Publications by authors named "Karl Lunsjo"

19 Publications

  • Page 1 of 1

Weighted or internal rotation radiographs are not useful in the classification of acromioclavicular joint dislocations.

Acta Radiol 2021 Jun 13;62(6):758-765. Epub 2020 Jul 13.

Department of Orthopedics, Helsingborg Hospital, Lund University, Helsingborg, Sweden.

Background: Weighted radiographs are performed to classify acromioclavicular joint dislocations; however, the evidence regarding their usefulness is conflicting. Laboratory studies suggest that internal rotation views can replace weighted radiographs, but this has not been clinically evaluated.

Purpose: To evaluate whether weighted or internal rotation radiographs uncovers more high-grade acromioclavicular joint dislocations than non-weighted radiographs.

Material And Methods: A total of 162 patients with acromioclavicular joint dislocations were prospectively included. After applying exclusion criteria, 140 remained. Three panorama radiographs, including both coracoclavicular intervals, were completed of each participant: first, a weighted radiograph with 5-kg weights suspended from the wrists; second, a non-weighted radiograph; and third, an internal rotation radiograph. The coracoclavicular intervals were measured by two radiologists independently, and measurements were translated into Rockwood classifications. The classifications and measurements derived from the different radiographic views were compared.

Results: Weighted radiographs caused no significant changes in classification. For the internal rotation views, there was a significant change in classification for radiologist 2; however, the reason was that more injuries were downgraded compared to the non-weighted views. Relative to the non-weighted radiographs, the mean increase of the coracoclavicular interval on the injured side in the weighted view was 0.5 mm (95% confidence interval [CI] 0.37-0.65) and in the internal rotation view 0.2 mm (95% CI 0.04-0.33). While these changes were statistically significant, they were small and not clinically important.

Conclusion: This study does not support the use of weighted and internal rotation radiographs in the classification of acromioclavicular joint dislocations.
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http://dx.doi.org/10.1177/0284185120939270DOI Listing
June 2021

Acromioclavicular joint dislocations: incidence, injury profile, and patient characteristics from a prospective case series.

JSES Int 2020 Jun 8;4(2):246-250. Epub 2020 Apr 8.

Department of Orthopedics, Lund University, Helsingborg Hospital, Helsingborg, Sweden.

Background: Acromioclavicular joint (ACJ) dislocations are common but evidence regarding the epidemiology of these injuries is incomplete. This study aims to describe the incidence, injury mechanisms, distribution of classifications, risk factors, and patient characteristics for ACJ dislocations in a general population.

Methods: Inclusion was performed prospectively during a 4-year period with the following criteria; age 18-75 years, shoulder trauma within 2 weeks, a clinical suspicion of ACJ dislocation, and radiographs that excluded fracture. The injuries were classified according to the Rockwood system, and epidemiologic variables were obtained. Rockwood types 1-2 were defined as low-grade injuries and types 3-6 as high-grade. Age groups were defined with a young group (18-39 years), an intermediate group (40-59), and an old group (60-75).

Results: A total of 158 patients were included; 139 were male and the mean age was 39 years (range 18-74). There were 73 low-grade and 85 high-grade injuries. The incidence was 2.0 [95% confidence interval (CI) = 1.7-2.4] per 10,000 person-years, gradually decreasing with higher age, groupwise. The incidence rate ratio (IRR) for men vs. women was 7.6 (95% CI = 4.7-12.6) and IRR >1 was seen comparing younger age groups to older. Odds ratio calculations showed that risk factors for high-grade injury were older age and traffic accidents.

Conclusion: The incidence of ACJ dislocations was 2.0 per 10,000 person-years in a general population. Male gender and younger age group were risk factors for injury, whereas the risk for high-grade injuries were greater in older patients and after traffic accidents.
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http://dx.doi.org/10.1016/j.jseint.2020.01.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256880PMC
June 2020

The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting.

BMC Musculoskelet Disord 2019 Mar 30;20(1):138. Epub 2019 Mar 30.

Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.

