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  • 1. Bjorling, Patrik
    et al.
    Fischer, Per
    Örebro University, School of Medical Sciences.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Pettersson, Kurt
    Ten Year Follow-up After Total Wrist Arthroplasty2017Conference paper (Refereed)
    Abstract [en]

    Hypothesis Total wrist arthroplasty (TWA) is an option in the management of wrist arthritis. The aim of the study was to evaluate the long-term results of TWA.

    Methods In this cohort study, we followed 56 cases that underwent TWA (Avanta, Biax, Universal 2 and Maestro) between 2005 and 2006 at a single-center. Data was collected preoperatively and 10 years postoperatively. Patient-related outcome measures, grip strength, range of motion (ROM), VAS pain scores were analyzed.

    Results VAS pain scores and patient-related measures were significantly improved at the 10-year follow-up. Jamar grip strength was also significantly improved. ROM remained largely unchanged, except for extension which improved significantly at the 10-year follow-up. Five of 56 TWAs were revised. Five patients died of unrelated causes and 10 were lost to follow-up.

    Summary Points This study shows good long-term results after TWA with a high level of patient satisfaction. The revision rate was acceptable.

  • 2.
    Björk, Marie
    et al.
    Dep of Hand Surgery, Örebro University Hospital (Örebro).
    Niklasson, Johan
    Dep of Hand Surgery, Örebro University Hospital (Örebro).
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Self-efficacy corresponds to wrist function after combined plating of distal radius fractures2019In: Abstract book IFSHT, Freiburg: Intercongress GmbH , 2019, article id IFSHT19-1054Conference paper (Refereed)
    Abstract [en]

    Clinical issue/s: Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability willmore likely reach a good outcome. The distal radius fracture (DRF) is the most common fracture in adults constituting 18% of all fractures in an orthopedic trauma unit. To our knowledge there are no reports investigating the role of patient-reported self-efficacy in the rehabilitation of surgically treated DRFs. A tool that could identify patients in need of increased postoperative rehabilitation could potentially improve the allocation of rehabilitation resources.

    Clinical reasoning: The aim of this study was to examine if SE has an effect on physical functioning, pain and patient-rated wrist function three months postoperatively in patients who underwent combined plating with a volar and dorsal plate due to a distal radius fracture (DRF).

    innovative, analytical or new approach: Methods: This prospective study involved 67 patients. Follow-up results were available for 55 of them. The patients rated SE at the first appointment with the physiotherapist. The three months follow-up contained the outcome values: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip-strength and range of motion. Thestudy was approved by the regional ethical committee.

    Results: Three months after surgery the average wrist motion was 62-93 percent and hand grip-strength was 58 percent compared to the uninjured hand. Patients who rated high SE showed significantly better ROM for flexion and supination, handgrip-strength and PRWE-scores.

    Contribution to advancing HT practice: Discussion: Patients with a high SE are more likely to have a better wrist functionthree months postoperatively compared to patients with a low SE. Conclusion: SE can be a tool to assist the hand therapist in the allocation of rehabilitation resources.

  • 3.
    Björk, Marie
    et al.
    Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden.
    Niklasson, Johan
    Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiotherapy.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Self-efficacy corresponds to wrist function after combined plating of distal radius fractures2020In: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, Vol. 33, no 3, p. 314-319Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: A prospective cohort single-center study.

    INTRODUCTION: Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability will more likely reach a good outcome.

    PURPOSE OF THE STUDY: The aim of this study was to examine if SE has an effect to physical functioning, pain and patient-rated wrist function three months postoperatively in patients undergoing plating due to a distal radius fracture.

    METHODS: Sixty-seven patients undergoing plating for a distal radius fracture rated SE at the first appointment with the physiotherapist. At the three-month follow-up, the following assessments were administered: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip strength, and range of motion.

    RESULTS: The group with a high SE showed significantly better range of motion for flexion (P = .046) and supination (P = .045), hand grip strength (P = .001) and PRWE scores (P = .04). The NRS pain during activity was lower, although not significantly lower (P = .09). Using Spearman's rank correlation coefficient, there was a moderate correlation between SE and pain during activity, wrist flexion, and PRWE score.

    DISCUSSION: SE corresponds to wrist function after combined plating of distal radius fractures.

    CONCLUSION: Measurement of SE could possibly be useful to identify patients in special need of support during the postoperative rehabilitation.

  • 4.
    Fischer, Per
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years2018In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 43, no 5, p. 489.e1-489.e7Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.

    METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).

    RESULTS: Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.

    CONCLUSIONS: Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

  • 5.
    Fischer, Per
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Jakobsson, H.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pettersson, K.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Total Wrist Arthroplasty: A 10-Year Follow-Up2020In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 45, no 8, p. 780.e1-780.e10Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess long-term implant survival in total wrist arthroplasty (TWA), comparing 4 different implants.

    Methods: In a prospective cohort of 124 patients, 136 TWAs were evaluated 5 years and 10 years after surgery. The TWAs were implanted between 2005 and 2009. The primary outcome was implant survival. Survival analysis was performed with revision and radiographic loosening as the final end point. Revision was defined as exchange of whole or parts of the prosthesis. Implant loosening was assessed using radiographic examination at the 5-year and 10-year follow-up. Secondary outcome measures included wrist range of motion, hand grip strength, visual analog scale (VAS) pain scores, and patient-related outcome measures, including Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and Canadian Occupational Performance Measure (COPM).

    Results: Total cumulative implant survival was 92% with revision as the primary end point. When including a nonrevised radiographic loose implant as a failure, total implant survival was 75%. Radiographic loosening differed significantly between the implants with a range in frequency from 0% to 37.5%. At the 10-year follow-up, assessing the nonrevised TWAs, range of motion was preserved compared with preoperative values. Significant improvement was recorded for hand grip strength, VAS pain scores, and patient-related outcome measures at the 10-year follow-up compared with preovperative values.

    Conclusions: High 10-year implant survival was found when defining the primary end point as revision of any cause. When including radiographic loosening of the implant in the survival analysis, implant survival was considerably lower. However, radiographic loosening does not seem to correlate with changes in secondary outcome measures, questioning the need for revision surgery in these cases.

