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BACKGROUND: Femoral neck fractures (FNF) are a severe and common injury that affect older adults physically, psychologically, and socially. Variation in the trajectory of recovery remains underexplored. This study was conducted to investigate older adults' recovery experiences during the first year after FNF.

METHOD: This longitudinal interview-based study was conducted with 13 participants aged ≥75 years with FNF who were admitted to the orthopedics wards of two hospitals in Sweden. Semi-structured interviews were conducted with participants at 1, 4, and 12 months after fracture. Reflexive thematic analysis of the interview transcripts was performed.

RESULTS: Participants described their recovery after FNF as a complex and non-linear journey. Four interrelated themes were identified as key aspects influencing recovery during the first year after FNF: engagement in daily activities, fear of falling, family members' bridging of the support gap, and striving for independence. Recovery was represented as a fluctuating personal experience that evolves over time.

CONCLUSION: Recovery after FNF extends beyond physical healing, encompassing emotional adjustment and social reintegration. The understanding of recovery as an evolving and individualized process highlights the need for follow-up and rehabilitation strategies that address not only functional outcomes, but also patients' confidence, motivation, and support in daily life.

Background: This study sought to characterize a cohort of talar neck and body fractures, focusing on fracture characteristics, associated injuries, treatment and outcome.

Methods: We reviewed adult patients registered in the Swedish Fracture Register 2011–2021 with talar neck and body fractures. A minimum 2-year follow-up was conducted for treatment outcomes.

Results: We included 313 patients (318 fractures, median age 34 years, 67 % men) of which 106 involved the neck, 134 the body and 78 combined body and neck. 36 % had associated injuries. Operative treatment was implemented for 55 neck (52 %), 81 body (60 %), and 70 combined fractures (90 %). Reoperation rates were, 35 % for neck, 32 % for body and 44 % for combined fractures.

Conclusion: Talar fractures primarily occur in men and are associated with other fractures. A majority of the fractures are treated operatively and one in three patients undergoes reoperation, with higher reoperation rates in combined body and neck fractures.

Femoral neck fractures (FNFs) are associated with loss of function in all ages and excess mortality. The societal costs are high. Treatment needs to be tailored based on fracture type, functional demand, and physiological age of the patient. Internal fixation is often preferred for undisplaced FNFs and for displaced FNFs in young patients. Anatomical reduction is essential, but slight valgus is accepted. For a majority of those with displaced FNFs, a cemented hemiarthroplasty is the best alternative. This educational article suggests a treatment algorithm for FNFs and describes the evidence base for the recommended surgical techniques. Basicervical fractures, stress and pathological fractures are not included in this review.

BACKGROUND: Surgical site infection (SSI) following orthopedic surgery impacts patient outcomes. Airborne transmission is one potential route of infection. Despite their high cost and resource demands, modern ventilation systems have shown limited efficacy in reducing SSI rates. This trial investigated the effectiveness of a low-cost air purifier in reducing SSI rates after orthopedic surgery.

METHODS: In a nationwide, multicenter, double-blind, cluster-randomized crossover, placebo-controlled superiority trial, we included all patients undergoing orthopedic surgery during the trial period. The intervention group underwent surgery in operating rooms with active Novaerus NV800 air purifiers, while the control group underwent surgery in operating rooms with the same air purifiers that were inactive. The primary end point was SSI within 12 weeks post surgery, defined as a postsurgery infection marker (PSIM), a custom composite outcome based on registry codes for prescribed antibiotics, diagnoses, and surgical procedures. Logistic regression was performed to evaluate the primary outcome.

RESULTS: Of the 40,547 patients analyzed, 19,869 were in the intervention group and 20,678 in the control group. The PSIM rate was 9.2% in the invention group, and 9.4% in the control group, with an odds ratio of 0.98 (95% confidence interval, 0.91 to 1.05) for the intervention group. This finding remained consistent across various subgroups based on diagnoses, hospital levels, and ventilation types.

CONCLUSIONS: In modern operating rooms equipped with standard, midrange airflow ventilation systems, the addition of wall-mounted plasma air purifiers did not reduce the PSIM rate after orthopedic surgery. 

Background: Lisfranc injuries are potentially severe but relatively uncommon. Limited epidemiological data regarding Lisfranc injuries of the midfoot are available. This study aimed to describe the injury's epidemiology, injury mechanism, and primary treatment.

Methods: An observational register study examined all Lisfranc injuries registered in the Swedish Fracture Register from 2013 to 2022. Data on sex, age, date of injury, injury type, injury mechanism, and primary treatment were analysed.