Background: The gracilis tendon is commonly used as an autograft to reconstruct torn tendons or ligaments in many parts of the body. Little is known about the subjective and functional outcome after gracilis tendon harvest. The aim of this study was to evaluate the outcome of the donor leg in patients undergoing such surgery.

Methods: Patients with chronic acromioclavicular joint dislocations undergoing coracoclavicular ligament reconstructions using autogenous gracilis tendon grafts were eligible for this study. The graft harvesting procedure was carried out in a standard fashion using a tendon stripper. Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and after 12 months. The first 5 patients were included retrospectively and lacked preoperative data, for these patients age- and gender matched normative KOOS scores were used as baseline values. Isometric knee flexor strength in 60° and 90° degrees of flexion was measured at final follow up at a median of 26 (14-56) months postoperatively with the non-operated leg used as reference.

Results: Twenty four patients were eligible for the study and 2 were excluded. The 22 patients available for analysis had a mean age of 44 (22-62) years at the time of surgery and 4 were women. There was no statistically significant change in KOOS 12 months postoperatively compared to baseline values but the patients were weaker in knee flexion in the operated leg compared to the non-operated one.

Conclusions: Gracilis tendon harvesting results in a weakness of knee flexion but does not impair subjective knee function and is a procedure that can be recommended when an autogenous tendon graft is needed.
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http://dx.doi.org/10.1186/s12891-019-2520-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441161PMC
March 2019

Return to work after early repair of acute traumatic rotator cuff tears.

Eur J Trauma Emerg Surg 2020 Aug 5;46(4):817-823. Epub 2019 Jan 5.

Department of Orthopedics, Helsingborg Hospital, Region Skåne, Sweden.

Background: Lost workdays following rotator cuff repair is not well-studied in the literature. We aimed to define the time away from work following early arthroscopic repair of acute traumatic rotator cuff tears and compare it with the recommendations of the American Medical Disability Advisor (MD Guidelines) and The Swedish Social Insurance Agency.

Methods: Thirty-two consecutive working patients with a median age of 58 (42-70) years suffering from acute traumatic rotator cuff tears who underwent arthroscopic repair were prospectively studied. The studied variables were age, gender, alcohol use, smoking, number of injured tendons, dominant side involvement, work-related injury, employment status, preoperative work level, alterations of work tasks at return to work, and time away from work.

Results: 97% of the patients returned to full-duty work. The median time to return to full-duty work was 5.0 (1.1-10.5) months. Preoperative work level (p = 0.025) and dominant side (p = 0.02) significantly affected the time away from work on the univariate analysis, while GLM model showed a trend (p = 0.09) for shorter sick leave by dominant side involvement. The sick leave was longer in all three work level categories compared with the MD Guidelines and longer in the light and medium work categories compared with the recommendations by FK.

Conclusions: According to the present study, acute traumatic rotator cuff tears cause a considerable loss of work days. However, almost all patients are expected to return to work after a median time of 5 months following arthroscopic repair. Current guidelines and recommendations regarding sick leave following repair of rotator cuff tears might have to be reviewed.
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http://dx.doi.org/10.1007/s00068-019-01074-9DOI Listing
August 2020

Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears: a prospective study.

Eur J Trauma Emerg Surg 2018 Oct 29;44(5):735-745. Epub 2017 Nov 29.

Department of Orthopedics, Skånevård Sund, Region Skåne, Sweden.

Background: Early diagnosis of traumatic acute full-thickness rotator cuff tears (FTRCT) is important to offer early surgical repair. Late repairs following fatty infiltration of the rotator cuff muscles have less favorable results. We think that physical therapists are valuable diagnosticians in a screening process. The objective of this study was to evaluate the usefulness of physical therapists as first-line diagnosticians in detecting acute traumatic FTRCT.