  • 6.
    Fischer, Per
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Jakobsson, Hugo
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Total wrist arthroplasty, a 10 year follow-upManuscript (preprint) (Other academic)
  • 7.
    Hooke, Alexander W.
    et al.
    Materials and Structural Testing Core Laboratory, Mayo Clinic, Rochester MN, USA.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    An, Kai-Nan
    Materials and Structural Testing Core Laboratory, Mayo Clinic, Rochester MN, USA.
    Rizzo, Marco
    Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA.
    An anatomic and kinematic analysis of a new total wrist arthroplasty design2015In: Journal of wrist surgery, ISSN 2163-3916, E-ISSN 2163-3924, Vol. 4, no 2, p. 121-127Article in journal (Other academic)
    Abstract [en]

    Background: Total wrist arthroplasty (TWA) is a viable surgical treatment for disabling wrist arthritis. While current designs are a notable improvement from prior generations, radiographic loosening and failures remain a concern.

    Purpose: The purpose of this investigation is to evaluate a new total wrist arthroplasty design kinematically. The kinematic function of a native, intact cadaveric wrist was compared with that of the same wrist following TWA.

    Method: Six, fresh-frozen wrist cadaveric specimens were utilized. Each wrist was fixed to an experimental table and its range of motion, axis of rotation, and muscle moment arms were calculated. The following tendons were attached to the apparatus to drive motion: extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and abductor pollicis longus (APL). The wrist was then manually moved along a guide by an experimenter through a series of motions including flexion-extension, radial-ulnar deviation, and circumduction. The experiment was then performed on the specimen following implantation of the TWA.

    Results: Following the TWA procedure, there were statistically significant decreases in the ulnar deviation and the flexion/ulnar deviation component of dart throw ranges of motion. There were no statistically significant changes in flexion, extension, radial deviation, the extension/radial deviation component of the dart thrower motion, or the circumduction range of motion.

    Conclusions: Kinematic analysis of the new TWA suggests that a stable, functional wrist is achievable with this design.

    Clinical Relevance: While appreciating the limitations of a cadaveric study, this investigation indicates that the TWA design studied merits study in human populations.

  • 8.
    Jakobsson, Hugo
    et al.
    Örebro University, School of Medical Sciences. Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lundqvist, Eva
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand and Orthopedic Surgery.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand and Orthopedic Surgery.
    Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome2023In: Archives of physiotherapy, E-ISSN 2057-0082, Vol. 13, no 1, article id 6Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF. MATERIALS &

    METHODS: This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength.

    RESULTS: Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse.

    CONCLUSIONS: Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.

  • 9.
    Karlsson, Emma
    et al.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedic Surgery.
    Björling, Patrik
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Combined volar and dorsal plating vs. volar plating of distal radius fractures: A single-center study of 105 cases2020In: Hand surgery & rehabilitation, ISSN 2468-1229, Vol. 39, no 6, p. 516-521Article in journal (Refereed)
    Abstract [en]

    Despite recent advances in the surgical management of distal radius fractures (DRFs), the optimal treatment remains controversial as different fixation methods often have similar clinical functional and radiographic outcomes. The objective of this study was to assess the differences in outcomes 1 year postoperatively between volar plating and combined plating for DRFs. In a retrospective cohort study, we evaluated 105 consecutive patients operated with either a volar locking plate or combined dorsal and volar plating. The primary outcome was wrist range of motion (ROM). Secondary outcome measures included hand grip strength, visual analog scale (VAS) pain scores, radiographic examination and patient-related outcome measures. Patients treated with combined plating had significantly inferior wrist flexion, extension and ulnar deviation. The radiographic Batra score 1 year postoperatively was similar for both groups. The PRWE (patient-rated wrist evaluation) score was 16 for the volar plating group and 14 for the combined plating group. The QuickDASH (Quick disabilities of the hand arm and shoulder) score was 9 for the volar plating group and 16 for the combined plating group. VAS pain scores were 0 at rest and 2 during activity for both groups. Grip strength was similar between the two groups. Hardware removal was done in 18/78 patients for the combined plating group and 1/27 for the volar plate group. Two patients operated with combined plating had tendon ruptures. Our findings indicate that both methods can yield satisfactory clinical and radiographic outcomes. However, combined plating resulted in inferior wrist ROM and substantially higher frequency of hardware removal. The potential advantages of combined plating in stabilizing a comminuted DRF must be balanced by the potential drawbacks such as inferior wrist ROM and higher frequency of hardware removal.

  • 10.
    Larsson, Sune
    et al.
    Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
    Berg, Per
    Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
    Sagerfors, Marcus
    Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
    Augmentation of Tibial Plateau Fractures with Calcium Phosphate Cement: A Randomized Study Using Radiostereometry2004Conference paper (Refereed)
    Abstract [en]

    Purpose: One problem with tibial plateau fractures that involve a depressed articular fragment is the difficulty of maintaining reduction until healing. The conventional method is to fill the subchondral void with autologous bone transplant followed by restricted weightbearing for 8 to 12 weeks. Recently, biomaterials have been introduced that might overcome several problems associated with bone transplant. The purpose of this study was to evaluate an injectible calcium-phosphate cement when used as a bone graft substitute in lateral tibial plateau fractures, with special emphasis on the stability of the elevated articular fragment.

    Methods: Twenty-four patients with a lateral tibial plateau fracture type 41-B2 or 41-B3 (OTA classification) were included. The authors operated on all patients. Conventional metal fixation was used to fix the fracture following elevation of the articular fragment. The subchondral void was filled with injectable calcium-phosphate cement (Norian SRS, Synthes) or conventional iliac bone graft according to randomization during surgery. There were 12 patients in each group with an average age of 50 and 52 years, respectively. During surgery, tantalum markers were inserted for subsequent radio stereometry (RSA) (RSA Biomedical Innovation, Umeå, Sweden), a radiologic technique that enables measurement of movement along and around three orthogonal axes with a precision of less than 0.5 mm and 0.7°. Continuous passive motion was begun immediately after surgery. Weightbearing was restricted to 20 kg for 6 weeks in the SRS group and for 12 weeks in the control group. Radio stereometry was performed before weightbearing and at 1, 6, and 12 weeks and at 6 and 12 months. Conventional radiographs were used for assessment of reduction and healing. Clinical evaluation (Lysholm score and a visual analog scale score of 0 to 10 for pain) was conducted by a physiotherapist. For assessment of compliance with regard to weightbearing, patients were examined with F Scan (Tecscan, Inc., Boston, Massachusetts, USA) at each time point.

