2020] [Revised: 03/28/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Ankle fractures treated with open reduction and internal fixation (ORIF) have a high incidence of wound complications. By reducing oedema, wound complications can, in theory, be minimized. This study investigates the impact of compression stocking (CS) on such complications after treatment with ORIF. METHODS Compression stockings were introduced as a standard postoperative treatment for all ankle fracture patients treated operatively with ORIF on February 1, 2013. Data were retrieved from medical records two years prior to and following the introduction date. The primary outcome was wound healing status after six weeks and secondary outcomes were wound-healing and major complications up to one year after surgery. RESULTS In total, 187 patients were studied, 74 in the CS group and 113 in the control (non-CS) group. Six weeks after the operation, wound-healing problems occurred in 23% and 13% of the patients in the CS group and the non-CS group (p < 0.0001) respectively. In total, 34% and 19% of the patients in the CS group and non-CS group experienced wound-healing complications one year after the operation (p < 0.02) respectively. Furthermore, major complications within one year occurred in 3% and 4% of patients respectively (p < 0.77). CONCLUSION An increase in wound-healing complications after six weeks and one year when using CS was found. However, owing to baseline differences in the two groups, it is only possible to caution against the use of CS.
Collapse
Affiliation(s)
- Charlotte Abrahamsen
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark; Department for Regional Health Research, University of Southern Denmark, Denmark; Department for Public Health, University of Southern Denmark, Denmark.
| | - Jesper Stork-Hansen
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark.
| | - Rajzan Joanroy
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark.
| | - Kristine Bollerup Arndt
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark.
| | - Anders Jordy
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark.
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Denmark; Department for Regional Health Research, University of Southern Denmark, Denmark.
| |
Collapse
|
47
|
Joanroy R, Stork-Hansen J, Rotwitt L, Viberg B. Cemented hemiarthroplasty for femoral neck fracture patients: collarless, polished tapered stem (CPT) versus anatomic matte stem (Lubinus SP2). Eur J Orthop Surg Traumatol 2021; 31:855-860. [PMID: 33839931 DOI: 10.1007/s00590-021-02948-8] [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] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cemented hemiarthroplasty is a well-documented treatment for patients with femoral neck fractures (FNFs). However, there are not many cohort studies comparing different types of hemiarthroplasty (HA). OBJECTIVE To compare CPT and Lubinus SP2 HA for FNF patients concerning complications and radiological measurements. METHODS From January 1, 2013, CPT was introduced instead of Lubinus SP2 as the new cemented HA due to a regional procurement. Data were retrieved 3 years prior and after the introduction. All patient health records were retrospectively reviewed for types of implant, American Society of Anesthesiologists (ASA) score and duration of admission. All X-ray images were analyzed for radiological measurements concerning offset, stem angulation and cement filling. Mortality and major complications within 1 year were retrieved from patient health records as well as the Danish National Patient Registry. Major complications were defined as dislocations, periprosthetic fractures and revisions. RESULTS 584 cemented HA were included, 300 CPT and 284 with Lubinus SP2. The mean age (SD) was 82 (8.2) years, and there was no baseline difference between the groups concerning age, sex, ASA score and mortality. There were 8.7% major complications for CPT and 9.2% for Lubinus SP2 (p = 0.836). There were, however, seven periprosthetic fractures in the CPT group and one in the Lubinus SP2 group (p = 0.04). In contrast, there were 20 dislocations in the Lubinus SP2 group and 10 in the CPT group (p = 0.042). There was no statistical difference between the stem angulation and periprosthetic fractures (p = 0.824) or major complications (p = 0.602). The Lubinus SP2 had a mean plus 2.7 mm offset postoperatively (p = 0.001), while the CPT had plus 10.6 mm (p < 0.000). The mean (SD) angle of the stems was 1.39 (1.75) degrees for Lubinus SP2 and 2.46 (1.99) for CPT. There was no difference in cementation (p = 0.308). CONCLUSION There was no overall statistical difference between the CPT and Lubinus SP2 stem regarding major complications. However, the CPT had a higher prevalence of periprosthetic fractures, while the Lubinus SP2 had a higher dislocation prevalence. The CPT stem had overcorrection of offset and a higher degree of varus positioning.