Methods: Between November 2010 and January 2014, 394 consecutive patients having an age between 18 and 75 years who sought medical care because of acute shoulder trauma with acute onset of pain, limited abduction and negative plain radiographs were included in the study. A clinical assessment was conducted by a physical therapist 1 week after the trauma. The patients were divided into three groups by the physical therapist according to the findings: FTRCT (Group I, n = 122); sprain (Group II, n = 62); or other specific diagnoses (Group III, n = 210). Group III patients were discharged and excluded from the study. Magnetic Resonance Imaging shoulder was performed for all Group I patients and for all patients with persistent symptoms in Group II.

Results: 79/184 patients had FTRCTs documented by MRI in groups I and II. The clinical assessment of the physical therapist had a sensitivity of 85%, specificity of 68%, and usefulness index of 0.45 (> 0.35 considered useful) for diagnosing FTRCT.

Conclusion: Physical therapists can be useful as first-line diagnosticians in detecting traumatic FTRCT.
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http://dx.doi.org/10.1007/s00068-017-0883-6DOI Listing
October 2018

High incidence of acute full-thickness rotator cuff tears.

Acta Orthop 2015 ;86(5):558-62

a 1 Department of Orthopedics , Skånevård Sund, Region Skåne ;

Background And Purpose: Epidemiological studies of full-thickness rotator cuff tears (FTRCTs) have mainly investigated degenerative lesions. We estimated the population-based incidence of acute FTRCT using a new diagnostic model.

Patients And Methods: During the period November 2010 through October 2012, we prospectively studied all patients aged 18-75 years with acute onset of pain after shoulder trauma, with limited active abduction, and with normal conventional radiographs. 259 consecutive patients met these inclusion criteria. The patients had a median age of 51 (18-75) years. 65% were males. The patients were divided into 3 groups according to the clinical findings: group I, suspected FTRCT; group II, other specific diagnoses; and group III, sprain. Semi-acute MRI was performed in all patients in group I and in patients in group III who did not recover functionally.

Results: We identified 60 patients with FTRCTs. The estimated annual incidence of MRI-verified acute FTRCT was 16 (95% CI: 11-23) per 10(5) inhabitants for the population aged 18-75 years and 25 (CI: 18-36) per 10(5) inhabitants for the population aged 40-75 years. The prevalence of acute FTRCT in the study group was 60/259 (23%, CI: 18-28). The tears were usually large and affected more than 1 tendon in 36 of these 60 patients. The subscapularis was involved in 38 of the 60 patients.

Interpretation: Acute FTRCTs are common shoulder injuries, especially in men. They are usually large and often involve the subscapularis tendon.
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http://dx.doi.org/10.3109/17453674.2015.1022433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564777PMC
December 2015

Chronic acromioclavicular joint dislocations treated by the GraftRope device.

Acta Orthop 2015 Apr 17;86(2):225-8. Epub 2014 Oct 17.

Department of Orthopedics , Helsingborg Hospital , Sweden.

Background And Purpose: Surgical treatment of chronic acromioclavicular joint dislocations is challenging, and no single procedure can be considered to be the gold standard. In 2010, the GraftRope method (Arthrex Inc., Naples, FL) was introduced in a case series of 10 patients, showing good clinical results and no complications. We wanted to evaluate the GraftRope method in a prospective consecutive series.

Patients And Methods: 8 patients with chronic Rockwood type III-V acromioclavicular joint dislocations were treated surgically using the GraftRope method. The patients were clinically evaluated and a CT scan was performed to assess the integrity of the repair.

Results And Interpretation: In 4 of the 8 patients, loss of reduction was seen within the first 6 weeks postoperatively. A coracoid fracture was the reason in 3 cases and graft failure was the reason in 1 case. In 3 of the 4 patients with intact repairs, the results were excellent with no subjective shoulder disability 12 months postoperatively. It was our intention to include 30 patients in this prospective treatment series, but due to the high rate of complications the study was discontinued prematurely. Based on our results and other recent reports, we cannot recommend the GraftRope method as a treatment option for chronic acromioclavicular joint dislocations.
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http://dx.doi.org/10.3109/17453674.2014.976806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404775PMC
April 2015

Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients.

Acta Orthop 2011 Dec 17;82(6):711-3. Epub 2011 Oct 17.

