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Sundkvist, J., Hulenvik, P., Schmidt, V., Jolbäck, P., Sundfeldt, M., Fischer, P., . . . Mukka, S. (2024). Basicervical femoral neck fractures: an observational study derived from the Swedish fracture register. Acta Orthopaedica, 95, 250-255
Open this publication in new window or tab >>Basicervical femoral neck fractures: an observational study derived from the Swedish fracture register
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2024 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 95, p. 250-255Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Limited research has been conducted on basicervical femoral neck fractures (bFNFs). The importance of displacement in clinical outcomes remains unclear. We aimed to characterize patient demographics, degree of displacement, treatment, treatment failures, and reoperations in a cohort of fractures from the Swedish Fracture Register (SFR).

METHODS: 1,260 fractures in 1,185 individuals ≥ 60 years who had a bFNF registered in the SFR at 6 orthopedic departments from 2011 to 2020 were screened through radiographic review. The final sample included 291 patients with a confirmed bFNF. The medical records of these 291 patients were reviewed. We assessed baseline characteristics, initial fracture dislocation, treatment methods, tip-apex distance, failures, reoperations, and mortality.

RESULTS: The mean age was 82 years (range 60-101, 55% women). 98 (34%) were undisplaced and 193 (66%) displaced. All patients underwent operative treatment. In the undisplaced group 95 (97%) patients received internal fixation (IF) and 3 (3%) had primary hip arthroplasty. In the displaced group 149 (77%) received IF and 41 (21%) had primary hip arthroplasty. 33 (11%) suffered treatment failure. When treating an undisplaced bFNF with IF, only 3 (3%) experienced treatment failure, in contrast to the 24 (16%) failure rate for a displaced bFNF.

CONCLUSION: Undisplaced bFNFs have a low failure rate when treated with IF. For displaced bFNF treated with IF the failure rate is considerably higher. There is a need for further investigation of classification, treatment, and outcome of bFNF.

Place, publisher, year, edition, pages
Medical Journals Sweden, 2024
Keywords
Basal femoral neck fracture, Basicervical femoral neck fracture, Hip, Trauma
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-224686 (URN)10.2340/17453674.2024.40503 (DOI)38775110 (PubMedID)
Available from: 2024-05-23 Created: 2024-05-23 Last updated: 2024-05-24Bibliographically approved
Schmidt, V., Mukka, S., Bergdahl, C., Ekholm, C., Brüggemann, A. & Wolf, O. (2024). Epidemiology, treatment, and mortality of 3,983 scapula fractures from the Swedish fracture register. Journal of shoulder and elbow surgery
Open this publication in new window or tab >>Epidemiology, treatment, and mortality of 3,983 scapula fractures from the Swedish fracture register
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2024 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500Article in journal (Refereed) In press
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Associated fractures, Epidemiology, High energy, Scapula fracture, Trauma, Treatment
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-223938 (URN)10.1016/j.jse.2024.03.024 (DOI)38688421 (PubMedID)
Available from: 2024-05-02 Created: 2024-05-02 Last updated: 2024-05-02
Schmidt, V., Gordon, M., Petterson, A., Buttazzoni, C., Seimersson, A., Sayed-Noor, A., . . . Wadsten, M. (2024). Functional outcomes are restored a decade after a distal radius fracture: a prospective long-term follow-up study. Journal of Hand Surgery, European Volume, 49(3), 322-328
Open this publication in new window or tab >>Functional outcomes are restored a decade after a distal radius fracture: a prospective long-term follow-up study
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2024 (English)In: Journal of Hand Surgery, European Volume, ISSN 1753-1934, E-ISSN 2043-6289, Vol. 49, no 3, p. 322-328Article in journal (Refereed) Published
Abstract [en]

We performed an 11-13-year prospective follow-up of patients after a distal radial fracture (DRF) to investigate the association between fracture malunion, radiocarpal osteoarthritis and clinical outcome. In total, 292 patients responded to patient-reported outcome measures; of them, 242 underwent clinical examination. Clinical outcomes improved with time. A decade after fracture, median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 5, EuroQol Five-dimensions score was 1.0, and range of motion and grip strength were 96% of the contralateral side. Neither osteoarthritis (6%) nor pseudoarthrosis of the ulnar styloid (30%) affected the outcomes. Dorsal tilt, radial inclination, ulnar variance and intra-articular extension did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process that lasts years. A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes.

