The functional and molecular impact of triamcinolone acetonide on primary human bone marrow mesenchymal stem cells.

Traumatic or degenerative joint pain is abundant in the population. Symptom relief by intra- and periarticular glucocorticoid administration is frequently used, however may have potentially devastating effects, changing the normal healing process of the joint. Mesenchymal stem cells (MSCs) are important for wound-healing processes due to their multipotency in regenerating osteoblasts, chondrocytes and adipocytes but also have immunomodulatory properties. The aim of this study was to investigate the impact of triamcinolone acetonide (TA) a common glucocorticoid administrated intra- and periarticularly, on human bone marrow derived MSC viability, functionality, multi-lineage differentiation and transcriptomic output. We found that TA treatment induced apoptosis and promoted adipogenesis while impairing chondrogenesis of MSCs. RNA sequencing indicated that TA modulated the inflammatory response of MSCs, which may have an impact on the immunologic environment where the inflammatory phase is a physiological part of the natural healing process. These data indicate that triamcinolone acetonide should be used with consideration bearing the patient's outcome in mind, with the intention to optimize joint recovery and homeostasis.

Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial.

BACKGROUND: Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking. METHODS AND FINDINGS: The primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. Between February 2011 and December 2019, 160 patients 60 years and older with 3- and 4-part PHFs were randomly assigned in 1:1:1 fashion in block size of 10 to undergo nonoperative treatment (control) or operative intervention with LP or HA. In total, 54 patients were assigned to the nonoperative group, 52 to the LP group, and 54 to the HA group. Five patients assigned to the LP group were reassigned to the HA group perioperatively due to high comminution, and all of these patients had 4-part fractures. In the intention-to-treat analysis, there were 42 patients in the nonoperative group, 44 in the LP group, and 37 in the HA group. The outcome assessors were blinded to the study group. The mean DASH score at 2-year follow-up was 30.4 (standard error (SE) 3.25), 31.4 (SE 3.11), and 26.6 (SE 3.23) points for the nonoperative, LP, and HA groups, respectively. At 2 years, the between-group differences were 1.07 points (95% CI [-9.5,11.7]; p = 0.97) between nonoperative and LP, 3.78 points (95% CI [-7.0,14.6]; p = 0.69) between nonoperative and HA, and 4.84 points (95% CI [-5.7,15.4]; p = 0.53) between LP and HA. No significant differences in primary or secondary outcomes were seen in stratified age groups (60 to 70 years and 71 years and over). At 2 years, we found 30 complications (3/52, 5.8% in nonoperative; 22/49, 45% in LP; and 5/49, 10% in HA group, p = 0.0004) and 16 severe pain-related adverse events. There was a revision rate of 22% in the LP group. The limitation of the trial was that the recruitment period was longer than expected due to a high number of exclusions after the assessment of eligibility and a larger exclusion rate than anticipated toward the end of the trial. Therefore, the trial was ended prematurely. CONCLUSIONS: In this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments. TRIAL REGISTRATION: ClinicalTrials.gov NCT01246167.

All professions can benefit - a mixed-methods study on simulation-based teamwork training for operating room teams.

BACKGROUND: Operating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants' reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace. METHODS: In a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team. Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years. Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis. RESULTS: All occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one's profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration. CONCLUSION: Simulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.

Decreasing incidence of knee arthroscopy in Sweden between 2002 and 2016: a nationwide register-based study.

BACKGROUND AND PURPOSE: Several randomized trials have demonstrated the lack of effect of arthroscopic lavage as treatment for knee osteoarthritis (OA). These results have in turn resulted in a change in Swedish guidelines and reimbursement. We aimed to investigate the use of knee arthroscopies in Sweden between 2002 and 2016. Patient demographics, regional differences, and the magnitude of patients with knee OA undergoing knee arthroscopy were also analyzed. PATIENTS AND METHODS: Trends in knee arthroscopy were investigated using the Swedish Hospital Discharge Register (SHDR) to conduct a nationwide register-based study including all adults (>18 years of age) undergoing any knee arthroscopy between 2002 and 2016. RESULTS: The total number of knee arthroscopies performed during the studied period was 241,055. The annual surgery rate declined in all age groups, for males and females as well as patients with knee OA. The incidence dropped from 247 to 155 per 105 inhabitants. Over 50% of arthroscopies were performed in metropolitan regions. CONCLUSION: We showed a dramatic decline in knee arthroscopy. There is variability in the surgery rate between males and females and among the regions of Sweden.

