Use of Concrete for Road Infrastructure: A SWOT Analysis Related to the three Catchwords Sustainability, Industrialisation and Digitalisation.

This paper aims at identifying the direction for more sustainable development of the use of concrete in road infrastructure in an industrialised context. The increase in the global mean temperature is one of the most severe challenges today. The concrete industry is responsible for significant emissions of greenhouse gases, most attributable to cement production. However, concrete is one of the most important building materials in the world and indispensable for the societal development in countries at all development stages. Thus, the concrete industry needs to take measures for reducing emissions. This paper investigates possible directions for the development of the concrete industry, to reduce climatic impact and accommodate positive societal growth. The investigation is carried out as a SWOT analysis, focusing on three terms dominating the present discussion on any development within the construction industry; sustainability, industrialisation and digitalisation. The result is a thorough discussion and a set of recommendations for the direction of future research and innovation on sustainable use of concrete in the construction of road infrastructure. The major opportunities and threats are summarised in the conclusions, and future research to be carried out in two of the authors’ PhD-projects are described.Use of Concrete for Road Infrastructure: A SWOT Analysis Related to the three Catchwords Sustainability, Industrialisation and Digitalisation.publishedVersio

Compensation claims in pediatric orthopedics in Norway between 2012 and 2018: a nationwide study of 487 patients

publishedVersionpublishedVersio

Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips: 20 patients followed for 1–6 years

Background and purpose Chronic hip dislocation in non-ambulatory individuals with cerebral palsy (CP) can lead to severe problems, of which pain is often the most severe. We studied the outcome of proximal femoral resection, especially regarding pain, sitting balance, perineal care, and patient satisfaction

Changes in lower limb rotation after soft tissue surgery in spastic diplegia: 3-dimensional gait analysis in 28 children

Background and purpose Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to correct deformities in the sagittal plane, would also have an effect on rotational parameters

The natural history of acetabular dysplasia and later total hip arthroplasty in late-detected DDH: 48 patients with closed reduction followed to a mean age of 62 years

Background and purpose: The long-term prognosis of acetabular dysplasia without subluxation in developmental dislocation of the hip (DDH) is uncertain. The aim of this study was to assess the consequence of having acetabular dysplasia at skeletal maturity on the need for having a total hip arthroplasty (THA) up to the age of 60 years. Patients and methods: Inclusion criteria were age at diagnosis 0.5–3.0 years, initial treatment with skin traction to obtain closed reduction during 1958–1962, and no acetabular procedures to improve femoral head coverage. 48 patients (57 hips) met these criteria, 41 girls and 7 boys. Hip dysplasia was defined as a center–edge (CE) angle at skeletal maturity of 10–19°, and hips with CE angles in the range 20–25° were termed borderline dysplastic. Results: At skeletal maturity, 18 hips had acetabular dysplasia with a mean CE angle of 15.8° (10–19), whereas 19 hips were borderline with CE angles 20–25°, and 20 hips were normal (CE angles ≥ 26°). During the follow-up period 16 hips had undergone THA, 11 of 18 hips with dysplasia, 4 of 19 with borderline dysplasia, and 1 of 20 hips without dysplasia (p < 0.001). Hip survival in the 18 dysplastic hips, with THA as the endpoint, was 100% up to patient age 40 years; thereafter survival fell to 83% at 50 years and 39% at 60 years. There was no significant correlation between CE angle at skeletal maturity and age at THA (p = 0.2). The mean age at the last follow-up in patients without THA was 62 years (60–64). Conclusion: Acetabular dysplasia without subluxation was a risk factor for THA, but less than one-fifth of the hips had undergone THA up to patient age 50 years

To what extent can soft-tissue releases improve hip displacement in cerebral palsy?: A prospective population-based study of 37 children with 7 years’ follow-up