Level of evidence: II.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
Distal radius fracture, functional outcomes, grip strength, long-term results, outcomes, patient-reported outcome measure, range of motion
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-214296 (URN)10.1177/17531934231194682 (DOI)001061922700001 ()37684021 (PubMedID)2-s2.0-85170554329 (Scopus ID)
Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2024-04-08Bibliographically approved
Blixt, S., Burmeister, F., Mukka, S., Bobinski, L., Försth, P., Westin, O. & Gerdhem, P. (2024). Reliability of thoracolumbar burst fracture classification in the Swedish Fracture Register. BMC Musculoskeletal Disorders, 25(1), Article ID 281.
Open this publication in new window or tab >>Reliability of thoracolumbar burst fracture classification in the Swedish Fracture Register
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2024 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 25, no 1, article id 281Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Swedish Fracture Register (SFR) is a national quality register for all types of fractures in Sweden. Spine fractures have been included since 2015 and are classified using a modified AOSpine classification. The aim of this study was to determine the accuracy of the classification of thoracolumbar burst fractures in the SFR.

METHODS: Assessments of medical images were conducted in 277 consecutive patients with a thoracolumbar burst fracture (T10-L3) identified in the SFR. Two independent reviewers classified the fractures according to the AOSpine classification, with a third reviewer resolving disagreement. The combined results of the reviewers were considered the gold standard. The intra- and inter-rater reliability of the reviewers was determined with Cohen's kappa and percent agreement. The SFR classification was compared with the gold standard using positive predictive values (PPV), Cohen's kappa and percent agreement.

RESULTS: The reliability between reviewers was  high (Cohen's kappa 0.70-0.97). The PPV for correctly classifying burst fractures in the SFR was high irrespective of physician experience (76-89%), treatment (82% non-operative, 95% operative) and hospital type (83% county, 95% university). The inter-rater reliability of B-type injuries and the overall SFR classification compared with the gold standard was low (Cohen's kappa 0.16 and 0.17 respectively).

CONCLUSIONS: The SFR demonstrates a high PPV for accurately classifying burst fractures, regardless of physician experience, treatment and hospital type. However, the reliability of B-type injuries and overall classification in the SFR was found to be low. Future studies on burst fractures using SFR data where classification is important should include a review of medical images to verify the diagnosis.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Accuracy, Agreement, Burst fracture, Classification, Register-based, Reliability, Thoracolumbar
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-223446 (URN)10.1186/s12891-024-07395-0 (DOI)38609938 (PubMedID)2-s2.0-85190244579 (Scopus ID)
Funder
Karolinska InstituteSwedish Research Council, 2020-00493Uppsala UniversityRegion Stockholm
Available from: 2024-04-16 Created: 2024-04-16 Last updated: 2024-04-24Bibliographically approved
Wolf, O., Lakic, T. G., Ljungdahl, J., Sundkvist, J., Möller, M., Rogmark, C., . . . Hailer, N. P. (2024). Reoperation-free survival after hip screws or hip arthroplasty for undisplaced femoral neck fractures in the elderly a nationwide population-based cohort study of 3,909 patients. Bone & Joint Open, 5(2), 87-93
Open this publication in new window or tab >>Reoperation-free survival after hip screws or hip arthroplasty for undisplaced femoral neck fractures in the elderly a nationwide population-based cohort study of 3,909 patients
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2024 (English)In: Bone & Joint Open, E-ISSN 2633-1462, Vol. 5, no 2, p. 87-93Article in journal (Refereed) Published
Abstract [en]

Aims: Our primary aim was to assess reoperation-free survival at one year after the index injury in patients aged ≥ 75 years treated with internal fixation (IF) or arthroplasty for undis-placed femoral neck fractures (uFNFs). Secondary outcomes were reoperations and mortality analyzed separately.

Methods: We retrieved data on all patients aged ≥ 75 years with an uFNF registered in the Swedish Fracture Register from 2011 to 2018. The database was linked to the Swedish Arthroplasty Register and the National Patient Register to obtain information on comorbidity, mortality, and reoperations. Our primary outcome, reoperation, or death at one year was analyzed using restricted mean survival time, which gives the mean time to either event for each group separately.