    Results: No patients were lost but two were excluded from the RSA evaluation due to technical problems. All fractures healed. There was one deep infection (SRS). At 6 weeks, average weightbearing was 22 kg in the SRS group and 19 kg among the controls (NS); at 12 weeks, 66 kg vs. 28 kg (P <0.001); and at 6 and 12 months, on average, between 66 and 72 kg with no difference between groups. Pain during activity was lower in the SRS group at 1 week (P <0.01), 6 weeks (P <0.004), 3 months (P <0.005), and at 6 months (P <0.02), with no difference at 1 year. The Lysholm knee score was better at 6 weeks (P <0.01), 12 weeks (P <0.002), and 6 months (P <0.02) in the SRS group, and there was no significant difference at 1 year. Radio stereometry revealed movement of the articular fragment in all patients. The total translation was, on average, 1.41 mm in the SRS group and 3.88 mm in the controls (P <0.001). In both groups the most significant movement occurred during the first 6 weeks, and there was no significant movement of the articular fragment from 6 to 12 months, indicating stable healing. The most typical pattern of movement was subsidence along the vertical axis or rotation in the transversal axis (forward tilt) or both, and as toe-out rotation around the vertical axis. One patient from the SRS group had a migration exceeding 3 mm, and two controls had a migration exceeding 5 mm.

    Conclusion/Significance: Injectable calcium-phosphate cement provided a more stable fixation of the elevated articular fragment in lateral tibial plateau fractures when compared with conventional bone graft, despite the fact that cement-augmented patients were allowed earlier weightbearing. Patients treated with cement also had less pain during the entire course of healing when compared with controls. Bone graft substitutes can offer new perspectives for treatment of fractures involving metaphyseal defects, without the side effects associated with bone grafting.

  • 11.
    Lundqvist, Eva
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Fischer, Per
    Örebro University, School of Medical Sciences. Karlstad Central Hospital, Karlstad, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Krauss, Wolfgang
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Örebro University Hospital, Örebro, Sweden.
    Posttraumatic Arthritis After Combined Plating of Distal Radius Fractures AO Type C: A 7-Year Follow-up of 97 Cases2022In: Hand (New York, N.Y.), ISSN 1558-9447, no Sup. 1, p. 50S-59SArticle in journal (Refereed)
    Abstract [en]

    BACKGROUND: Volar locking plate fixation is the most common method of operative fixation of distal radius fractures (DRFs). For more complex cases, combined plating is an option for stabilizing intra-articular fragments. The prevalence of posttraumatic arthritis (PA) after an intra-articular DRF, and its relation to patient-reported outcome measures (PROMs), remains unclear. The purpose of this study was to study the prevalence of PA and its correlation to clinical outcome measures.

    METHODS: We evaluated 97 consecutive patients with intra-articular DRF, operated with combined plating, 7 years postoperatively. The primary outcome measure was the prevalence of radiographic PA. Secondary outcome measures included visual analog scale (VAS) pain score, hand grip strength, wrist range of motion (ROM), Patient-Rated Wrist Evaluation (PRWE) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographic examination was performed between 1 and 7 years postoperatively.

    RESULTS: The prevalence of PA was 29% at the 7-year follow-up. No correlation was found between PA and ROM, hand grip strength, PRWE, QuickDASH, VAS pain scores, or radiographic reduction. Median wrist ROM and grip strength were significantly inferior compared with the uninjured side. Hardware removal was performed in 51.5% of cases. There were 2 cases of tendon ruptures.

    CONCLUSIONS: Combined plating can yield a good clinical outcome 7 years postoperatively and a low prevalence of PA. The presence of PA did not correlate to clinical outcome measures or to the accuracy of anatomical reduction 1 year postoperatively. The frequency of tendon ruptures was acceptable, but the high frequency of hardware removal is a concern.

  • 12.
    Lundqvist, Eva
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Fischer, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics, Karlstad Central Hospital, Karlstad, Region Värmland, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Pettersson, Kurt
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Region Västernorrland, Sundsvall, Sweden.
    Lopez Personat, Adolfo
    Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures: A Randomized Controlled Study of 150 Cases2022In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 47, no 9, p. 813-822Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating.

    METHODS: In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score.

    RESULTS: Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group.

    CONCLUSIONS: In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

  • 13.
    Lundqvist, Eva
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    Kempe, Louise
    Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Krauss, Wolfgang
    Örebro University, School of Medical Sciences. Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    Pyrolytic Carbon Hemiarthroplasty for Proximal Interphalangeal Joint Arthritis, Long-Term Follow-Up2023In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to assess the long-term clinical, subjective, and radiographic results of pyrocarbon hemiarthroplasty for proximal interphalangeal joint (PIPJ) arthritis at a single institution.

    METHODS: Patients treated with a pyrolytic carbon hemiarthroplasty between 2005 and 2015 were contacted for a clinical follow-up visit. Patients were assessed before surgery, one year after surgery, and again after a mean of 11 years (range: 6-16 years). Objective outcomes were assessed with grip strength, pinch strength, and range of motion (ROM). Subjective outcomes were assessed by the Disabilities of the Arm, Shoulder, and Hand score, Canadian Occupational Performance Measure (performance and satisfaction), and Visual Analog Scale pain scores at rest and during activity. Radiographic assessments were completed according to Sweets and Stern as modified by Wagner et al.

    RESULTS: A total of 68 fingers in 52 patients underwent PIPJ hemiarthroplasty. Thirty-six arthroplasties in 29 patients were available for the long-term follow-up, five patients had died, and the remaining cases were contacted by phone. Three cases were lost to follow-up. Preoperative diagnoses included 41 fingers with osteoarthritis or posttraumatic arthritis, and 27 fingers with inflammatory arthritis. Eight cases had undergone revision at the time of follow-up, and the 10-year implant survival was 72%. The revisions were performed after a mean of two years after surgery. Three patients had undergone soft-tissue procedures. Visual Analog Scale pain scores, Disabilities of the Arm, Shoulder, and Hand scores, and Canadian Occupational Performance Measure scores improved significantly compared with that before surgery. Grip strength and pinch grip remained unchanged. However, PIPJ ROM deteriorated significantly one year after surgery, when compared with that before surgery.

    CONCLUSIONS: Pyrocarbon hemiarthroplasty of the PIPJ has an acceptable long-term implant survival, and the significant improvement in pain scores and patient-reported outcomes is maintained over time. Pyrocarbon hemiarthroplasty could be a viable option in the management of PIPJ arthritis. Patients should be advised that PIPJ ROM deteriorates over time.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

  • 14.
    Lundqvist, Eva
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    Olivecrona, Henrik
    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    CT-Based Micromotion Analysis After Locking Plate Fixation of AO Type C Distal Radius Fractures2023In: Indian Journal of Orthopaedics, ISSN 0019-5413, E-ISSN 1998-3727, Vol. 57, no 12, p. 2031-2039Article in journal (Refereed)
    Abstract [en]

    Background: Volar locking plate fixation (VLPF) is the most common method for operative fixation of distal radius fractures (DRF). The dorsal ulnar corner (DUC) can be difficult to stabilize as the fragment is small and not exposed when using the volar approach. The purpose of this study was to study fracture fragment migration after VLPF of AO type C DRF, using a volume registration technique of paired CT scans with special focus on the DUC fragment.