Background and purpose — Hip displacement is frequent in nonambulatory children with cerebral palsy (CP) and treatment is controversial. This prospective study assesses the effectiveness of soft-tissue releases to treat hip subluxation, analyses prognostic factors for outcome, and identifies time to failure in hips with poor outcome. Patients and methods — 37 children (16 girls) with hip subluxation were recruited from the population-based screening program for children with CP in Norway. They had consecutively undergone soft-tissue releases (bilateral tenotomies of adductors and iliopsoas) at a mean age of 5.0 (2.8–7.2) years. Functional classification was Gross Motor Function Classification System (GMFCS) level III in 9 children, level IV in 10, and level V in 18 children. The outcome was termed good if the patient had not undergone further hip surgery and if the migration percentage (MP) of the worst hip at the latest follow-up was <50%. The mean follow-up time was 7.3 (5.1–9.8) years. Results — The outcome was good in all the ambulatory children and in 17 of 28 of the nonambulatory children. The only independent preoperative risk factor for poor outcome was MP ≥50%. The mean time to failure was 2.2 (1–5) years postoperatively and the reasons for failure were insufficient initial correction and later deterioration of displacement. Interpretation — Bilateral soft-tissue release is recommended in both ambulatory and nonambulatory children with hip sub­luxation. The operation should be performed before the hip displacement reaches 50%

To what extent can soft-tissue releases improve hip displacement in cerebral palsy?

<p><b>Background and purpose — Hip displacement is frequent in nonambulatory children with cerebral palsy (CP) and treatment is controversial. This prospective study assesses the effectiveness of soft-tissue releases to treat hip subluxation, analyses prognostic factors for outcome, and identifies time to failure in hips with poor outcome.</b></p> <p><b>Patients and methods — 37 children (16 girls) with hip subluxation were recruited from the population-based screening program for children with CP in Norway. They had consecutively undergone soft-tissue releases (bilateral tenotomies of adductors and iliopsoas) at a mean age of 5.0 (2.8–7.2) years. Functional classification was Gross Motor Function Classification System (GMFCS) level III in 9 children, level IV in 10, and level V in 18 children. The outcome was termed good if the patient had not undergone further hip surgery and if the migration percentage (MP) of the worst hip at the latest follow-up was <50%. The mean follow-up time was 7.3 (5.1–9.8) years.</b></p> <p><b>Results — The outcome was good in all the ambulatory children and in 17 of 28 of the nonambulatory children. The only independent preoperative risk factor for poor outcome was MP ≥50%. The mean time to failure was 2.2 (1–5) years postoperatively and the reasons for failure were insufficient initial correction and later deterioration of displacement.</b></p> <p><b>Interpretation — Bilateral soft-tissue release is recommended in both ambulatory and nonambulatory children with hip sub­luxation. The operation should be performed before the hip displacement reaches 50%.</b></p

The femoral head-shaft angle is not a predictor of hip displacement in children under 5 years with cerebral palsy: A population-based study of children at gmfcs levels III-V

Background: The aim of this study was to evaluate whether the femoral head-shaft angle (HSA) is a predictor of hip displacement in children with cerebral palsy (CP). Methods: The patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilateral CP, Gross Motor Function Classification System (GMFCS) levels III-V, and migration percentage (MP) of both hips <40% at the primary radiograph. With these criteria, 101 children (61 boys) were included. GMFCS was level III in 26 patients, level IV in 23, and level V in 52. An anteroposterior radiograph of the pelvis was taken at diagnosis and at the last follow-up. Only the worst hip of each patient (the hip with the largest MP) was used for the analyses. Results: The mean age at the primary radiograph was 2.4 years (range, 0.8 to 4.9 y). The mean primary HSA was 171.0 degrees (range, 152 to 190 degrees). The mean follow-up time was 4.3 years (range, 0.9 to 11.8 y). The mean MP at the primary radiograph was 17.5% (range, 0% to 39%) and at the last follow-up 41.9% (range, 0% to 100%). At that point, MP was <40% in 54 hips and ≥40% in 47 hips. There was no significant difference in primary HSA between patients with final MP<40% and those with final MP≥40% (170.8 and 171.3 degrees, respectively; P=0.761). At the last follow-up, the mean HSA was significantly larger in hips with final MP≥40% than in hips with final MP<40% (171.1 vs. 167.4 degrees; P=0.029). Conclusions: There was a markedly increased valgus position of the proximal femur in nonambulatory children with CP. However, the primary HSA in children below 5 years of age was not a predictor of later hip displacement, defined as MP≥40%