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Introduction: Elective osteotomy is a well-established treatment for malunited fractures and degenerative deformities of the wrist and hand. However, contemporary population-based evidence regarding temporal, demographic and regional trends is limited.

Methods: This nationwide observational study analysed all wrist and hand osteotomies in Sweden between 2008 and 2023 using data from the National Patient Register. Procedures were identified by NOMESCO codes for rotational/angular osteotomy (NDK59, NCK59) and lengthening/shortening osteotomy (NDK69, NCK69). Incidence rates were calculated per 100,000 inhabitants and stratified by sex, age and region. Predictive modelling was applied to estimate trends up to 2040.

Results: A total of 6911 wrist and hand osteotomies were identified between 2008 and 2023, including rotational/angular osteotomies (NDK59: 2833; NCK59: 1276) and lengthening/shortening osteotomies (NDK69: 1682; NCK69: 1120). The annual incidence declined steadily across the study period. Women consistently accounted for more procedures than men across all osteotomy types. Incidence was highest among middle-aged and older adults, with younger patients representing a small proportion of cases. Substantial regional variation was observed throughout Sweden, with some regions carrying out several times more procedures than others. Forecast modelling predicts a continued decline to 2040.

Conclusions: The incidence of osteotomies of the wrist and hand in Sweden has declined markedly over the past 16 years, which may reflect improvements in primary fracture care. These findings reflect evolving surgical practices, demographic influences and systemic factors such as regional disparities. A continued decline in osteotomy procedures has major implications: as case volumes decrease, exposure for trainees diminishes, with fewer surgeons proficient in osteotomies, even though patients will continue to benefit from the procedure. Similar concerns have been raised in the context of other high-skill orthopaedic interventions. This might prompt centralization of complex cases and cross-border collaborations to ensure adequate surgical competence.

Level of evidence: III

Introduction: The optimal timing for distal radial fracture fixation remains controversial. Most previous studies have dichotomized timing into early or delayed categories, potentially obscuring the true effect of delay. This study investigated surgical timing as a continuous variable to determine its influence on radiographic alignment.

Methods: In a retrospective multicentre cohort study, we reviewed 691 surgically treated distal radial fractures across four Swedish hospitals. Radiographic parameters assessed included dorsal tilt (primary outcome), radial inclination, ulnar variance, intra-articular step, coronal shift and anterior apposition. Logistic regression was used to analyse overall acceptable alignment, while linear regression was used for dorsal tilt. Models were adjusted for age and sex. Interobserver reliability was evaluated with intraclass correlation coefficients.

Results: The mean patient age was 61 years, and 80% of the cohort were female. Each additional day delay to surgery increased the risk of unacceptable alignment by 6%, corresponding to a twofold risk increase with a 2 week delay. Dorsal tilt worsened linearly by approximately 0.34 degrees per day, accumulating to nearly 5 degrees after 2 weeks. Male sex was associated with significantly greater dorsal tilt (mean difference >2 degrees) and reduced correction compared with females. Interclass correlation coefficients demonstrated excellent reliability for dorsal tilt (0.952) and radial inclination (0.947), and moderate reliability for ulnar variance (0.748) and coronal shift (0.611).

Conclusion: A linear relationship was identified between surgical delay and declining radiographic outcomes, highlighting that each day's delay progressively compromises fracture alignment. These findings emphasize the importance of prompt surgical intervention for distal radial fractures to achieve optimal radiographic results.

Background: Boarding sports, such as skateboarding and snowboarding, are associated with a significant risk of fractures. This study provides a comprehensive overview of the epidemiology, fracture locations, and treatment approaches for skateboarding and snowboarding-related fractures using data from the Swedish Fracture Register.

Purpose: To provide a comprehensive overview of the epidemiology, fracture locations, and treatment modalities for fractures incurred during skateboarding and snowboarding.

Study Design: Descriptive epidemiology study.

Level of Evidence: Level 4.

Methods: This observational study included all patients registered in the Swedish Fracture Register who sustained fractures while snowboarding or skateboarding from January 2015 to December 2023. Variables studied were age, sex, trauma energy level, seasonal variation, fracture location (body part), and treatment modality.

Results: A total of 5155 patients (28% women) with 5446 fractures were included. Adults (≥16 years old) comprised 58% of all patients. The cohort experienced an approximately equal number of fractures from skateboarding (55%) and snowboarding (45%). A greater propensity for high-energy trauma injuries was observed among snowboarders and males. The mean age was similar in both groups, slightly above 20 years. Upper extremity fractures were the most common in both sports. However, discrepancies were noted: lower extremity fractures were more common in skateboarders, whereas injuries to the spine and pelvis were about 8 times more common in snowboarders. Specific injury patterns, such as the "snowboarder's fracture" and "skateboard elbow", appear unique to each sport.

Conclusion: While skateboarding and snowboarding share similarities, notable differences exist in lower extremity and spinal fractures. Furthermore, specific fracture patterns are characteristic of each sport. Understanding these differences is crucial for developing targeted prevention strategies and improving safety measures.

Introduction: Rotator cuff tears (RCTs) are a common source of pain in the shoulder girdle. There is still debate about the optimal treatment for older adults with RCTs. In clinical practice, patients who do not respond well to non-surgical management may still be eligible for operative treatment. In this study, we assessed the outcome of arthroscopic repair of RCTs in patients ≥60 years old.