    Materials and Methods: This pilot study included ten patients with AO type C DRF, all operated with VLPF. The primary outcome was radiographic outcome. Postoperative and 1-year scans were compared and analyzed. Fragment migration was assessed with CT-based micromotion analysis (CTMA), a software technique used for volume registration of paired CT scans.

    Results: All plates were stable over time. Two patients showed signs of screw movement (0.2-0.35 mm and 0.35- > 1 mm respectively). Postoperative reduction was maintained, and there was no fragment migration at the 1-year follow-up except for one case with increased dorsal tilt. The DUC fragment was found in 8/10 cases, fixated in 7/8 cases, and not dislocated in any case at the 1-year follow-up.

    Conclusion: The CTMA results indicate that variable-angle VLPF after AO type C DRF can yield and maintain a highly stable reduction of the fracture fragments. The DUC fragment remained stable regardless of the number of screws through the fragment. CT volume registration can be a valuable tool in the detailed assessment of fracture fragment migration following volar plate fixation of DRFs.

  • 15.
    Lundqvist, Eva
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery, Örebro University Hospital, Sweden.
    Olivecrona, Henrik
    Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery, Örebro University Hospital, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery, Örebro University Hospital, Sweden.
    CT-based micromotion analysis of fracture fragment migration after locking plate fixation of AO type C distal radius fracturesManuscript (preprint) (Other academic)
  • 16.
    Lundqvist, Eva
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    Olivecrona, Henrik
    Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery, Örebro University Hospital, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    CT-based micromotion analysis of fracture fragment migration after locking plate fixation of AO type C distal radius fractures2023In: FESSH-EFSHT 2023 Congress: Abstract Book, 2023, p. 22-23, article id A-0047Conference paper (Other academic)
  • 17.
    Niklasson, Johan
    et al.
    Dep of Hand Surgery, Örebro University Hospital (Örebro).
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Pettersson, Kurt
    Dep of Hand Surgery, Örebro University Hospital (Örebro).
    Pulp-to-palm distance is associated with functional outcome 3 months after combined plating for distal radius fracture2019In: Abstract book IFSHT, Freiburg: Intercongress GmbH , 2019Conference paper (Refereed)
    Abstract [en]

    Clinical issue/s: Objective: The Distal Radius Fracture (DRF) is the most common fracture in adults. After surgical management, extensive rehabilitation programs are common in order to restore function. Some patients are not able to fully move their fingers during the first month after a DRF-surgery (Pulp-to-palm distance=PTP).

    Clinical reasoning: The purpose of this study was to investigate if increased PTP 4 weeks after DRF surgery is associated with an inferior functional outcome 3 months postoperatively after DRF-surgery.

    innovative, analytical or new approach: Materials and Methods: This prospective study involved 53 DRF-patients with intra-articular type C fractures according to the AO-classification. All patients were treated with combined volar and dorsal plating. The patients were assessed at 4 weeks and 3 months postoperatively according to PTP-distance, wrist range of motion, grip strength, VAS pain scores and self-assessed hand function. Rehabilitation was the same for all patients with focus on self-training instructions, regardless of individual finger and wrist status.

    Results: 20 patients had a PTP > 0 cm 4 weeks after surgery. Three months after surgery, all patients had regained full fingermotion. The group with PTP > 0 cm showed significantly inferior range of motion regarding dorsal- and volar flexion, radial- and ulnar deviation as well as grip strength and quick-DASH 3 months after surgery. Inferior outcomes for pro- and supination and PRWE-scores was seen but were not significant. Pain at rest and during activity showed no significant differences between the groups.

    Contribution to advancing HT practice: Conclusions: Impaired finger motion 4 weeks postoperatively is a significant predictor of functional outcome 3 months postoperatively in surgically treated DRFs. Measuring the PTP-distance can assist the physiotherapist in the allocation of rehabilitation resources.

  • 18.
    Reiser, Daniel
    et al.
    Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Fischer, Per
    Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pettersson, Kurt
    Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    Total Wrist Arthroplasty With a New Design, 20 Cases With 8-Year Follow-Up2023In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design.

    METHODS: Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed.

    RESULTS: In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases.

    CONCLUSIONS: The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

  • 19.
    Reiser, Daniel
    et al.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hedspång, Mattias
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Dry Arthroscopy of the Wrist With a Single-use, 1.9 mm Chip-on-tip System in Wide-awake Local Anesthesia No Tourniquet2022In: Techniques in Hand & Upper Extremity Surgery, ISSN 1089-3393, E-ISSN 1531-6572, Vol. 26, no 4, p. 246-249Article in journal (Refereed)
    Abstract [en]

    We retrospectively reviewed our 34 first wrist dry arthroscopy cases using a single-use, 1.9 mm chip-on-tip system in wide-awake local anesthesia no tourniquet (WALANT). Thirteen patients were acute injuries; all acute patients underwent a magnetic resonance imaging (MRI) before arthroscopy. In total, 20 of 34 patients had a preoperative MRI. We use this method as a diagnostic tool in patients with wrist pain with suspected ligament tears and for the planning of treatment. We see 2 main advantages in the use of the needle chip-on-tip system: the simplicity of the procedure, and the minimal invasive character of the procedure due to the needle size that makes it possible to perform the procedure in WALANT. We find that the needle chip-on-tip arthroscopy system is a safe and cost-efficient alternative to wrist MRI with superior diagnostic ability. The procedure is minimally invasive and well suited for WALANT.

  • 20.
    Reiser, Daniel
    et al.
    Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
    Pettersson, Kurt
    Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
    Fischer, Per
    Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden; Karlskoga Hospital, Sweden.
    Clinical, Radiographic, and Patient-Perceived Outcome After Radial Hemi-Wrist Arthroplasty With a New Implant: 20 Cases With 5-Year Follow-up2023In: Hand (New York, N.Y.), ISSN 1558-9447, article id 15589447231151427Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design.

    METHODS: In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively.

    RESULTS: A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged.

    CONCLUSIONS: The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.