Mortality following proximal humerus fracture-a nationwide register study of 147,692 fracture patients in Sweden.

Little is known about survival after proximal humerus fracture. In this manuscript, we found the mortality to be high (almost four times higher than in age- and sex-matched controls). While frailty hip fracture has gained attention, we hope our manuscript will shed light on frailty proximal humerus fracture patients. INTRODUCTION: Proximal humerus fractures (PHF) are common and occur mostly after the 6th decade of life. While mortality following PHF has been reported previously, mortality data after longer follow-up on a national level is lacking. METHODS: We obtained data from the Swedish Hospital Discharge Register (SHDR), on all adult patients (≥ 18 years) with a diagnosis of PHF (S42.2, S42.20, or S42.21) for the period between 2001 and 2016. We used the Swedish Cause of Death Register (SCDR) to investigate mortality in the fracture cohort. We compared the mortality of fracture patients with age- and sex-matched population-based mortality data obtained from Statistics Sweden. RESULTS: A total of 147 692 PHF patients were identified, with a male to female ratio of 1:3. The mean age was 69 years (range, 18 to 111). Most patients were treated non-surgically (n = 126,487, 86%). The crude mortality rate was 2.2% at 1 month, 4.1% at 3 months, 8.5% at 12 months, and 24% at 48 months after sustaining a PHF. Mortality increased with age; however, the standardized mortality rate (SMR) was highest among young patients. SMR was 5.4 in the 18- to 39-year age group, 3.9 in the 40- to 64-year age group, 1.8 in the 65-79-year age group, and 1.2 in the ≥ 80-year-old population. The age-adjusted SMR was 3.9 in the whole adult PHF population. CONCLUSION: The mortality rate and SMR suggest that PHF patients are heterogeneous. Some older PHF patients may benefit from specialized care (e.g., orthogeriatric), and this should be evaluated in future studies.

Careful patient selection together with optimal implant positioning may reduce but does not eliminate the risk of elevated serum cobalt and chrome levels following metal-on-metal hip resurfacing.

BACKGROUND: Elevated serum chrome (sCr) and cobalt (sCo) concentrations are associated with local tissue adverse reactions to metal debris following metal-on-metal hip resurfacing (MoM-HR). Serum metal ions <2 µg/l are probably of little clinical relevance and a pragmatic "safe" threshold <5 µg/l has been suggested.The primary aim of this study was to evaluate if a careful selection of patients combined with optimal implant positioning could eliminate cases with "unsafe" serum metal ion levels. A secondary aim was to study the association between different risk factors and having Co and/or Cr levels >5 µg/l. PATIENTS AND METHODS: This is a retrospective, single-institution cohort study of 410 consecutive patients operated on with a Birmingham Hip Resurfacing (BHR) implant between 2001 and 2014. 288 of these had a unilateral MoM-HR, pelvic and true lateral radiographs, and a related sCo and sCr sample, and were included in the final analysis. They were allocated to either a presumed "optimal group" consisting of only men aged <60 years old, with femoral head component >48 mm diameter, and with a cup positioned within Lewinnek's safe zones, or a "suboptimal group" consisting of the remaining patients. Fisher's exact test and multiple logistic regression analyses were performed. RESULTS: In the optimal group 48% (47/97) had serum metal ions >2 µg/l and 8% (8/97) >5 µg/l compared to 61% (116/191) and 18% (34/191) in the suboptimal group, p = 0.059 and p = 0.034 respectively. Acetabular cups with an anteversion <5 degrees had the highest odds ratio, 6.5 (95% CI, 3.0-14.3), of having sCo and sCr concentrations exceeding 5 µg/l. CONCLUSIONS: A well oriented BHR acetabular component in a presumably "optimal" patient reduces the risk of having elevated serum metal ions but does not eliminate it. Insufficient cup anteversion seems to be the strongest associated factor of elevated serum metals.

Growth Differentiation Factor 7 promotes multiple-lineage differentiation in tenogenic cultures of mesenchymal stem cells.