Results: Some 2084 Lisfranc injuries in 2079 patients (54 % men) were included in the study. The mean age at injury was 43 (18-92, SD 17.3) years for men and 49 (18-96, SD 17.4) for women. One of five cases were caused by high-energy trauma, and the most common injury mechanism was a simple fall - tripping (31 %). Approximately 39 % of patients underwent operative treatment, with fixation using plates (51 %) being the prevailing choice of treatment. Primary arthrodesis was performed in 11 % of the operatively treated cases.

Conclusions: Lisfranc injuries are the consequence of a broad spectrum of injury mechanisms, are primarily induced by low-energy trauma and found in all age groups in adults. The majority of Lisfranc injuries are treated non-operatively. This comprehension can aid in accurate diagnosis and management in everyday clinical practice.Keywords: Lisfranc injury; Swedish Fracture Register; Trauma epidemiology.

BACKGROUND: Scapula fractures are relatively uncommon, accounting for <1% of all fractures and approximately 3-5% of shoulder girdle fractures. This study comprehensively describes the epidemiology, fracture classification, treatment, and mortality associated with scapula fractures within a large adult Swedish population.

METHODS: This observational study included all patients ≥18 years old at the time of injury with a scapula fracture (ICD S42.1) registered in the Swedish Fracture Register between March 2011 and June 2020. Variables studied were age, sex, and injury mechanism, including energy level, fracture classification, associated fractures, treatment, and mortality.

RESULTS: We included 3,930 patients (mean age 58 years, SD 18, 64% men) with 3,973 scapula fractures. Some 22% of the fractures were caused by high-energy trauma and 21% had at least one associated fracture. High energy-injuries were most common in glenoid neck (44%) and scapular body (35%) fractures. However, same-level falls were the most common cause of glenoid rim (62%) and intra-articular glenoid (55%) fractures. Clavicle fractures (9%) and proximal humerus fractures (5%) were the most commonly associated fractures. The most common fracture types were the glenoid rim (n=1,289, 32%) and scapular body (n=1,098, 28%) fractures. Nonoperative treatment was performed in 81% of patients. Glenoid rim and intra-articular glenoid fractures were treated operatively in over 30% of cases. The mortality rate for the whole cohort was 4% at 1 year.

CONCLUSIONS: Scapula fractures are predominately sustained by men. High energetic injuries and associated fractures are present in one in five patients. Nonoperative treatment is chosen in four of five patients, but for some fracture types one in three undergo surgery.

Aim: To explore factors associated with one-year mortality risk after hip fracture among very old adults (85 +) in Northern Sweden.

Methods: This cohort study includes data derived from Umeå 85 + /Gerontological Regional Database (GERDA), encompassing a representative sample of those aged 85, 90 and ≥ 95 years in Northern Sweden. Data were assessed during home visits and interviews conducted between 2000 and 2017. Associations of baseline characteristics with hip fracture during a follow-up period of 5 years and one-year mortality were analyzed using Cox proportional hazards regression.

Results: Of 1,277 participants, 184 (14.4%) sustained a hip fracture during follow-up, of whom 47.8% died within 1 year of the fracture. Among those with hip fracture, 65% were women. Increased 1-year mortality risk was associated with the presence of depressive disorders (hazard ratio, HR 2.55, 95% confidence interval 95%CI, 1.32–4.93), history of stroke (HR 2.34, 95%CI 1.17–4.66) and subtrochanteric fractures (HR 4.40, 95%CI 1.73–11.21). Conversely, obesity (HR 0.26, 95%CI 0.10–0.67) was associated with reduced mortality risk.

Conclusion: Nearly half of all very old adults sustaining a hip fracture die within 1 year. Depressive disorders, history of stroke and subtrochanteric fractures were identified as significant predictors of increased mortality, whereas obesity appeared to mitigate mortality risk. These findings underscore the need for targeted interventions to manage these risk factors in hip fracture patients very old adults.

BACKGROUND: Short stems in total hip arthroplasty (THA) have the potential to improve periprosthetic bone preservation compared to conventional stems due to a more anatomical distribution of biomechanical force. This study is a follow-up study of a randomised controlled trial using ultra-short and conventional stems in THA with the aim to investigate the long-term changes in periprosthetic bone mineral density (BMD) at 6 and 10 years post-THA.

METHODS: A cohort of 51 patients with hip osteoarthritis were randomized to either an ultra-short stem (n = 26) or a conventional stem (n = 25) group. Periprosthetic BMD was measured at 6- and 10-years post-surgery. Primary endpoint was BMD changes in Gruen zones 1 and 7. Lumbar spine, L1-4, BMD was used as an indicator of overall bone loss. Clinical outcome scores and BMD changes in Gruen zone 1-7 were used as secondary endpoints.