Department of Orthopaedics, Helsingborg Hospital, Sweden.

Background: Although arthroscopic subacromial decompression (ASD) is a common procedure for treatment of shoulder impingement, few long term results have been published. In this prospective study, we determined whether the high degree of patient satisfaction at 6 months postoperatively reported by us earlier remained at the 6-year follow-up.

Patients And Methods: We originally reported high patient satisfaction 6 months after ASD for shoulder impingement in 50 prospectively studied patients using the Disability of the Arm Shoulder and Hand questionnaire (DASH) and the Visual Analog Scale (VAS). Patients with associated shoulder disorders were excluded. The surgeons were experienced shoulder arthroscopists. 6 years after surgery, the DASH questionnaire and the VAS were sent to these 50 patients. 2 patients had other medical problems of the upper extremity that affected the DASH and VAS scores, 1 patient was lost to follow-up, and another refused to participate. Thus, 46 patients with a mean age of 55 (33-78) years were included in this 6-year evaluation.

Results: The considerable improvement in both the DASH score and the VAS that was observed 6 months after surgery persisted or had even improved 6 years after surgery.

Interpretation: Properly selected patients with shoulder impingement treated with ASD remain satisfied 6 years after surgery.
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http://dx.doi.org/10.3109/17453674.2011.623571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247890PMC
December 2011

Overlapping dislocation of the pubic symphysis: report of three cases and review of the literature.

Arch Orthop Trauma Surg 2009 May 23;129(5):679-83. Epub 2009 Jan 23.

University of British Columbia, Vancouver General Hospital, 910 West 10th Ave, Unit 3114, Vancouver, BC V5Z 4E3, Canada.

We present three cases of overlapping pubic symphysis dislocation and revise all the fully reported similar ones in the literature. The mechanism of injury, clinical presentation, radiographic assessment, associated injuries, management and complications of this uncommon injury are discussed.
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http://dx.doi.org/10.1007/s00402-009-0813-0DOI Listing
May 2009

Factors affecting anatomical region of injury, severity, and mortality for road trauma in a high-income developing country: lessons for prevention.

Injury 2009 Jul 30;40(7):703-7. Epub 2008 Dec 30.

Department of Surgery, Faculty of Medicine & Health Sciences, UAE University, Al Ain, United Arab Emirates.

Objectives: To study the factors affecting anatomical region of injury, severity, and mortality among road users in United Arab Emirates so as to improve preventive measures.

Methods: Data of the Trauma Registry of Al Ain city were collected prospectively over 3 years (2003-2006) at the main trauma hospital. For traffic injuries, the following were assessed: gender, nationality, road user type, anatomical region(s) of injury, systolic blood pressure on admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and mortality. Analysis included frequencies, cross-tabulations, and logistic regression.

Results: There were 1070 patients, 89% male, 25% UAE nationals, and with a mean age of 31 years. Expatriates, mainly from non-Arabic speaking, low-income countries, accounted for 88% of injured pedestrians, whilst nationals were overrepresented among vehicle occupants (29%), and motorcyclists 37%. Injuries of the extremities and head were frequent among pedestrians, motorcyclists, and bicyclists, whilst head and spine injuries were most common among front and rear vehicle occupants and drivers. The median ISS was five for pedestrians and four for all other road user types, including rear vehicle occupants. The mean hospitalisation was 9.7 days; 13% of patients were admitted to ICU with mean stay of 6.5 days. Overall mortality was 4%; pedestrians accounted for 61% of deaths. Predictors of mortality were GCS (p<0.001), ISS (p<0.01) and systolic blood pressure on admission (p<0.03).

Conclusions: Head injury was a major factor affecting mortality, followed by injury severity and hypotension. To reduce injury incidence and severity, legislation and education are needed to ensure use of seat belts by all vehicle occupants including rear passengers, high-visibility devices by other road users, helmets by motorcyclists and bicyclists, protective clothing and boots for motorcyclists, and traffic engineering for pedestrians.
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http://dx.doi.org/10.1016/j.injury.2008.07.012DOI Listing
July 2009

The Hansson Twin Hook is adequate for fixation of trochanteric fractures: 2 fixation failures in a series of 157 prospectively followed patients.