Results: Overall, 3,909 patients presenting with uFNFs were included. Of these patients, 3,604 were treated with IF and 305 with primary arthroplasty. There were no relevant differences in age, sex, or comorbidities between groups. In the IF group 58% received cannulated screws and 39% hook pins. In the arthroplasty group 81% were treated with hemiarthroplasty and 19% with total hip arthroplasty. At one year, 32% were dead or had been reoperated in both groups. The reoperation-free survival time over one year of follow-up was 288 days (95% confidence interval (CI) 284 to 292) in the IF group and 279 days (95% CI 264 to 295) in the arthroplasty group, with p = 0.305 for the difference. Mortality was 26% in the IF group and 31% in the arthroplasty group at one year. Reoperation rates were 7.1% in the IF group and 2.3% in the arthroplasty group.

Conclusion: In older patients with a uFNF, reoperation-free survival at one year seems similar, regardless of whether IF or arthroplasty is the primary surgery. However, this comparison depends on the choice of follow-up time in that reoperations were more common after IF. In contrast, we found more early deaths after arthroplasty. Our study calls for a randomized trial comparing these two methods.

Place, publisher, year, edition, pages
British Editorial Society of Bone and Joint Surgery, 2024
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-222423 (URN)10.1302/2633-1462.52.BJO-2023-0143.R1 (DOI)001157142100001 ()38301730 (PubMedID)2-s2.0-85184697675 (Scopus ID)
Funder
Swedish Research Council, 2018-00462
Available from: 2024-03-28 Created: 2024-03-28 Last updated: 2024-03-28Bibliographically approved
Wänman, J., Kjartansdóttir, S., Wolf, O., Sundkvist, J., Wennergren, D. & Mukka, S. (2023). Age, sex, primary tumor type and site are associated with mortality after pathological fractures: an observational study of 1453 patients from the Swedish Fracture Register. Journal of Orthopaedic Surgery and Research, 18(1), Article ID 150.
Open this publication in new window or tab >>Age, sex, primary tumor type and site are associated with mortality after pathological fractures: an observational study of 1453 patients from the Swedish Fracture Register
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2023 (English)In: Journal of Orthopaedic Surgery and Research, E-ISSN 1749-799X, Vol. 18, no 1, article id 150Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pathological fractures are challenging in orthopedic surgery and oncology, with implications for the patient's quality of life, mobility and mortality. The efficacy of oncological treatment on life expectancy for cancer patients has improved, but the metastatic pattern for bone metastases and survival is diverse for different tumor types. This study aimed to evaluate survival in relation to age, sex, primary tumor and site of the pathological fractures.

METHODS: All pathological fractures due to cancer between 1 September 2014 and 31 December 2021 were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, tumor type, fracture site and mortality were collected.

RESULTS: A total of 1453 patients with pathological fractures were included (48% women, median age 73, range 18-100 years). Unknown primary tumors were the most common primary site (n = 308). The lower extremities were the most common site of pathological fractures. Lung cancer had the shortest median survival of 78 days (range 54-102), and multiple myeloma had the longest median survival of 432 days (range 232-629). The site at the lower extremity had the shortest (187 days, range 162-212), and the spine had the longest survival (386 days, range 211-561). Age, sex, primary type and site of the pathological fractures were all associated with mortality.

INTERPRETATION: Age, sex, primary tumor type and site of pathological fractures were associated with survival. Survival time is short and correlated with primary tumor type, with lung cancer as the strongest negative predictor of survival.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-205330 (URN)10.1186/s13018-023-03620-z (DOI)000942300000001 ()36859299 (PubMedID)2-s2.0-85149366041 (Scopus ID)
Available from: 2023-03-02 Created: 2023-03-02 Last updated: 2024-03-14Bibliographically approved
Schmidt, V., Gordon, M., Tägil, M., Sayed-Noor, A., Mukka, S. & Wadsten, M. (2023). Association between radiographic and clinical outcomes following distal radial fractures: a prospective cohort study with 1-year follow-up in 366 patients. Journal of Bone and Joint Surgery. American volume, 105(15), 1156-1167
Open this publication in new window or tab >>Association between radiographic and clinical outcomes following distal radial fractures: a prospective cohort study with 1-year follow-up in 366 patients
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2023 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 105, no 15, p. 1156-1167Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Several studies of distal radial fractures have investigated final displacement and its association with clinical outcomes. There is still no consensus on the importance of radiographic outcomes, and published studies have not used the same criteria for acceptable alignment. Previous reports have involved the use of linear or dichotomized analyses.

METHODS: The present study included 438 patients who were managed with either reduction and cast immobilization or surgery for the treatment of distal radial fractures. Radiographic outcomes were determined on the basis of radiographs that were made 3 months after the injury. Clinical outcome was determined on the basis of the QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) score, range of motion, and grip strength at 1 year after the injury. Nonlinear relations were analyzed with cubic splines.