The repair of the tendon-bone interface, which is composed of tendon, fibrocartilage, and bony attachment, remains a clinical challenge. The application of mesenchymal stem cells (MSCs), collagen-rich extracellular matrix (ECMs), as well as growth factors, has the potential to regenerate this special multiple-tissue structure through the so-called biological augmentation. We present here an in vitro tendon regeneration model with C3H10T1/2 cells cultured on Collagen I matrix and evaluated the lineage determination effects of Growth Differentiation Factor 7 (GDF-7). We found that besides tenogenic effect, GDF-7 also stimulates the expression of osteoblastic as well as adipocytic genes. Our results indicate that GDF-7 might be a promising growth factor for regeneration of the tendon-bone interface due to its multiple-lineage stimulating effects. However, the side effect on adipogenic differentiation should be of concern, as it is a known risk factor for repair failures.

Secular trends in incidence and seasonal variation of distal radius fracture among children: A nationwide study based on the Swedish National Patient Register 2002-2016.

BACKGROUND AND PURPOSE: Although distal radius fracture (DRF) is the most common fracture type in children, research on its seasonality across different age groups is limited. We investigated secular trends in incidence and seasonal variation of pediatric DRF based on Swedish nationwide population database. PATIENTS AND METHODS: In this observational study, data for all children aged <18 years in Sweden with DRF defined by ICD-codes were analyzed for each month and each year during 2002-2016 using the Swedish National Patient Register. The general population counts for each age and sex-category were acquired to evaluate population at risk for each period. We calculated the age standardized and sex specific annual incidence rates, seasonal incidence rates, and monthly incidence rates and analyzed the seasonal variation in the mechanisms of injury. RESULTS: A total of 155,891 DRF cases were identified. The age standardized and sex specific incidence rate was 531 (95%CI 528-533) per 100,000 patient years at risk. Fracture risk was highest during summer and lowest in the winter. The highest seasonal variation was observed among boys 2- < 5 years. The crude incidence rate and the age-standardized incidence rates in winter significantly decreased between 2002 and 2016 (annual percentage change, -2 %). INTERPRETATION: We found significant seasonal variation in DRF among all age groups in Swedish children. The findings can help in developing strategies to prevent fractures as well as in allocating medical and social resources.

A pilot multicentre cluster randomised trial to compare the effect of trauma life support training programmes on patient and provider outcomes.

INTRODUCTION: Trauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a cluster randomised controlled trial comparing advanced trauma life support (ATLS) and primary trauma care (PTC) with standard care. METHODS AND ANALYSIS: We will pilot a pragmatic three-armed parallel, cluster randomised controlled trial in India, where neither of these programmes are routinely taught. We will recruit tertiary hospitals and include trauma patients and residents managing these patients. Two hospitals will be randomised to ATLS, two to PTC and two to standard care. The primary outcome will be all-cause mortality at 30 days from the time of arrival to the emergency department. Our secondary outcomes will include patient, provider and process measures. All outcomes except time-to-event outcomes will be measured both as final values as well as change from baseline. We will compare outcomes in three combinations of trial arms: ATLS versus PTC, ATLS versus standard care and PTC versus standard care using absolute and relative differences along with associated CIs. We will conduct subgroup analyses across the clinical subgroups men, women, blunt multisystem trauma, penetrating trauma, shock, severe traumatic brain injury and elderly. In parallel to the pilot study, we will conduct community consultations to inform the planning of the full-scale trial. ETHICS AND DISSEMINATION: We will apply for ethics approvals to the local institutional review board in each hospital. The protocol will be published to Clinical Trials Registry-India and ClinicalTrials.gov. The results will be published and the anonymised data and code for analysis will be released publicly.

Incidence of femoral fractures in children and adolescents in Finland and Sweden between 1998 and 2016: A binational population-based study.