Material and method: A retrospective case series was conducted to include patients who underwent arthroscopic repair of RCTs from 1 January 2018 to 1 January 2021. The study included individuals aged ≥60 years who had radiologically confirmed RCTs (verified by MRI) and clinical findings including sleep-disturbing pain and reduced range of motion. Preoperative treatment included physiotherapy for at least 6 months and one subacromial corticosteroid injection.

Results: Fifty-three RCTs were treated during the study period. After exclusion because of incomplete documentation, 45 patients remained. The mean age was 66 years and 80% had isolated supraspinatus tears and 25% had variable degrees of fatty infiltration (Goutallier grade 1-3) on MRI examination with positive tangent sign. There were no surgical site infections and three symptomatic re-ruptures (6%). At follow-up, (71%) reported no remaining sleep-disturbing shoulder pain. Abduction improved from 62° to 122°. Flexion improved from 68° to 135°. This study found that people aged 60 years and older who underwent repair of RCTs showed statistically significant clinical improvement in shoulder flexion and abduction with less sleep-disturbing shoulder pain. These encouraging results may contribute to the existing literature, favoring the choice of surgical treatment for symptomatic RCTs in this age group with failed nonoperative treatment.

Conclusion: The arthroscopic repair of RCTs in patients 60 years and older yielded a substantial increase in shoulder flexion and abduction, significantly reducing sleep-disturbing shoulder pain. Postoperative complications were minimal.

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.

Purpose: The outcome after a distal radius fracture (DRF) is often evaluated with radiography, clinical examination, and patient-reported outcome measures. However, research has identified associations between psychological factors and outcomes after a DRF. A knowledge gap exists about psychological factors and their potential implications for long-term outcomes after a DRF. The aim of this study was to examine the long-term association between psychological factors and patient-reported outcomes.

Methods: This multicenter investigation included patients aged 15–75 years with closed physes presenting with an acute DRF. Patients who completed a long-term follow-up (after 11–13 years) with patient-reported outcome measures were invited to participate in the study, and surveys measuring psychological factors were sent to the patients.

Results: Two hundred and four patients (70%) completed the follow-up (mean [range] age at injury, 56 [18–75] years; 154 were females [75%]). Multivariable analysis showed that higher age, injury to the dominant hand, and greater pain catastrophizing were associated with an increase in scores on the Disabilities of the Arm, Shoulder, and Hand questionnaire.

Conclusions: A decade after sustaining a DRF, patients with higher scores on the Pain Catastrophizing Scale reported inferior outcomes as measured by the Disabilities of the Arm, Shoulder, and Hand. The Pain Catastrophizing Scale accounts for 13% of the observed variance in Disabilities of the Arm, Shoulder, and Hand. Type of study/level of evidence: Therapeutic level IIb.

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.

Treatment recommendations in fractures of the distal radius are often based on the degree of displacement and functional demands. The fracture may be within an acceptable radiological range, but a marginal deterioration in alignment then occurs between the initial visit and follow-up. This may pose a risk for late displacement that may require further treatment. We secondarily analysed prospectively collected data and included 165 patients. We found that marginal secondary displacement (odds ratio (OR) 9.7), anterior comminution (OR 8.8), loss of anterior apposition (OR 6.8) and dorsal comminution (OR 2.6) were predictors of late displacement. Marginal secondary displacement is an important predictor of late displacement and malunion in fractures of the distal radius. Clinicians should not unequivocally accept general guidelines on alignment but also assess a deterioration in fracture alignment on radiographic follow-up and be aware of the potential need for surgery to avoid malunion in cases that show early secondary displacement, even when radiographic measures are within acceptable limits.Level of evidence: III.

BACKGROUND AND PURPOSE: National guidelines for treatment of distal radius fractures (DRFs) were presented in Sweden in 2021. In the guidelines, a fast-track is recommended for 4 subgroups of highly unstable DRFs. Regardless of the results of the closed reduction these are recommended for surgery within 1 week of injury. This study aims to evaluate the potential consequences of the newly presented national guidelines on incidence of surgical interventions.

PATIENTS AND METHODS: In all, 1,609 patients (1,635 DRFs) with primary radiographs after a DRF between 2014 and 2017 at two Swedish hospitals were included in a retrospective cohort study. An estimation was made of the percentage of patients in the historical pre-guidelines cohort, that would have been recommended early primary surgery according to the new national guidelines compared to treatment implemented without the support of these guidelines.

RESULTS: On a strict radiological basis, 32% (516 out of 1635) of DRFs were classified into one of the 4 defined subgroups. At 9-13 days follow-up, cast treatment was converted into delayed primary surgery in 201 cases. Out of these, 56% (112 out of 201) fulfilled the fast-track criteria and would with the new guidelines have been subject to early primary surgery.

INTERPRETATION: The fast-track regimen in the new guidelines, has a high likelihood of identifying the unstable fractures benefitting from early primary surgery. If the proposed Swedish national guidelines for DRF treatment are implemented, a greater proportion of fractures would be treated with early primary surgery, and a delayed surgery avoided in the majority of cases. The potential benefits in relation to possible costs when using the fast-track criteria in every day practice are still unknown.