Acta Orthop 2008 Oct;79(5):602-8

Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.

Background And Purpose: The Hansson Twin Hook (HTH) is an alternative to the lag screw in the treatment of trochanteric fractures. In osteoporotic bone, mechanical tests have indicated that the HTH has better fixation properties than the lag screw. We evaluated the fixation stability of the HTH in a large series of elderly patients with trochanteric fractures. Many surgeons were involved in assessment of whether the device was user-friendly.

Patients And Methods: In a prospective bicentric study, 55 surgeons used the HTH and a standard plate in 157 consecutive patients with trochanteric fractures, 83% of which were unstable. The mean age of the patients was 83 (43-98) years. They were followed regularly clinically and radiographically for at least 4 months, with a radiographic file search at 2 years.

Results: Technical errors occurred intraoperatively in 7 cases. The reduction of the fracture was inaccurate in these patients; thus, the HTH had not been placed centrally in the femoral head. One of these errors was immediately and easily corrected without interference with the standard plate, and caused no further problems. 2 of the remaining 6 intraoperative errors developed into failures of fixation during the 2-year period.

Interpretation: The HTH gives adequate fixation in the bone of elderly patients with trochanteric fractures and has a low failure rate. It is also easy to use.
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http://dx.doi.org/10.1080/17453670810016605DOI Listing
October 2008

Causes of delayed diagnosis of scapular fractures.

Injury 2008 Mar;39(3):314-8

Department of Orthopaedics, Al Ain Hospital, United Arab Emirates.

Objectives: To study the causes of delayed diagnosis of scapular fractures in blunt trauma cases, and to advise on early fracture detection.

Patients And Methods: Between February 2003 and September 2004, 64 consecutive patients (3 females) with a median (range) age of 35 (8-60) years, treated at Al-Ain Hospital for scapular fractures, were prospectively collected. Fractures diagnosed after more than 24h from admission were considered missed; 8 people with missed scapular fractures were compared with a control group of 56 who had timely diagnosis, regarding the mechanism and distribution of injury, injury severity score, and type and quality of radiological methods used.

Results: The median (range) abbreviated injury scale scores for the missed scapular fracture group and the control group were 4 (0-5) and 2 (0-2), respectively. The missed scapular fracture group stayed significantly longer in the intensive care unit compared with the control group, with a median (range) stay of 15 (5-37) days compared with 9 (1-26) days. Associated injuries overshadowed the scapula on chest trauma radiographs. If computed tomography did not cover the whole scapula, some fractures might not be shown. Convulsive seizures were the only significantly different mechanism of injury between the missed fracture and the control groups.

Conclusion: Delayed diagnosis of scapular fractures can be due to extensive chest injuries overshadowing the scapula on the chest trauma radiographs, inappropriately performed computer tomography or an unusual mechanism of injury.
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http://dx.doi.org/10.1016/j.injury.2007.10.014DOI Listing
March 2008

Multiple-region scapular fractures had more severe chest injury than single-region fractures: a prospective study of 107 blunt trauma patients.

J Trauma 2007 Oct;63(4):889-93

Department of Orthopaedics, Al Ain Hospital, Al Ain, United Arab Emirates.

Background: We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients.

Methods: One hundred seven consecutive patients with fractured scapulae (100 men) with a mean age of 35 (8-65) years were prospectively studied between January 2003 and December 2005. Mechanism of injury, associated injuries, Injury Severity Score (ISS), and the number of anatomic scapular regions involved in each fracture were studied. Patients were divided into single-region fracture (SRF), two-region fracture, and more than two-region fracture groups. Computer tomography was used for fracture classification in 99 patients and plain radiographs were used for the remaining 8.