BACKGROUND AND OBJECTIVE: Femoral fractures in children have significant impact for patients, family, and trauma resources as they usually require hospitalization and surgical treatment. The aim of this study was to determine the incidence and trends of femoral fractures among children and adolescents hospitalized between 1998 and 2016 in Finland and Sweden. METHODS: All patients younger than 17 years of age in Finland and Sweden with a femoral fracture treated surgically between 1998 and 2016 were included in the study. Data were collected from National Hospital Discharge Registries. Patients were classified by gender and age into four groups. The annual incidences per 100,000 were calculated using annual mid-year population census data obtained from the Official Statistics of Finland and Sweden. RESULTS: In total, 6410 patients younger than 17 years of age diagnosed with femoral fracture were included in this study. The total incidence per 100,000 femoral fractures was 13.3 in Finland and 11.0 in Sweden. The incidence of femoral fractures decreased during the study period in all age groups, except for teenage Finnish girls. Most of the fractures were located in femoral shaft. Fractures of the upper and distal femur were rare. Male predominance was detected in all age groups older than 1 year. CONCLUSIONS: The incidence of femoral fractures decreased in all age groups except in teenage Finnish girls. Majority of femoral fractures were located in femoral shaft with male predominance. In children younger than 1 year of age, female predominance was found.

Personal protection equipment for orthopaedic and trauma surgery during the COVID-19 pandemic: The results of an EFORT survey initiative.

Orthopaedic and trauma surgeons performing surgery in the COVID-19 pandemic environment faced problems with availability, use, rationing, modification, compliance and recycling of personal protection equipment (PPE). Orthopaedic and trauma surgeons were not well informed concerning the use of PPE for aerosol-generating orthopaedic and trauma procedures. Scientific bodies, health authorities and management have provided insufficient guidelines for the use of PPE in aerosol-generating orthopaedic and trauma procedures. The availability of specific PPE for orthopaedic and trauma operating theatres is low. Hospital management and surgeons failed to address the quality of operating theatre ventilation or to conform to recommendations and guidelines. Operating theatre PPE negatively affected surgical performance by means of impaired vision, impaired communication, discomfort and fatigue. Existing PPE is not adequately designed for orthopaedic and trauma surgery, and therefore, novel or modified and improved devices are needed.

Technology-Enhanced Learning of Human Trauma Biomechanics in an Interprofessional Student Context.

Phenomenon: This study aimed to investigate how students can develop their understanding of trauma biomechanics by means of technology-enhanced learning-an interactive visualization tool developed to enhance understanding of the biomechanics underlying an injury via dynamic imaging sequences. Approach: Students were invited to explore the content as a learning resource during an interprofessional clinical placement on an orthopedic ward. Thirty volunteer medical, nursing, and physiotherapy/occupational therapy students participated in 10 interprofessional groups of three participants. They were video recorded while interacting with learning software that was divided into five sections: Work Up, General Information, Biomechanical Case Study, Biomechanical Risk Assessment, and Treatment. Investigators probed students' learning experiences via four focus group discussions. A sociomaterial perspective was adopted, directing the analytical focus to how students' made use of talk, gestures, bodies, and material objects to understand the visualized phenomena. Findings: When connecting the visualization to a patient case, certain features of the technology stood out as important for promoting engagement and understanding trauma mechanisms. Decreased tempo, showing the directions and dynamics of trauma biomechanics in slow-motion, and color coding of the strain on the affected structures were especially important for evoking the emotional responses. The visualization tool also supported students' explorations of causal relationships between external forces and their biomedical effects. These features emphasize the sociomaterial relation between the design of the technology and the student activities. Insights: Dynamic visualization of biomechanical events has the potential to improve the understanding of injury mechanisms and specifically to identify anatomical structures at high risk of injury. Dynamic visualizations for educational purposes seem to promote possibilities for learners to contextualize visual representations relative to one's own body. Educational methods and practice need explicit attention and development in order to use the full potential of the visualization technology for learning for the health care professions.

The bone anchored prostheses for amputees - Historical development, current status, and future aspects.

In the past 50 years, bone anchored prostheses have evolved from a concept for experimental treatment to a rapidly developing area in orthopedics and traumatology. Up to date, there are dozens of centers in the world providing osseointegration amputation reconstructions and more than a thousand patients using the bone anchored prostheses. Compared with conventional socket prostheses, the bone anchored prosthesis by osseointegration avoids the debilitating problems related with soft tissues. It also provides physiological weight bearing, improved range of motion, and sensory feedback, all of which contribute to the improvement on quality of life for amputees. The present article briefly reviews the historical development of osseointegration surgery for amputation reconstruction and the current challenges. The implant design characters and surgical techniques of the two types of implants; the screw-type implant (presented by the OPRA system), and the press-fit implants (presented by EEP and OPL systems) are described. The major complications, infections and mechanical failures, are discussed in detail based on the latest evidence. Future aspects and experimental trials aiming to overcome the current challenges are presented.