RESULTS: Three hundred and sixty-six patients (84%) had both radiographic and clinical follow-up. Seventy patients were lost to follow-up. The mean age was 57 years (range, 18 to 75 years), and 79% of the patients were female. Dorsal tilt was the radiographic parameter that was most strongly associated with the QuickDASH score, grip strength, and range of motion. We found nonlinear relations. Clinical outcomes were found to worsen with increasing dorsal tilt, with the cutoff value being approximately 5°.

CONCLUSIONS: We found that clinical outcomes following distal radial fractures have a nonlinear relationship with dorsal tilt, with worse outcomes being associated with increasing dorsal tilt. The decline in clinical outcome starts at 5°, but there is unlikely to be a noticeable difference in capability as measured with the QuickDASH until 20° of dorsal tilt (based on the minimum clinically important difference) in a population up to 75 years old.

LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-208252 (URN)10.2106/JBJS.22.01096 (DOI)001041574300005 ()37172109 (PubMedID)2-s2.0-85166396145 (Scopus ID)
Available from: 2023-05-15 Created: 2023-05-15 Last updated: 2024-04-08Bibliographically approved
Olofsson, E., Gustafson, Y., Mukka, S., Tengman, E., Lindgren, L. & Olofsson, B. (2023). Association of depressive disorders and dementia with mortality among older people with hip fracture. BMC Geriatrics, 23(1), Article ID 135.
Open this publication in new window or tab >>Association of depressive disorders and dementia with mortality among older people with hip fracture
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2023 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, no 1, article id 135Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hip fracture (HF) is a significant cause of mortality among older people. Almost half of the patients with HF have dementia, which increases the mortality risk further. Cognitive impairment is associated with depressive disorders (DDs) and both dementia and DDs are independent risk factors for poor outcome after HF. However, most studies that evaluate mortality risk after HF separate these conditions.

AIMS: To investigate whether dementia with depressive disorders (DDwD) affects the mortality risk at 12, 24, and 36 months after HF among older people.

METHODS: Patients with acute HF (n = 404) were included in this retrospective analysis of two randomized controlled trials performed in orthopedic and geriatric departments. Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive function was assessed using the Mini-Mental State Examination. A consultant geriatrician made final depressive disorder and dementia diagnoses using the Diagnostic and Statistical Manual of Mental Disorders criteria, with support from assessments and medical records. The 12-, 24- and 36-month mortality after HF was analyzed using logistic regression models adjusted for covariates.

RESULTS: In analyses adjusted for age, sex, comorbidity, pre-fracture walking ability, and fracture type, patients with DDwD had increased mortality risks at 12 [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.75-12.51], 24 (OR 3.61, 95% CI 1.71-7.60), and 36 (OR 4.53, 95% CI 2.24-9.14) months. Similar results were obtained for patients with dementia, but not depressive disorders, alone.

CONCLUSION: DDwD is an important risk factor for increased mortality at 12, 24, and 36 months after HF among older people. Routinely assessments after HF for cognitive- and depressive disorders could identify patients at risk for increased mortality, and enable early interventions.

TRIAL REGISTRATION: RCT2: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN15738119.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Dementia, Depressive disorders, Hip fracture, Mortality, Older people
National Category
Orthopaedics Geriatrics
Identifiers
urn:nbn:se:umu:diva-205678 (URN)10.1186/s12877-023-03862-w (DOI)000945613200001 ()36890449 (PubMedID)2-s2.0-85149626612 (Scopus ID)
Funder
Vårdal FoundationVisare NorrThe Kempe FoundationsUmeå UniversityRegion VästerbottenSwedish Research Council, K2005‐27VX‐15357‐01A
Available from: 2023-03-14 Created: 2023-03-14 Last updated: 2023-04-03Bibliographically approved
Lagergren, J., Mukka, S., Wolf, O., Nauclér, E., Möller, M. & Rogmark, C. (2023). Conversion to arthroplasty after internal fixation of nondisplaced femoral neck fractures: results from a Swedish register cohort of 5,428 individuals 60 years of age or older. Journal of Bone and Joint Surgery. American volume, 105(5), 389-396
Open this publication in new window or tab >>Conversion to arthroplasty after internal fixation of nondisplaced femoral neck fractures: results from a Swedish register cohort of 5,428 individuals 60 years of age or older
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2023 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 105, no 5, p. 389-396Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although most nondisplaced or minimally displaced femoral neck fractures are routinely treated with internal fixation, high rates of secondary surgical procedures are common, especially in the elderly population. Primary arthroplasty in elderly patients has been proposed as an alternative treatment to reduce the need for a secondary surgical procedure. The objective of this study was to describe the rate of conversion to arthroplasty within 5 years after internal fixation of nondisplaced femoral neck fractures in patients ≥60 years of age.

