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  • 1.
    Adini, B.
    et al.
    Tel Aviv University, Israel.
    Bodas, M.
    Tel Aviv University, Israel.
    Nilsson, Heléne
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Disaster Medicine and Traumatology.
    Peleg, K.
    Tel Aviv University, Israel; Gertner Institute Health Policy and Epidemiol, Israel.
    Policies for managing emergency medical services in mass casualty incidents2017In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 9, p. 1878-1883Article in journal (Refereed)
    Abstract [en]

    Introduction: Diverse decision-making is needed in managing mass casualty incidents (MCIs), by emergency medical services (EMS). The aim of the study was to review consensus among international experts concerning policies of EMS management during MCIs. Methods: Applicability of 21 EMS policies was tested through a 2-cycle modified e-Delphi process, in which 38 multi-disciplinary experts from 10 countries participated. Threshold for approving proposed solutions was defined as consensus of amp;gt;80%. Policies that did not achieve the targeted consensus were reviewed to detect variability according to respondents origin country. Results: 16 policies were endorsed in the first cycle including collaboration between ambulance service providers; implementing a unified mode of operation; preparing criteria for ground versus aerial evacuation; and, developing support systems for caregivers exposed to violence. An additional policy which proposed that senior EMS officers should not necessarily act as on-site MCI commanders was endorsed in the second cycle. Demographic breakdown of views concerning non-consensual policies revealed differences according to countries of origin. Assigning ambulances to off-duty team members was highly endorsed by experts from Israel and South Africa and strongly rejected by European respondents. Avoiding entry to risk areas until declared safe was endorsed by European, Asian and Oceanic experts, but rejected by Israeli, South African and North American experts. Conclusions: Despite uniqueness of countries and EMS agencies, solutions to most dilemmas were applicable to all organizations, regardless of location or affiliation. Cultural diversity was found concerning readiness to implement military-civilian collaboration in MCIs and a rigid separation between work-leisure responsibilities. (C) 2017 Elsevier Ltd. All rights reserved.

  • 2.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Atypical fractures, a biased perspective2016In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 47, no 1, p. S28-S30Article in journal (Refereed)
    Abstract [en]

    When stress fractures started to show up in the femurs of elderly ladies, it was soon evident that bisphosphonate use lay behind, and the absolute risk increase due to bisphosphonate use was reasonably well estimated already in 2008. Thereafter followed a period of confusion: the term atypical fracture was introduced, with a definition so vague that the true stress fractures tended to disappear in a cloud of ambiguity. This cast doubt on the association with bisphosphonates. The association was then re-established by large epidemiological studies based on radiographic adjudication. Atypical fractures are largely caused by bisphosphonates. With a correct indication, bisphosphonates prevent many more fractures than they cause, at least during the first years of use. With an incorrect indication they are likely to cause more harm than good. (C) 2016 Elsevier Ltd. All rights reserved.

  • 3.
    Bernhardsson, Magnus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Sandberg, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Anti-RANKL treatment improves screw fixation in cancellous bone in rats2015In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 46, no 6, p. 990-995Article in journal (Refereed)
    Abstract [en]

    Bisphosphonates improve implant fixation in randomised clinical trials of knee prostheses, hip prostheses and dental implants. However, a limited amount of bone resorption is required for bisphosphonates to exert an effect. Anti-RANKL treatment does not have this limitation, and we therefore tested whether if they might be more effective for improvement of implant fixation. This is of interest, as anti-RANKL treatment with denosumab is now in common clinical use. Male SD rats received a stain-less steel screw in the right proximal tibia and a drill hole in the left (n = 42). They were randomised to subcutaneous injections of either alendronate (20 mu g/kg/day), alendronate (200 mu g/kg/day), osteoprotegerin with an Fc tag (OPG-Fc; 8 mg/kg, twice weekly), or saline control. After 4 weeks, the fixation of the steel screw was measured by pull-out test. The tibia with the drill hole was evaluated with mu CT. OPG-Fc increased the pull-out force compared to saline controls by 153% (p less than 0.001). There was no significant difference between OPG-Fc and the alendronate groups. OPG-Fc increased the bone density (BV/TV) in the previous drill hole compared to controls 7-fold (p less than 0.001). This increase was higher than with any alendronate dose (p less than 0.001). OPG-Fc increased the bone density of the L5 vertebral body, but there was no significant difference between OPG-Fc and alendronate. Our results suggest that screw fixation in cancellous bone can be dramatically improved by an antiRANKL agent. The effect was comparable to very high bisphosphonate doses. Screw insertion in cancellous bone elicits a metaphyseal fracture healing response, and our findings might be relevant not only for implant fixation, but also for fracture healing in cancellous bone.