  • 21.
    Reiser, Daniel
    et al.
    Department of Hand Surgery and Orthopedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Szallasi, Arpad
    Department of Pathology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery and Orthopedics.
    ALK1-negative primary cutaneous anaplastic large cell lymphoma of the hand and wrist2023In: Journal of Hand Surgery, European Volume, ISSN 1753-1934, E-ISSN 2043-6289, Vol. 48, no 3, p. 276-277Article in journal (Refereed)
  • 22.
    Sagerfors, Marcus
    Örebro University, School of Medical Sciences.
    Total wrist arthroplasty: A clinical, radiographic and biomechanical investigation2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: To study patient-related functional outcome measures, implant survival and radiographic loosening after total wrist arthroplasty (TWA) using four different implants. To evaluate a new TWA design biomechanically and clinically.

    Methods: The studies included two cohort studies with prospectively collected data (n=206 and n=219), an anatomic and kinematic analysis in a cadaveric model and a pilot study (n=20).

    Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. Summarized patientrelated functional outcome was significantly better for the Maestro than for the Remotion TWA. Cumulative implant survival after 8 years was 94% for Remotion, and 95% for Maestro implants. Radiographic loosening five years postoperatively was present in 26% of the Biax wrists, 18% of those with Remotion, and 2% of those with Maestro. Following TWA with the new implant design in a cadaveric model, there were no statistically significant changes compared to a native wrist regarding flexion, extension, radial deviation, the extension/radial deviation component of the dart-thrower’s motion, or the circumduction range of motion. Clinically, there was significant improvement of COPM, PRWE and VAS pain scores. Wrist extension and ulnar deviation improved, while grip strength remained largely unchanged.

    Conclusions: TWA is a surgical procedure which may offer a high level of patient satisfaction. Implant design may affect patient-related functional outcome after TWA. Implant survival as well as the frequency of radiographic loosening differed considerably between the four types of implants and might be a result of different implant design. Kinematic analysis of the new TWA design suggests that a stable and functional wrist is achievable with this design. Surgical placement of the new total wrist implant was reproducible and the implant yielded good patient-related outcome measures in the short term. Since TWA is an evolving procedure, further studies are warranted in order to refine indications and the place for TWA in modern hand surgery.

    List of papers
    1. Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases
    Open this publication in new window or tab >>Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases
    Show others...
    2015 (English)In: Hand Surgery, ISSN 0218-8104, Vol. 20, no 1, article id 81Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden.

    Methods: 206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity.

    Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion.

    Conclusions All four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.

    Place, publisher, year, edition, pages
    Singapore: World Scientific Publishing, 2015
    Keywords
    Arthroplasty, Rheumatoid, Total Wrist, Joint
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-52144 (URN)10.1142/S0218810415500112 (DOI)000216862600012 ()25609279 (PubMedID)2-s2.0-84941743295 (Scopus ID)
    Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2019-03-26Bibliographically approved
    2. Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up
    Open this publication in new window or tab >>Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up
    2015 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 40, no 12, p. 2380-2387Article in journal (Refereed) Published
    Abstract [en]

    Purpose: To assess implant survival and radiographic loosening after total wrist arthroplasty (TWA) operated at a single tertiary referral center in Sweden.

    Methods: In a prospective cohort study, we evaluated 189 consecutive patients with a TWA(219 wrists). The wrists were implanted between 2002 and 2013. The primary end point was revision for any reason. The mean follow-up period was 7 years (range, 2-13 years). In addition, radiological examination was done for evidence of prosthetic loosening 5 years postoperatively. Implant survival was estimated using the Kaplan-Meier method. Secondary outcome measures included range of motion, visual analog scale pain scores, hand grip strength, and patient-related outcome measures.

    Results: Cumulative implant survival after 8 years was 81% for Biax, 94% for Remotion, and 95% for Maestro implants. Radiographic loosening was present in 26% of wrists with the Biax design, 18% of those with Remotion, and 2% of those with Maestro. Visual analog scale pain scores and patient-related outcome scores improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except for the Universal 2. Range of motion improved somewhat, especially for the Biax and Maestro TWAs.

    Conclusions: Good midterm to long-term results were achieved in patients undergoing TWA. Radiographic loosening did not necessarily correlate with implant survival rates, but rather to severe arthritic destruction of the wrist preoperatively. All TWA implants studied offered a high level of patient satisfaction.

    Place, publisher, year, edition, pages
    Saunders Elsevier, 2015
    Keywords
    Osteoarthritis, rheumatoid arthritis, total wrist arthroplasty
    National Category
    Orthopaedics Surgery
    Research subject
    Orthopaedics; Surgery
    Identifiers
    urn:nbn:se:oru:diva-47985 (URN)10.1016/j.jhsa.2015.09.016 (DOI)000368270600009 ()26612635 (PubMedID)2-s2.0-84955472864 (Scopus ID)
    Note

    Funding Agency:

    Research Committee of the Örebro County Council

    Available from: 2016-02-05 Created: 2016-02-05 Last updated: 2019-03-26Bibliographically approved
    3. An anatomic and kinematic analysis of a new total wrist arthroplasty design
    Open this publication in new window or tab >>An anatomic and kinematic analysis of a new total wrist arthroplasty design
    Show others...
    2015 (English)In: Journal of wrist surgery, ISSN 2163-3916, E-ISSN 2163-3924, Vol. 4, no 2, p. 121-127Article in journal (Other academic) Published
    Abstract [en]

    Background: Total wrist arthroplasty (TWA) is a viable surgical treatment for disabling wrist arthritis. While current designs are a notable improvement from prior generations, radiographic loosening and failures remain a concern.

    Purpose: The purpose of this investigation is to evaluate a new total wrist arthroplasty design kinematically. The kinematic function of a native, intact cadaveric wrist was compared with that of the same wrist following TWA.

    Method: Six, fresh-frozen wrist cadaveric specimens were utilized. Each wrist was fixed to an experimental table and its range of motion, axis of rotation, and muscle moment arms were calculated. The following tendons were attached to the apparatus to drive motion: extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and abductor pollicis longus (APL). The wrist was then manually moved along a guide by an experimenter through a series of motions including flexion-extension, radial-ulnar deviation, and circumduction. The experiment was then performed on the specimen following implantation of the TWA.

    Results: Following the TWA procedure, there were statistically significant decreases in the ulnar deviation and the flexion/ulnar deviation component of dart throw ranges of motion. There were no statistically significant changes in flexion, extension, radial deviation, the extension/radial deviation component of the dart thrower motion, or the circumduction range of motion.