METHODS: In this observational cohort study of prospectively collected data from the Swedish Fracture Register (SFR) between 2012 and 2018, cross-matched with the Swedish Arthroplasty Register (SAR), 5,428 nondisplaced femoral neck fractures in patients ≥60 years of age were included. Competing risk analysis was used to estimate conversion rates to arthroplasty and mortality in various age groups at 1, 2, and 5 years.

RESULTS: The cumulative incidence function (CIF) for conversion to arthroplasty was 6.3% at 1 year, 8.1% at 2 years, and 10.1% at 5 years. The conversion rates within 2 years were 6.5% in 60 to 69-year-olds, 9.6% in 70 to 79-year-olds, and 7.8% in ≥80-year-olds. Women had a higher risk of conversion; the hazard ratio (HR) was 1.49 (95% confidence interval [CI], 1.19 to 1.87). The cumulative mortality was 21.3% (95% CI, 20.3% to 22.5%) at 1 year, 31.3% (95% CI, 30.0% to 32.6%) at 2 years, and 54.9% (95% CI, 53.1% to 56.7%) at 5 years. Mortality was higher in men at all time points, and the adjusted 1-year HR was 1.79 (95% CI, 1.61 to 2.00).

CONCLUSIONS: One in 10 patients ≥60 years of age treated with internal fixation for a nondisplaced femoral neck fracture underwent conversion to arthroplasty within 5 years, and more than one-half of the conversions occurred within the first year. The risk of conversion was highest in women and in patients 70 to 79 years of age. These data warrant further studies in this frail patient group to identify subgroups of patients who would benefit from primary arthroplasty for nondisplaced femoral neck fractures.

LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-205641 (URN)10.2106/JBJS.22.01035 (DOI)000941639300010 ()36729034 (PubMedID)2-s2.0-85149182878 (Scopus ID)
Available from: 2023-03-13 Created: 2023-03-13 Last updated: 2023-09-05Bibliographically approved
Hernefalk, B., Rydberg, E. M., Ekelund, J., Rogmark, C., Möller, M., Hailer, N. P., . . . Wolf, O. (2023). Inter-departmental variation in surgical treatment of proximal femoral fractures: A nationwide observational cohort study. PLOS ONE, 18(2), Article ID e0281592.
Open this publication in new window or tab >>Inter-departmental variation in surgical treatment of proximal femoral fractures: A nationwide observational cohort study
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 2, article id e0281592Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Hip fractures should be treated based on the best available evidence and cost-effectively to optimize the outcome for this large group of frail patients. This study examined nationwide variation in surgical methods used for hip fractures.

METHODS: In this cohort study 46,243 patients ≥65 years with a trochanteric hip fracture (THF) or a femoral neck fracture (FNF) registered in the Swedish Fracture Register (SFR) between 1 January 2016 and 31 December 2020 were included. Fractures were classified according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. The choice of surgical methods was assessed for each fracture type to compare national variation.

RESULTS: 21,312 THFs and 24,072 FNFs (67% women) with a mean age of 83 years (SD 8) were surgically treated. In the treatment of two-fragment THFs (AO/OTA A1) departments ranged from using 90% short intramedullary nails to 98% sliding hip screws. Treating displaced FNFs (AO/OTA B3), the proportion of hemiarthroplasty ranged from 9 to 90%, and internal fixation between 0.6 to 21%, depending on the department.

INTERPRETATION: A mature national fracture register permits the monitoring of treatment provided and thus serves as an important aid in assessing compliance with guidelines. The large inter-departmental variation in the surgical management of hip fractures in Sweden appears unwarranted based on the current evidence, indicating a need for updated national guidelines. Further research will have to clarify the impact of this variation on mortality and re-operation rates.

Place, publisher, year, edition, pages
Public Library of Science, 2023
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-204789 (URN)10.1371/journal.pone.0281592 (DOI)000929724500090 ()36757969 (PubMedID)2-s2.0-85147834375 (Scopus ID)
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2023-03-06Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-5469-2730

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