Increasing incidence of pelvic and acetabular fractures. A nationwide study of 87,308 fractures over a 16-year period in Sweden.

BACKGROUND: Fractures of the pelvis and acetabulum are major injuries, often associated with hospitalization, reduced function and sometimes life-threatening conditions. Current data on nationwide incidence and treatment is sparse. Existing epidemiological studies are either single-centered or investigating only in-patients. The aim of this study was to investigate the epidemiology and treatment of pelvic and acetabular fractures in a nationwide register study including all adult patients in Sweden during 2001-2016. METHODS: We used the Swedish National Patient Register to collect data on the entire Swedish population aged ≥18 years from 2001 to 2016. Variables included age, gender, fracture type and treatment. RESULTS: We found a total of 87,308 pelvic and acetabular fractures (71% females) in Sweden during the 16-year study period and the incidence increased from 64 to 80 per 100,000 person-years from 2001 to 2016. The incidence of pelvic fractures increased from 58 to 73 per 100,000 person-years and the majority of the patients (74%) were female. The incidence of acetabular fracture increased from 8.7 to 11 per 100,000 person years and the majority of the patients (58%) were male. Only 2.0% of all patients with a pelvic fracture were treated surgically, as compared to 15% for acetabular fractures. The rate of surgical treatment was higher for males compared to females for both pelvic (4.4 and 1.2% respectively) and acetabular (19 and 10% respectively) fractures. CONCLUSION: The incidence of pelvic and acetabular fractures increased markedly in Sweden from 2001-2016. Pelvic fractures were more common among females and acetabular among males. The surgical rate was higher for acetabular compared to pelvic fractures. Major gender differences in treatment choices were found with higherproportion of men treated surgically for both fracture types, and in all age groups.

Secular trends in hip fracture incidence and subsequent mortality in dialysis patients and the general population in Sweden.

BACKGROUND: Declining trends of hip fracture incidence in dialysis patients were reported from USA and Japan while studies from Europe are lacking. We investigated trends in hip fracture incidence and subsequent mortality in Swedish dialysis patients, comparing with the Swedish general population. METHODS: We used the population-based Swedish national database of fractures and the Swedish National Renal Registry to retrieve data on hip fractures incidence and subsequent mortality for years 2007-2016. Trends for age-standardized hip fracture incidence rate (ASRhip fracture) and age-standardized 30-day (ASMR30day) and 180-day (ASMR180day) post-hip fracture mortality rate in Swedish general population were evaluated by joinpoint regression analysis. Standardized incidence ratios of hip fracture (SIR) and standardized mortality ratios (SMR) were calculated for Swedish dialysis patients. RESULTS: In the general population, ASRhip fracture declined significantly: in women from 2007 and in men from 2009. In dialysis patients, SIR was 3-5 times higher compared to the general population and declined over time in women but not in men. In general population, mortality (ASMR30day and ASMR180day) declined significantly in women and men. In dialysis patients, post-fracture mortality (SMR, mainly for 180-day mortality) remained two-fold higher than in general population with no consistent trend towards improvement. CONCLUSIONS: Hip fracture incidence and subsequent mortality fell among women and men in the Swedish general population. In dialysis patients, hip fracture incidence declined in women but not in men while post-fracture mortality did not improve, and the incidence and subsequent mortality remained 3 to 5-fold and 2-fold higher than in the general population.

Living with a recalled implant: a qualitative study of patients' experiences with ASR hip resurfacing arthroplasty.