    Conclusions: Kinematic analysis of the new TWA suggests that a stable, functional wrist is achievable with this design.

    Clinical Relevance: While appreciating the limitations of a cadaveric study, this investigation indicates that the TWA design studied merits study in human populations.

    Place, publisher, year, edition, pages
    New York: Thieme Medical Publishers, 2015
    Keywords
    Arthroplasty, rheumatoid, total wrist, joint, biomechanics
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-52145 (URN)10.1055/s-0035-1549288 (DOI)000218778400009 ()25945297 (PubMedID)
    Note

    Funding agencies:

    TriMed, Inc 

    Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2019-03-26Bibliographically approved
    4. Clinical, radiographical and functional evaluation of a new total wrist implant: A pilot study
    Open this publication in new window or tab >>Clinical, radiographical and functional evaluation of a new total wrist implant: A pilot study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-52146 (URN)
    Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2019-03-26Bibliographically approved
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  • 23.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Björling, Patrik
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Niklasson, Johan
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases2019In: Journal of wrist surgery, ISSN 2163-3916, E-ISSN 2163-3924, Vol. 8, no 3, p. 180-185Article in journal (Refereed)
    Abstract [en]

    Background The distal radius fracture (DRF) is the most common fracture among adults. In recent years, there has been a shift toward volar locking plates in the treatment of DRFs, and this shift has taken place with a low degree of evidence.

    Question/purposes Can combined volar T-plating and dorsal pi-plating of AO type C fractures yield a good functional and radiographic outcome 1 year postoperatively?

    Patients and Methods In a retrospective cohort study, we evaluated 102 consecutive patients operated with combined dorsal and volar plating, of whom 80 completed the 1-year follow-up. The DRFs were operated between 2012 and 2013. All cases were AO type C2 and C3 fractures. The primary outcome was functional scoring including radiographic examination. Secondary outcome measures included range of motion, visual analog scale (VAS) pain scores, and hand grip strength.

    Results The median Batra radiographic score was 84.5. Wrist extension was 74% of the uninjured side, flexion was 70%, pronation was 94%, and supination was 90%. The Patient-Rated Wrist Evaluation score was 21 points, and the Disabilities of the Arm, Shoulder, and Hand score was 19.4 points. VAS pain scores were 0 at rest and 3 during activity. Hand grip strength was 80% of the uninjured side. Radiographic outcome did not correspond to a patient-reported outcome. Hardware removal was performed in 15/80 cases.

    Conclusions We conclude that a good outcome can be expected after combined dorsal and volar plating of DRFs. Radiographic outcome is not necessarily associated with functional outcome 1 year postoperatively. The rate of hardware removal was acceptable.

  • 24.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery.
    Brus, Ole
    Faculty of Medicine and Health, Örebro university, Örebro, Sweden.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Clinical, radiographical and functional evaluation of a new total wrist implant: A pilot studyManuscript (preprint) (Other academic)
  • 25.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
    Patient-Perceived Outcome After Total Wrist Arthroplasty: A Single-Center Study of 223 Cases2016In: Hand, ISSN 1558-9447, Vol. 11, no 1_suppl, p. 2S-2SArticle in journal (Refereed)
    Abstract [en]

    Purpose: Total wrist arthroplasty (TWA) is an established surgical treatment for wrist arthritis. The aim of the investigation is to report patient-perceived outcome measures after TWA operated at a single referral center in Sweden.

    Methods: In a cohort study with prospective collection of data, we evaluated 193 consecutive patients with a TWA (223 wrists) preoperatively, 1 and 5 years postoperatively. The wrists were implanted between 2002 and 2014. Outcome measures studied were range of motion (ROM), visual analogue scale (VAS) pain scores, hand grip strength, and patient-related outcome measures. Secondary outcome measures included implant survivorship, which was estimated using the Kaplan-Meier method, and radiographic loosening 5 years postoperatively.

    Results: VAS pain scores and patient-related outcome measures improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except Universal 2. ROM improved somewhat, especially for the Biax and Maestro TWAs. Cumulative implant survival after 5 years was 99% for Remotion, 95% for Maestro, and 84% for Biax. Radiographic loosening was present in 26% of the Biax cases, 18% of the Remotion cases, and 2% of the Maestro cases.

    Conclusions: All TWA designs in this study offer a high level of patient satisfaction. The design of the implant may affect patient-perceived outcome 5 years postoperatively. Good mid to long-term results can be achieved in patients undergoing TWA.

  • 26.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Brus, Ole
    Örebro University, Örebro, Sweden.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up2015In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 40, no 12, p. 2380-2387Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess implant survival and radiographic loosening after total wrist arthroplasty (TWA) operated at a single tertiary referral center in Sweden.

    Methods: In a prospective cohort study, we evaluated 189 consecutive patients with a TWA(219 wrists). The wrists were implanted between 2002 and 2013. The primary end point was revision for any reason. The mean follow-up period was 7 years (range, 2-13 years). In addition, radiological examination was done for evidence of prosthetic loosening 5 years postoperatively. Implant survival was estimated using the Kaplan-Meier method. Secondary outcome measures included range of motion, visual analog scale pain scores, hand grip strength, and patient-related outcome measures.

    Results: Cumulative implant survival after 8 years was 81% for Biax, 94% for Remotion, and 95% for Maestro implants. Radiographic loosening was present in 26% of wrists with the Biax design, 18% of those with Remotion, and 2% of those with Maestro. Visual analog scale pain scores and patient-related outcome scores improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except for the Universal 2. Range of motion improved somewhat, especially for the Biax and Maestro TWAs.

    Conclusions: Good midterm to long-term results were achieved in patients undergoing TWA. Radiographic loosening did not necessarily correlate with implant survival rates, but rather to severe arthritic destruction of the wrist preoperatively. All TWA implants studied offered a high level of patient satisfaction.

  • 27.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Brus, Ole
    Örebro University, Örebro, Sweden.
    Rizzo, Marco
    Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA.
    Pettersson, Kurt
    Department of Hand Surgery, Örebro University, Örebro, Sweden.
    Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases2015In: Hand Surgery, ISSN 0218-8104, Vol. 20, no 1, article id 81Article in journal (Refereed)
    Abstract [en]

    Objectives: To prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden.

    Methods: 206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity.

    Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion.

    Conclusions All four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.