RESULTS: 37 hips, 17 ultra-short stems and 20 conventional stems, were followed up until 10 years. At 6- and 10-years post-THA, the ultra-short stem group had less periprosthetic BMD reduction compared to the conventional stem group in Gruen zone 1; mean differences (%) were -17.6 (CI, -23.4--10.6) and -18.3 (CI, -28.0--9.0), respectively (p < 0.001). There was similar BMD loss in Gruen zone 7 and zones 1-7 between groups. Compared to overall bone loss, the ultra-short stem group lost less BMD than the conventional group. Adverse events and clinical outcomes did not differ between groups.

CONCLUSIONS: Over a 10-year follow-up, THA using an ultra-short stem exhibited significantly reduced periprosthetic BMD loss in Gruen zone 1 compared to the conventional stem but this did not result in better clinical results. The observed preservation of bone density suggests potential long-term advantages of the ultra-short stem in minimising stress shielding and maintaining periprosthetic bone quality.

TRIAL REGISTRATION: ClinicalTrials.gov registration (number NCT01319227).

BACKGROUND: Total hip replacement (THR) is commonly used for active and lucid elderly patients with displaced femoral neck fractures (FNF). Historically, cemented stems have been favoured, demonstrating superior early outcomes. Controversy still exists regarding the use of cemented or uncemented stems in the most active group of patients with FNF and there is a need for extended follow-up studies to assess long-term outcome of cemented and uncemented stem results.

METHODS: A 4 and 10-year follow-up was conducted on a single-centre, single-blinded, randomized controlled trial. Patients aged 65-79 years with an acute displaced FNF (Garden III-IV) were included, and surgeries were performed between 2009 and 2014. The study was terminated after an interim analysis indicated that the total number of early hip-related complications was substantially higher in the uncemented group. Baseline and follow-up assessments included hip-related complications, reoperations, health-related quality of life scores, Harris hip score and pain ratings.

RESULTS: In total, 69 patients were randomized. At 4 years, there were 8 complications in the uncemented group and 2 complications in the cemented groups. The uncemented group had several periprosthetic fractures and dislocations necessitating revisions in several cases. From 4 to 10 years, the cemented group showed a single periprosthetic fracture, while none occurred in the uncemented group. The total number of complications during the study period were 8 in the uncemented group and 3 in the cemented group. The median Harris hip score for the uncemented group remained consistent at 81 for both the 4- and 10-year follow-ups. In contrast, the cemented group showed scores of 92 and 93 at the respective 4- and 10-year follow-ups, with no statistically significant difference between the two groups. Health-related quality of life and pain ratings were similar between groups throughout the study.

CONCLUSION: Our study presents a 10-year follow-up of uncemented femoral stems in THR for elderly FNF patients. Our findings not only underscore the importance of cautious decision-making in selecting patients for uncemented implants, but also highlight that most patients suitable for THR would benefit from a cemented arthroplasty to avoid an increased risk of short-term complications.

INTRODUCTION: Dislocation is a major complication of total hip arthroplasty (THA) for femoral neck fractures (FNFs). Dual mobility cups (DMCs) are in clinical practice for patients at risk of dislocation in primary-and revision arthroplasty. This study investigated whether changing routines from conventional THA (cTHA) to DMC for fracture patients at our orthopaedic unit resulted in a reduced dislocation rate.

MATERIAL AND METHODS: In 2016, a change was implemented in our department's standard procedure for patients undergoing THA for FNFs, replacing the cTHA with DMC as the preferred acetabular component. A search in the medical records retrospectively identified all patients with acute FNFs treated with THA from 2010 through 2021. Age, sex, American Society of Anesthesiologists (ASA) score 3-4 vs. 1-2, surgeon experience (hip specialist vs. orthopaedic surgeon) and cup type cTHA vs. DMC were included in the multivariable Cox regression analysis.

RESULTS: After screening and exclusion, 219 patients were included in the analysis: 108 patients treated with cTHA and 111 patients with DMC. The groups did not statistically significantly differ in age, sex and ASA score. There was, furthermore, no statistically significant difference in waiting time to surgery or length of surgery between groups. The follow-up time was longer for cTHA due to a change of routines. Fracture surgery with DMC was predominately performed by a specialized hip surgeon whereas cTHA was predominately performed by a general orthopaedic surgeon. 24 (11 %) patients had at least one dislocation during the study period: 22 in the cTHA group and 2 in the DMC group (p < 0.001). The multivariable Cox regression analysis revealed an independent association between the risk of dislocation and the use of cTHA (compared to DMC) with a hazard ratio (HR) of 14.16 (95 % confidence interval [CI] 2.80-71.75).

CONCLUSION: After implementing a DMC, the occurrence of dislocations in patients with FNFs who underwent THA decreased.