BACKGROUND: Total hip arthroplasty is the traditional treatment for osteoarthritis in the hip joint. Hip resurfacing arthroplasty, with metal on metal bearing, is a modern concept initially developed mainly for young active people. The metal-on-metal hip arthroplasty implant, Articular Surface Replacement (ASR), was implanted in approximately 93,000 patients before it was recalled in 2010 due to a high complication rate. This study aimed to evaluate patients' own experiences living with an implant that they knew had a high complication rate and had been recalled from the market. METHODS: A total of 14 patients, still living with the implant, of a cohort of 34 patients were available for follow-up. Qualitative semi-structured interviews were conducted with 14 patients where a majority actively sought for metal-on-metal hip resurfacing arthroplasty (HRA), and subsequently underwent HRA with an ASR prosthesis between 11/21/2006 and 09/28/2009. The responses were analyzed using content analysis described by Graneheim and Lundman to compress text and identify categories and subcategories. RESULTS: The results showed that most patients had already decided that they wanted a metal-on-metal HRA implant before meeting the surgeon. They expressed that the implant made it possible to live an active life. A majority did not think about the fact that they had a hip implant, because they lacked subjective pain. Most of the patients were positive about the annual exams at the hospital and wanted them to continue. None of them felt that their trust towards the healthcare system had changed after the implant recall. They expressed a belief that they would need new surgery sooner than they first thought. CONCLUSIONS: Despite all the attention when the ASR prosthesis was recalled, patients with ASR-HRA did not report themselves negatively affected by the recall in this group of patients where a majority had actively sought for an HRA procedure. The healthcare system has an obligation to continue the annual exams, even if the implant provider does not continue reimbursement.

Epidemiology and mortality of pelvic and femur fractures-a nationwide register study of 417,840 fractures in Sweden across 16 years: diverging trends for potentially lethal fractures.

Background and purpose - Fractures of the pelvis and femur are serious and potentially lethal injuries affecting primarily older, but also younger individuals. Long-term trends on incidence rates and mortality might diverge for these fractures, and few studies compare trends within a complete adult population. We investigated and compared incidence and mortality rates of pelvic, hip, femur shaft, and distal femur fractures in the Swedish adult population.Patients and methods - We analyzed data on all adult patients ≥ 18 years in Sweden with a pelvic, hip, femur shaft, or distal femur fracture, through the Swedish National Patient Register. The studied variables were fracture type, age, sex, and 1-year mortality.Results - While incidence rates for hip fracture decreased by 18% (from 280 to 229 per 105 person-years) from 2001 to 2016, incidence rates for pelvic fracture increased by 25% (from 64 to 80 per 105 person-years). Incidence rates for femur shaft and distal femur fracture remained stable at rates of 15 and 13 per 105 person-years respectively. 1-year mortality after hip fracture was 25%, i.e., higher than for pelvic, femur shaft, and distal femur fracture where mortality rates were 20-21%. Females had an almost 30% lower risk of death within 1 year after hip fracture compared with males.Interpretation - Trends on fracture incidence for pelvic and femur fractures diverged considerably in Sweden between 2001 and 2016. While incidence rates for femur fractures (hip, femur shaft, and distal femur) decreased or remained constant during the studied years, pelvic fracture incidence increased. Mortality rates were different between the fractures, with the highest mortality among patients with hip fracture.

Distal Biceps Tendon Rupture Surgery: Changing Incidence in Finnish and Swedish Men Between 1997 and 2016.

PURPOSE: Distal biceps tendon rupture is a relatively rare injury usually occurring with excess external extension force applied to a flexed elbow. The aim of this study was to examine the incidence of distal biceps tendon rupture surgery in the Finnish and Swedish adult population between the years 1997 and 2016. A secondary aim was to investigate the distal biceps rupture incidence in the Swedish population in 2001 to 2016. METHODS: We assessed the number and rate of distal biceps tendon rupture surgery using the Finnish and Swedish Hospital Discharge Register as databases. The study included the entire Finnish and Swedish adult population aged 18 years and older between January 1, 1997 and of December 31, 2016. RESULTS: During the study period, 2,029 patients had a distal biceps tendon rupture in Finland, and the corresponding figure was 2,000 in Sweden. The rate of distal biceps tendon rupture surgery increased steeply, but equally, in both countries, in Finnish men from 1.3 per 100,000 person-years in 1997 to 9.6 in 2016, and in Swedish men from 0.2 in 1997 to 5.6 in 2016. The incidence of distal biceps tendon rupture in Sweden increased in men from 1.6 to 10.0 per 100,000 person-years from 2001 to 2016. CONCLUSIONS: There was a 7-fold and a 28-fold increase in the incidence of distal biceps tendon rupture surgery in Finnish and Swedish men during 1997 to 2016. The incidence of distal biceps tendon rupture rose 6-fold in Swedish men in 2001 to 2016. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.