  • 28.
    Sagerfors, Marcus
    et al.
    Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Hedspång, Mattias
    Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Reiser, Daniel
    Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Dry Arthroscopy of the Wrist With a Single-use, 1.9 mm Chip-on-tip System in Wide-awake Local Anesthesia No Tourniquet2022Conference paper (Other academic)
  • 29.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Hedspång, Mattias
    Reiser, Daniel
    NanoScope in WALANT vsMRI in diagnosing acute ligament-tears of the wrist, 30 consecutivecases2023In: International Guest Society ePoster Abstract Book, 2023, article id IGS0015Conference paper (Other academic)
  • 30.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    Jakobsson, Hugo
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery.
    Thórdardóttir, Ásgerdur
    Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery.
    Möller, Michael
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
    Distal radius fractures in the superelderly: an observational study of 8486 cases from the Swedish fracture register2022In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, no 1, article id 140Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The distal radius fracture (DRF) is the most common fracture in adults. With an ageing population, the number of wrist fractures in the superelderly (≥ 80 years) is expected to rise. Optimal treatment for displaced DRFs remains controversial, especially in the superelderly group. In addition, basic knowledge of the outcome after a DRF in this heterogenic group is lacking. The aim of this study was to study injury characteristics, treatment and outcome of DRFs in superelderly patients using data from a large national register.

    METHODS: We used prospectively collected data from the Swedish Fracture Register. All distal radius fractures registered between April 2012 and December 2018 in patients ≥ 80 years of age were included. Data on epidemiology, fracture type, trauma mechanism and treatment are registered by the physician treating the patient. Patients are also sent a subjective outcome questionnaire including EQ-5D, EQ-VAS and Short Musculoskeletal Function Assessment questionnaire (SMFA-score) at the time of injury and after 12 months. The 12-month questionnaire was sent to those who had completed the questionnaire at the time of injury. A Mann-Whitney U-test was used to assess differences between treatment methods.

    RESULTS: Mean age for this population was 86 years (80-105 years), a majority of the patients were female (86.7%). The dominating injury mechanism was a simple fall (74.6%) in the patient's residence. The majority of fractures were AO type A (70%) followed by AO type C (20.9%) and type B (8.6%). The incidence of open fractures was significantly higher in females (2.6%) compared to males (1.5%). A majority of the fractures were treated with a cast (87.5%) with volar locking plate as the second most common treatment method (6.6%). Patient-reported outcome measures (PROMs) EQ-5D, EQ-VAS and the Arm Hand Function Index of the SMFA-score deteriorated somewhat one year after injury compared to pre-injury. PROMs did not correlate to treatment with cast or a volar plate.

    CONCLUSIONS: This nationwide register study provides detailed data on DRFs in the superelderly regarding epidemiology, treatment and self-reported outcome. A good self-reported outcome is possible, but many patients do not recover completely. PROMs did not correlate to type of treatment. The frequency of open fractures was significantly higher in females. The reason for this is unclear but different skin thickness in older males versus females may be one explanation.

  • 31.
    Sagerfors, Marcus
    et al.
    Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Jakobsson, Hugo
    Department of Orthopedics and Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Thórdardóttir, Ásgerdur
    Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Möller, Michael
    Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Distal radius fractures in the superelderly: an observational study of 8486 cases from the Swedish fracture register2022Conference paper (Other academic)
  • 32.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Jakobsson, Hugo
    Örebro University, School of Medical Sciences.
    Wretenberg, Per
    Örebro University, School of Medical Sciences.
    Distal Radius Fracture AO type C, Treatment and Outcome. An Observational Study of 12,199 Fractures from the National Swedish Fracture Register2022In: AAHS 2022 American Association of Hand Surgery, 2022Conference paper (Other academic)
  • 33.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics and Hand Surgery.
    Jakobsson, Hugo
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopedics and Hand Surgery.
    Brus, Ole
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics unit.
    Möller, Michael
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg. Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
    Treatment and outcome of AO/OTA type C distal radius fractures: 12 199 fractures from the Swedish Fracture Register2023In: Acta Orthopaedica Belgica, ISSN 0001-6462, Vol. 89, no 2, p. 241-247Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine the epidemiology, treatment, and patient-reported outcome of AO/OTA type C distal radius fractures (DRF) using data from a large national fracture register. We used prospectively collected data from the Swedish Fracture Register covering all AO/OTA type C DRFs registered between April 2012 and December 2018. Data on fracture type, epidemiology, trauma-mechanism, and treatment had been recorded by the treating physician. Patients had been sent an outcome questionnaire including EQ-VAS, EQ-5D, and the SMFA at the time of injury and 12 months after. A total of 12 199 cases with AO/OTA type C fracture were identified. AO/OTA type C1 fracture was most common, with 5400 cases, followed by AO type C2 with 4304 and AO/OTA type C3 with 2495. Cast treatment and surgical treatment with volar locking plate fixation were the most common treatments. Patient-reported outcome measures worsened significantly one year after the fracture, and 56% reported moderate problems with pain and discomfort one year after the fracture. Patients treated with a volar plate reported a significantly larger deterioration in EQ-5D outcome compared to patients treated with a cast. No treatment method was found to be superior. A good outcome after a type C fracture is possible, but many patients do not recover completely. Our findings indicate a relatively better self-reported outcome for patients treated with a cast, but as treatment was not randomized the clinical relevance is unclear.

  • 34.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Lundqvist, Eva
    Örebro University, School of Medical Sciences. Department of Hand Surgery.
    Bjorling, Patrik
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden.
    Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases2020In: Journal of wrist surgery, ISSN 2163-3916, E-ISSN 2163-3924, Vol. 9, no 5, p. 388-395Article in journal (Refereed)
    Abstract [en]

    Background: The distal radius fracture (DRF) is themost common fracture in adults. For unstable intra- articular fractures, the choice of treatment is often operative. The optimal choice of fixation remains a matter of discussion.

    Question/Purpose: Can combined volar and dorsal plating, using a dorsal frame plate, achieve a good functional and radiographic 1-year outcome in intra-articular DRFs? Methods In a retrospective cohort study, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate. The DRFs were operated between 2016 and 2017 and all cases were AO type C intraarticular fractures. The primary outcome was patient- reported outcome measures including radiographic examination 1 year postoperatively. Secondary outcome measures included wrist range of motion, visual analog scale (VAS) pain scores, and hand grip strength.

