Nivelkirurgiaa - perustellusti

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Ikääntyvän potilaan värttinäluun alaosan murtuman hoito - kohti potilaslähtöisyyttä

Värttinäluun alaosan murtuma on erittäin yleinen ikääntyvillä ihmisillä. Tavallisin vammamekanismi on ojennetun käden varaan kaatuminen. Murtumaa epäiltäessä ensisijainen kuvantamistutkimus on ranteen natiiviröntgenkuvaus. Virheasentoiset murtumat reponoidaan paikallispuudutuksessa. Hoitolinjaksi valitaan konservatiivinen hoito tukemalla ranne toiminnalliseen asentoon dorsaalisella kipsilastalla tai volaarinen lukkolevytys. Suurimpia haasteita hoidossa ovat murtuma-asennon mahdollinen pettäminen kipsihoidon aikana ja sen vaikutuksen arviointi hoidon lopputulokseen. Tuoreimman kirjallisuusnäytön mukaan leikkaushoito ei ole selvästi parempi hoitolinja ikääntyvien värttinäluun alaosan murtuman hoidossa, ja kipsihoitoa suositellaan edelleen. Molemmissa hoitolinjoissa on hyötynsä ja haittansa, joiden painoarvo riippuu potilaslähtöisistä tekijöistä ja näkemyksistä. Keskeistä hoitolinjan valinnassa on noudattaa jaetun päätöksenteon periaatteita.publishedVersionPeer reviewe

Revision Rates After Primary ACL Reconstruction Performed Between 1969 and 2018 : A Systematic Review and Metaregression Analysis

Background: Numerous studies, including randomized controlled trials (RCTs), have been published on the optimal graft choice for primary anterior cruciate ligament (ACL) reconstruction. Purpose: To review existing studies to investigate whether advances in orthopaedics have affected revision rates after primary ACL reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed database was searched from inception to December 31, 2020, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Patient series, observational studies, clinical trials, and registry-based studies investigating primary ACL reconstruction were included, as were high-quality RCTs from an additional study. The minimum required follow-up time for inclusion was 1 year. The primary outcome measure was the pooled prevalence of revision ACL reconstruction. The effect of the year the surgery was performed on revision rates was evaluated with metaregression analysis. All graft types were analyzed simultaneously, and all analyses were repeated separately for each graft type. Results: Overall, 330 articles with 52,878 patients were included, with a median patient age of 28 years (range, 15-57 years). The primary ACL reconstructions were performed between 1969 and 2018. At a median of 2.3 years of follow-up, the overall revision rate was 3.14% (95% CI, 2.76% to 3.56%); it was 2.71% (95% CI, 2.25% to 3.27%) for hamstring autografts, 2.38% (95% CI, 1.82% to 3.11%) for bone–patellar tendon–bone (BPTB) autografts, and 5.24% (95% CI, 4.02% to 6.80%) for other graft types. For hamstring grafts, the revision rate increased over time (year of surgery), with a 0.0434 (95% CI, 0.0150 to 0.0718) increase effect in the logit-transformed scale for every additional year. There was a slight decrease in revision rates for BPTB (β = –0.0049; 95% CI, –0.0352 to 0.0254) and other graft types (β = –0.0306; 95% CI, –0.0608 to −0.0005) over time; however, confidence intervals for BPTB included the zero change. Conclusion: Based on this systematic review and meta-analysis, ACL reconstruction is a reliable procedure with overall low historical revision rates. BPTB autograft had the lowest revision rate and a slightly decreasing trend of failures during the past 45 years, although both BPTB and hamstring autografts are reliable graft choices.publishedVersionPeer reviewe

Changes in operative treatment of tibia fractures in Finland between 2000 and 2018: A nationwide study

Introduction:Incidences of different tibia fractures are not well reported. Possible changes in the operative treatment methods have also not been studied. The aim of this nationwide registry study is to determine the incidence of operatively treated tibia fractures and investigate the possible changes in treatment methods in Finland between 2000 and 2018.Methods:All patients aged 16 years or older with operatively treated tibia fractures in Finland from 2000 to 2018 were included. The incidence of operatively treated proximal, diaphyseal, and distal tibia fractures per 100,000 person years by age, sex, mechanism of injury, and study year was calculated. Data were extracted from the Finnish National Hospital Discharge Register.Results:A total of 5996 proximal, 6874 diaphyseal, and 5658 distal tibia fractures were reported during the 18-year study period, resulting in incidences of 7.2/100,000, 8.1/100,000, and 6.9/100,000 person years for operatively treated proximal, diaphyseal, and distal tibia fractures, respectively. Over the study period, a clear change in fixation method in distal tibia fractures was found as plating became popular in the beginning of the 21st century. During the last 5 years of the study period, nailing and plating were equally used.Conclusions:Operatively treated proximal tibia fractures are most common among older females while diaphyseal fractures are most frequent in young male patients. Distal tibia fractures occur most often among middle-aged people.</p

Incidence of Electric Scooter-Associated Injuries in Finland From 2019 to 2021

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Association of Nighttime Speed Limits and Electric Scooter-Related Injuries

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