  • 4.
    Johan, Scheer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
    Lars, Adolfsson
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures2012In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 43, no 6, p. 926-932Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to examine triangular fibrocartilage (TFCC) injury patterns associated with unstable, extra-articular dorsally displaced distal radius fractures.

    Methods: Twenty adult patients with an Arbeitsgemeinschaft für Osteosynthesefragen (AO), type A2 or A3, distal radius fracture with an initial dorsal angulation greater than 20° were included. Nine had a tip fracture (distal to the base) of the ulnar styloid and 11 had no such fracture. They were all openly explored from an ulnopalmar approach and TFCC injuries were documented. Eleven patients also underwent arthroscopy and intra-articular pathology was recorded.

    Results: All patients had TFCC lesions of varying severity, having an extensor carpi ulnaris subsheath avulsion in common. Eighteen out of 20 also displayed deep foveal radioulnar ligament lesions, with decreasingly dorsal fibres remaining. The extent of this foveal injury could not be appreciated by radiocarpal arthroscopy.

    Conclusions: Severe displacement of an extra-articular radius fracture suggests an ulnar-sided ligament injury to the TFCC. The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers.

  • 5.
    Kildal, Morten
    et al.
    Uppsala University Hospital.
    Willebrand, Mimmie
    Uppsala University Hospital.
    Andersson, Gerhard
    Uppsala University.
    Gerdin, Bengt
    Uppsala University Hospital.
    Ekselius, Lisa
    Uppsala University.
    Coping strategies, injury characteristics and long term outcome after burn injury2005In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 36, no 4, p. 511-518Article in journal (Refereed)
    Abstract [en]

    Coping consists of cognitive and behavioural strategies aimed at enhancing adaptation, and the use of certain coping strategies is proposed to be beneficial for health. The relationship between coping strategies and burn injury characteristics, sociodemographics and long-term outcome was evaluated in 161 previous victims of severe burn injury. Functional and psychosocial restrictions were measured with the burn specific health scale-brief (BSHS-B) and related to coping strategies measured by the coping with burns questionnaire (CBQ). Patients were on average 47.7 years at measurement of health status and they were assessed 9.2 (S.D. = 4.8) years after injury. The mean area burned was 24.0 and 7.2% was full thickness injury.There was no relation between coping strategies and injury characteristics except in individuals with a full thickness burn exceeding 10%, who exhibited more Revaluation/adjustment. An Avoidant coping strategy was related to work status, marital status and living conditions, and this was the strategy most clearly related to--Bad outcome-- in all scales of the BSHS-B. Emotional support was the most beneficial strategy and was mainly associated with the psychosocial scales of the BSHS-B.

  • 6.
    McClure, Roderick John
    et al.
    Monash University.
    Davis, Elizabeth
    Injury Prevention and Control Australia Ltd.
    Yorkston, Emily
    ARTD Consultants.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Schluter, Philip
    Auckland University of Technology.
    Bugeja, Lyndal
    Monash University.
    Special issues in injury prevention research: Developing the science of program implementation2010In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 41, p. 16-19Article in journal (Refereed)
    Abstract [en]

    Introduction: Despite widespread application of the public health approach to injury prevention, there is an acknowledged limitation in the extent to which it facilitates translation of research evidence to injury prevention practice. Aim: In this paper we clarify the ecoepidemiological principles that underpin the public health approach to injury control in order to support explicit efforts to address the multilevel component causes and improve the evidence base on which effective program implementation depends. Keypoints: If injury causation is understood in terms of the ecoepidemiological model rather than the proximal risk factor model, then quantification of the context in which the event occurs is evidently as important as quantification of the energy exchange event itself. The ecoepidemiological model of injury causation recognises barriers and facilitators to injury prevention as component causes of population burden of injury and thus delineates these factors as legitimate targets for intervention. Injury prevention programs that are designed to specifically address the factors causally related to the programs implementation, as well as the contextual factors that determine the characteristics of the energy exchange event, are more likely to be implemented and more likely to result in effective uptake of recommended energy exchange countermeasures. Conclusion: Interventions to reduce the burden of injury in the population should address the individual level factors that increase the risk of injury, but also the upstream factors that influence the extent to which there is widespread adoption by individuals of the recommended countermeasures.