    Results: The median patient-rated wrist evaluation score was 18 points; the quick disabilities of the arm, shoulder, and hand score was 14.8 points. The median Batra radiographic score was 88. Wrist extension was 76% of the uninjured side, flexion was 74%, pronation was 94%, and supination was 94%. VAS pain scores were 0 at rest and 2 during activity. Hand grip strength was 82% compared with the uninjured side. The radiographic outcome according to Batra did not correspond to the patient-reported outcome. Patients older than 60 years had significantly better QuickDASH (quick disabilities of the arm, shoulder, and hand) and PRWE scores (patient-rated wrist evaluation scores) and less pain during activity compared with younger patients despite similar radiographic outcome. There were no tendon ruptures; hardware removal was performed in 21 of the 74 patients.

    Conclusion: The radiographic outcome did not correspond to the functional outcome 1 year postoperatively. Older patients report less pain and better functional outcome compared with younger patients. There were no tendon ruptures and the frequency of hardware removal was acceptable. Complex intra-articular DRFs AO type C can be managedwith volar and dorsal frame-plate fixation to restore distal radius anatomy and achieve a good functional outcome.

  • 35.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Lundqvist, Eva
    Örebro University, School of Medical Sciences.
    Bjorling, Patrik
    Orebro university, Orebro, Sweden.
    Combined Volar and Dorsal Plating for Distal Radius Fractures using a Dorsal Frame Plate, a Consecutive Series of 74 AO type C Cases2020Conference paper (Refereed)
    Abstract [en]

    Introduction: The distal radius fracture (DRF) is the most common fracture in adults. For unstable intra-articular fractures, the choice of treatment is often operative. The type of operation and optimal choice of implant remains a matter of discussion.

    Materials and Methods: In a retrospective cohort study, following ethical approval, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate (Medartis AG.). The DRFs were operated between 2016 and 2017. All cases were AO type C fractures. The primary outcome was patient reported outcome measures including radiographic examination one year postoperatively. Secondary outcome measures included wrist range of motion, VAS pain-scores and hand grip-strength.

    Results: The median Batra radiographic score was 88. Median wrist extension was 76 % of the uninjured side, flexion was 74 %, pronation was 94 % and supination was 94 %. The Patient-Rated Wrist Evaluation-score was 18 points, the Disabilities of the Arm, Shoulder and Hand-score was 14.8 points. VAS-pain scores were 0 at rest and 2 during activity. Hand grip-strength was 82 % compared to the uninjured side. There were no tendon ruptures. Hardware removal was performed in 21 of the 74 patients. The radiographic outcome according to Batra did not correspond to the patient-reported outcome.

    Conclusions: A good functional and radiographic outcome can be anticipated after combined plating of AO type C DRFs. The radiographic outcome does not necessarily correspond to the functional outcome one year postoperatively. The frequency of hardware removal was acceptable. Complex intra-articular distal radius fractures AO type C can be managed with combined volar and dorsal frame-plate fixation to restore distal radius anatomy.

  • 36.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.
    Niklasson, J.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pettersson, K.
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pulp-to-palm distance is associated with inferior short-term outcome after combined plating for distal radius fractures2019In: Hand surgery & rehabilitation, ISSN 2468-1210, Vol. 38, no 6, p. 369-374Article in journal (Refereed)
    Abstract [en]

    Distal radius fractures (DRF) are the most common fracture in adults. A tool is needed to identify patients who may need extra attention from the physical therapist during the rehabilitation process. The purpose of the study was to examine if pulp-to-palm distance (PTP) 4 weeks postoperatively is associated with wrist function 3 months postoperatively in patients undergoing combined plating for a complex DRF. This prospective study involved 53 patients. PTP was assessed by a physical therapist at the second visit, 4 weeks postoperatively. The 3-month follow-up visit consisted of evaluating the following outcomes: PRWE (Patient-Rated Wrist Evaluation), QuickDASH (Disabilities of the Arm, Shoulder and Hand), VAS pain scores, hand grip strength and wrist range of motion. All patients received the same amount of hand therapy. Patients with zero PTP at 4 weeks postoperative had a significantly better range of motion in wrist extension, flexion, radial deviation, ulnar deviation, hand grip strength and QuickDASH scores compared to patients with a PTP>0cm. VAS pain scores did not differ between the two groups. Patients with zero PTP at 4 weeks postoperative were more likely to have a better wrist function at 3 months postoperative compared to patients with measurable PTP. Based on this study's findings, measuring the PTP distance at 4 weeks postoperative could be useful for identifying patients in need of support during the rehabilitation process after DRF surgery. This could potentially improve the allocation of hand rehabilitation resources; screening patients postoperatively could help to begin relevant interventions.

  • 37.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Pettersson, Kurt
    Rizzo, Marco
    Pyrolytic Carbon Hemiarthroplasty in the Management of Proximal Interphalangeal Joint Arthritis2014In: 69th Annual Meeting of the ASSH: Meeting Abstracts, 2014Conference paper (Refereed)
    Abstract [en]

    Hypothesis: Arthroplasty remains an established motion preserving treatment for proximal interphalangeal (PIP) joint arthritis. The aim of this report is to review clinical, subjective and radiographic results of pyrocarbon hemi-arthroplasty in the treatment of PIP arthritis.

    Methods: 45 fingers in 40 patients underwent hemiarthroplasty between 2005 and 2011. Preoperative diagnoses included 30 with osteo or post-traumatic arthritis and 10 with inflammatory arthritis. The female to male ratio was 33:7. The average age at time of surgery was 56 years. The average follow-up period was 4.62 years. A student’s t-test was used to assess statistical significance.

    Results: To date there has been significant improvement in patient satisfaction measures including COPM (performance and satisfaction) scores and DASH as well as VAS pain scores. There was no significant change in ROM, grip and pinch strength following surgery. Four joints were revised for failure: 3 underwent salvage to succesful arthrodesis and another was converted to a silicone hinged PIP arthroplasty. Radiographic positions of the implant demonstrate a Sweets and Stern grade 0 in 44 implants to date and grade 3 in one.

    Summary Points: PIP pyrocarbon hemiarthroplasty appears to be a viable alter-native to PIP arthroplasty in the treatment of PIP joint arthritis. Clinical and patient satisfaction outcomes compare favorably with published outcomes of arthroplasty. Radiographic outcomes are encouraging with respect to implant positioning and loosening. Hemiarthroplasty affords a simpler procedure that preserves more bone stock which hopefully allows for better success of salvage options such as fusion and revision arthroplasty. Indications are still being refined and longer term outcomes will better validate its use.

  • 38.
    Sagerfors, Marcus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Reiser, Daniel
    Pseudotumor metallosisafter Maestro Total Wrist Arthroplasty2023In: International Guest Society ePoster Abstract Book, 2023, article id IGS0009Conference paper (Other academic)
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