Collapse
Affiliation(s)
- Rajzan Joanroy
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital, Part of Hospital Lillebaelt, Kolding, Denmark.
| | - Jesper Stork-Hansen
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital, Part of Hospital Lillebaelt, Kolding, Denmark
| | - Lars Rotwitt
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital, Part of Hospital Lillebaelt, Kolding, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital, Part of Hospital Lillebaelt, Kolding, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
48
|
Hermansen LL, Viberg B, Overgaard S. Development of a diagnostic algorithm identifying cases of dislocation after primary total hip arthroplasty-based on 31,762 patients from the Danish Hip Arthroplasty Register. Acta Orthop 2021; 92:137-142. [PMID: 33438503 PMCID: PMC8158188 DOI: 10.1080/17453674.2020.1868708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Dislocation of total hip arthroplasties (THA) is often treated with closed reduction and traditionally not registered in orthopedic registers. This study aimed to create an algorithm designed to identify cases of dislocations of THAs with high sensitivity, specificity, and positive predictive value (PPV) based on codes from the Danish National Patient Register (DNPR).Patients and methods - All patients (n = 31,762) with primary osteoarthritis undergoing THA from January 1, 2010 to December 31, 2014 were included from the Danish Hip Arthroplasty Register (DHR). We extracted available data for every hospital contact in the DNPR during a 2-year follow-up period, then conducted a comprehensive nationwide review of 5,096 patient files to register all dislocations and applied codes.Results - We identified 1,890 hip dislocations among 1,094 of the included 31,762 THAs. More than 70 different diagnoses and 55 procedural codes were coupled to the hospital contacts with dislocation. A combination of the correct codes produced a sensitivity of 63% and a PPV of 98%. Adding alternative and often applied codes increased the sensitivity to 91%, while the PPV was maintained at 93%. Additional steps increased sensitivity to 95% but at the expense of an unacceptable decrease in the PPV to 82%. Specificity was, in all steps, greater than 99%.Interpretation - The developed algorithm achieved high and acceptable values for sensitivity, specificity, and predictive values. We found that surgeons in most cases coded correctly. However, the codes were not always transferred to the discharge summary. In perspective, this kind of algorithm may be used in Danish quality registers.
Collapse
Affiliation(s)
- Lars L Hermansen
- Department of Orthopedics, Hospital of South West Jutland, Esbjerg; ,The Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Department of Clinical Research, University of SouthernDenmark; ,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense; ,Correspondence:
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of SouthernDenmark; ,Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Søren Overgaard
- The Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Department of Clinical Research, University of SouthernDenmark;
| |
Collapse
|
49
|
Viberg B, Frøslev T, Overgaard S, Pedersen AB. Mortality and revision risk after femoral neck fracture: comparison of internal fixation for undisplaced fracture with arthroplasty for displaced fracture: a population-based study from Danish National Registries. Acta Orthop 2021; 92:163-169. [PMID: 33228452 PMCID: PMC8158198 DOI: 10.1080/17453674.2020.1850940] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 02/07/2023] Open
Abstract
Background and purpose - Hemiarthroplasty has lower reoperation frequency and better mobilization compared with internal fixation (IF) in patients with undisplaced femoral neck fractures (FNF), which might translate into lower mortality. In this population-based cohort study we compare the risk of mortality and reoperation in undisplaced FNF treated with IF and displaced FNF treated with arthroplasty in patients older than 70 years old. We assume that, per se, there is no difference in mortality risk between patients with a displaced and an undisplaced FNF.Patients and methods - Hip fracture patients were identified in the Danish Multidisciplinary Hip Fracture Registry during 2005-2015. Data on medication, comorbidities, reoperation, and mortality were retrieved from other Danish medical databases. IF and arthroplasty patients were compared with regards to mortality and reoperation up to 5 years postoperatively. We calculated hazard ratios (HR) with 95% confidence intervals (CI) adjusting for relevant confounders.Results - We included 19,260 FNF treated with arthroplasty and 10,337 FNF with IF. There was an increased risk of mortality for arthroplasty within 30 days, HR 1.3 (95% CI 1.3-1.4), compared with IF but not after 1 and 5 years. Arthroplasty patients had adjusted HRs for reoperation of 0.8 (0.8-0.9) within 1 year, 0.8 (0.7-0.9) within 2 years, and 0.8 (0.8-0.9) within 5 years postoperatively compared with IF.Interpretation - Patients treated for a displaced FNF with arthroplasty had a higher risk of 30-day mortality compared with patients who had an undisplaced FNF treated with IF. It has to be considered that there were baseline differences in the groups but there was no difference in mortality risk up to 5 years post-surgery. Concerning reoperation, patients with a displaced FNF treated with arthroplasty had a lower risk of reoperation compared with IF for undisplaced FNF.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital – University Hospital of SouthernDenmark, Kolding; ,Department of Regional Health Research, University of Southern Denmark, Odense; ,Orthopaedics Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense; ,Correspondence:
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital;
| | - Søren Overgaard
- Orthopaedics Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense; ,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | |
Collapse
|
50
|
Viberg B, Gundtoft PH, Schønnemann JO, Pedersen L, Andersen LR, Titlestad K, Madsen CF, Clemmensen SB, Halekoh U, Lauritsen J, Overgaard S. Is tranexamic acid use in patients with a hip fracture safe? Bone Joint J 2021; 103-B:449-455. [PMID: 33641426 DOI: 10.1302/0301-620x.103b3.bjj-2020-1375.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 01/21/2023]
Abstract
AIMS To assess the safety of tranexamic acid (TXA) in a large cohort of patients aged over 65 years who have sustained a hip fracture, with a focus on transfusion rates, mortality, and thromboembolic events. METHODS This is a consecutive cohort study with prospectively collected registry data. Patients with a hip fracture in the Region of Southern Denmark were included over a two-year time period (2015 to 2017) with the first year constituting a control group. In the second year, perioperative TXA was introduced as an intervention. Outcome was transfusion frequency, 30-day and 90-day mortality, and thromboembolic events. The latter was defined as any diagnosis or death due to arterial or venous thrombosis. The results are presented as relative risk (RR) and hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS A total of 3,097 patients were included: 1,558 in the control group and 1,539 in the TXA group.31% (n = 477) of patients had transfusions in the control group compared to 27% (n = 405) in the TXA group yielding an adjusted RR of 0.83 (95% CI 0.75 to 0.91). TXA was not associated with increased 30-day mortality with an adjusted HR of 1.10 (95% CI 0.88 to 1.39) compared to the control group as well as no association with increased risk of 90-day mortality with a per protocol adjusted HR of 1.24 (95% CI 0.93 to 1.66). TXA was associated with a lower risk of thromboembolic events after 30 days (RR 0.63 (95% CI 0.42 to 0.93)) and 90 days (RR 0.72 (95% CI 0.52 to 0.99)). A subanalysis on haemoglobin demonstrated a median 17.7 g/L (interquartile range (IQR) 11.3 to 27.3) decrease in the control group compared to 17.7 g/L (IQR 9.7 to 25.8) in the per protocol TXA group (p = 0.060 on group level difference). CONCLUSION TXA use in patients with a hip fracture, was not associated with an increased risk of mortality but was associated with lower transfusion rate and reduced thromboembolic events. Thus, we conclude that it is safe to use TXA in this patient group. Cite this article: Bone Joint J 2021;103-B(3):449-455.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Kolding, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Kolding, Denmark
| | | | - Lasse Pedersen
- Department of Orthopaedic Surgery and Traumatology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Lis Røhl Andersen
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Kolding, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Carsten Fladmose Madsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Signe Bedsted Clemmensen
- Department of Public Health, EBB - Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Ulrich Halekoh
- Department of Public Health, EBB - Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| |
Collapse
|