  • 7.
    Mellema, J.J.
    et al.
    Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States.
    Doornberg, J.N.
    University of of Amsterdam Orthopaedic Residency Program (PGY 4), Academic Medical CenterAmsterdam, Netherlands.
    Guitton, T.G.
    University of of Amsterdam Orthopaedic Residency Program (PGY 4), Academic Medical CenterAmsterdam, Netherlands.
    Ring, D.
    Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States.
    Biomechanical studies: Science (f)or common sense?2014In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 45, no 12, p. 2035-2039Article in journal (Refereed)
    Abstract [en]

    Introduction: It is our impression that many biomechanical studies invest substantial resources studying the obvious: that more and larger metal is stronger. The purpose of this study is to evaluate if a subset of biomechanical studies comparing fixation constructs just document common sense. Methods: Using a web-based survey, 274 orthopaedic surgeons and 81 medical students predicted the results of 11 biomechanical studies comparing fracture fixation constructs (selected based on the authors sense that the answer was obvious prior to performing the study). Sensitivity, specificity, and accuracy were calculated according to standard formulas. The agreement among the observers was calculated by using a multirater kappa, described by Siegel and Castellan. Results: The accuracy of predicting outcomes was 80% or greater for 10 of 11 studies. Accuracy was not influenced by level of experience (i.e., time in practice and medical students vs. surgeons). There were substantial differences in accuracy between observers from different regions. The overall categorical rating of inter-observer reliability according to Landis and Koch was moderate (k = 0.55; standard error (SE) = 0.01). Conclusion: The results of a subset of biomechanical studies comparing fracture fixation constructs can be predicted prior to doing the study. As these studies are time and resource intensive, one criterion for proceeding with a biomechanical study should be that the answer is not simply a matter of common sense. © 2014 Elsevier Ltd. All rights reserved.

  • 8.
    Schilcher, Jörg
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    High revision rate but good healing capacity of atypical femoral fractures. A comparison with common shaft fractures2015In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 46, no 12, p. 2468-2473Article in journal (Refereed)
    Abstract [en]

    Introduction: Healing of complete, atypical femoral fractures is thought to be impaired, but the evidence is weak and appears to be based on the delayed healing observed in patients with incomplete atypical fractures. Time until fracture healing is difficult to assess, therefore we compared the reoperation rates between women with complete atypical femoral fractures and common femoral shaft fractures. Methods: We searched the orthopaedic surgical registry in Ostergotland County for patients with subtrochanteric and femoral shaft fractures (ICD-10 diagnosis codes S72.2, S72.3 and M84.3F) between January 1st 2007 and December 31st 2013. Out of 895 patients with surgically treated femoral shaft fractures, 511 were women 50 years of age or older. Among these we identified 24 women with atypical femoral shaft fractures, and 71 with common shaft fractures. Results: Reoperations were performed in 6 and 5 patients, respectively, odds ratio 4.4 (95% CI 1.2 to 16.1). However, 5 reoperations in the atypical fracture group could not be ascribed to poor healing. In 3 patients the reoperation was due to a new fracture proximal to a standard intramedullary nail. In 2 patients the distal locking screws were removed due to callus formation that was deemed incomplete 5 months post-operatively. The one patient with poor healing showed faint callus formation at 5 months when the fracture was dynamised and callus remained sparse at 11 months. Among patients with common shaft fractures, 2 reoperations were performed to remove loose screws, 2 because of peri-implant fractures and 1 reoperation due to infection. Discussion: Reoperation rates in patients with complete atypical femoral fractures are higher than in patients with common shaft fractures. The main reason for failure was peri-implant fragility fractures which might be prevented with the use of cephalomedullary nails at the index surgery. Fracture healing however, seems generally good. A watchful waiting approach is advocated in patients with fractures that appear to heal slowly. (C) 2015 Elsevier Ltd. All rights reserved.

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