Results: Road traffic collisions were the most common cause of scapular fracture. Ninety-five patients (89%) sustained associated injuries. The most frequent was chest injury (68 [64%]). The median ISS was 9 (4-57) for the SRF group (n = 55), 20 (4-59) for the two-region fracture group (n = 30), and 22.5 (4-54) for the more than two-region fracture group (n = 22) (p = 0.02, Kruskal-Wallis test). The median values of the Abbreviated Injury Scale for chest injuries for the three groups were 1 (0-4), 3 (0-5), and 3 (0-5), respectively (p = 0.001, Kruskal-Wallis test). The SRF group had significantly less posterior structure injury (9 of 55) compared with the multiple-region fracture group (46 of 52) (p < 0.001, Fisher's exact test).

Conclusions: Associated injuries are common in patients with scapular fractures. ISS and Abbreviated Injury Scale score for chest injuries are higher and posterior structure injuries are more frequent in patients with fractures involving multiple scapular regions.
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http://dx.doi.org/10.1097/01.ta.0000235876.32569.dbDOI Listing
October 2007

Epidemiology of geriatric trauma in United Arab Emirates.

Arch Gerontol Geriatr 2008 Nov-Dec;47(3):377-82. Epub 2007 Oct 23.

Trauma Group, Department of Surgery, Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates.

The mechanisms and outcome of trauma in hospitalized elderly patients were studied. The data of Al-Ain Hospital Trauma Registry were prospectively collected over a period of 3 years (2003-2006). All elderly trauma-patients above 60 years who were admitted to surgical ward or who died on arrival were studied. Demography of patients, mechanism of injury, Injury Severity Score (ISS), hospital stay and mortality were analyzed. There were 121 patients (70 males and 51 females). Mean (range) age was 69 years (60-100), 42% were United Arab Emirates (UAE) nationals. The two most common mechanisms of injury were falls (55%) followed by road traffic collisions (RTC) (32%). The median (range) ISS of the group was 5 (1-34). The ISS median (interquartile range) of falling down, RTC, and fall from height were 4 (4-9), 6 (4-10), and 8 (5-9), respectively (p=0.31). Forty-one percentage of injuries occurred at home. The mean (range) hospital stay was 12.4 (1-150) days. Six patients (5%) were admitted to the intensive care unit. Overall mortality was 6% (7 patients), of whom 5 were pedestrians hit by cars. We concluded that low-energy trauma from falls was the most common cause of injury in the elderly. Mortality was high mainly from pedestrian injuries.
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http://dx.doi.org/10.1016/j.archger.2007.08.018DOI Listing
November 2008

Associated injuries and not fracture instability predict mortality in pelvic fractures: a prospective study of 100 patients.

J Trauma 2007 Mar;62(3):687-91

Department of Orthopaedics, Faculty of Medicine and Health Sciences, UAE Univeristy, Al Ain, UAE.

Background: Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality.

Methods: There were 100 consecutive patients (77 males, mean age of 31 [3-73] years) studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, Injury Severity Score (ISS), Revised Trauma Score, blood transfusions, and mortality. The fractures were classified according to instability, where type O is stable, type R is rotationally unstable, and type RV is both rotationally and vertically unstable. Because a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients.

Results: There were 77 fractures caused by road traffic collisions. Type O fractures (n = 63) had lower median ISS (13 [4-48]) than type R (n = 19) (18 [9-75]) and type RV (n = 18) (18 [6-66]) (p = 0.019, Kruskall Wallis). There was no significant difference in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality.

Conclusions: ISS is the most important predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.
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http://dx.doi.org/10.1097/01.ta.0000203591.96003.eeDOI Listing
March 2007

Does colostomy prevent infection in open blunt pelvic fractures? A systematic review.

J Trauma 2006 May;60(5):1145-8

Department of Surgery, UAE University, Al Ain, United Arabic Emirates.

Background: Open pelvic fracture is a rare injury. Our aim in this study is to systematically review the literature to define when diverting colostomy is indicated to protect the patient from infection in open blunt pelvic fractures.

Methods: Papers studying open pelvic fractures and the use of colostomy were retrieved through MEDLINE and PUBMED. The papers were critically appraised regarding their methodology and conclusions. Relevant information was combined.

Results: The level of evidence for the use of colostomy in open pelvic fractures is very low. All reports are retrospective and no statistical methods have been used to support conclusions drawn. We found no difference in the overall infectious complication rate between the colostomy and noncolostomy groups. There is an assumption that patients with perineal wounds would benefit from colostomy; however, rectal involvement in these injuries was not detailed.

Conclusion: The role of colostomy in open blunt pelvic fractures is unresolved and randomized multicenter trials are needed.
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http://dx.doi.org/10.1097/01.ta.0000197615.31553.1eDOI Listing
May 2006

High patient satisfaction after arthroscopic subacromial decompression for shoulder impingement: a prospective study of 50 patients.

Acta Orthop 2006 Feb;77(1):138-42

Department of Physiotherapy, Helsingborg Hospital, Sweden.

Background: Arthroscopic subacromial decompression (ASD) for shoulder impingement has gained popularity. We evaluated the result of this common procedure prospectively, from a patient perspective.

Method: We used the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Visual Analogue Scale (VAS) to evaluate 50 patients with a mean age of 49 (27-72) years. All patients had undergone 6 months of failed nonoperative treatment prior to surgery. Exclusion criteria were total rotator cuff rupture, shoulder instability, clinically verified acromioclavicular joint osteoarthritis, calcifying tendonitis or neurological symptoms. All the decompressions were done by experienced shoulder arthroscopists.

Results: A significant improvement in both the median DASH score and the VAS had occurred 6 months after surgery.

Interpretation: ASD for impingement in properly selected patients performed by experienced surgeons gives a high degree of patient satisfaction 6 months after surgery.
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http://dx.doi.org/10.1080/17453670610045821DOI Listing
February 2006

Costs and quality of life associated with osteoporosis-related fractures in Sweden.

Osteoporos Int 2006 9;17(5):637-50. Epub 2005 Nov 9.

Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.

This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral and wrist fracture 1 year after the fracture, based on a patient sample consisting of 635 male and female patients surviving a year after fracture. Data regarding resource use and quality of life related to fractures was collected by questionnaires at baseline, 4 months and 12 months. Information was collected by the use of patients' records, register sources and by asking the patient. Quality of life was estimated with the EQ-5D questionnaire. Costs were estimated from a societal perspective, including direct and indirect costs. The mean fracture-related cost the year after a hip, vertebral and wrist fracture were estimated, in euros (), at 14,221, 12,544 and 2,147, respectively [converted from Swedish krona (SEK) at an exchange rate of 9.1268 SEK/]. The mean reduction in quality of life was estimated at 0.17, 0.26 and 0.06 for hip, vertebral and wrist fracture, respectively. Based on the results, the yearly burden of osteoporosis in Sweden could be estimated at 0.5 billion (SEK 4.6 billion). The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization, but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived.
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http://dx.doi.org/10.1007/s00198-005-0015-8DOI Listing
March 2007

Adhesive intestinal obstruction following blunt abdominal trauma.

Saudi Med J 2005 Sep;26(9):1464-7

Department of Surgery, Al-Ain Hospital, Al-Ain, United Arab Emirates.

Advances in diagnosis and management of multiple trauma patients have lead to adopting a conservative approach for most patients with blunt abdominal trauma. Intestinal obstruction is a rare complication for this approach. Herein, we report a 37-year-old male, who did not have an abdominal operation, and who developed adhesive intestinal obstruction 7 weeks following blunt abdominal trauma. We detected no signs of peritonitis or intra-abdominal bleeding clinically or radiologically on admission. We initially treated the intestinal obstruction conservatively, but the obstruction did not resolve. Finally, we performed laparotomy, which showed that the small bowel was matted together by thick fibrous layers of adhesions. We performed adhesiolysis, and the patient was discharged home 3 weeks later. Histopathological findings of the fibrous layer were consistent with repair due to previous trauma and hemorrhage. We review the literature of this rare condition.
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September 2005
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