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Jan Tidermark

Publications and source records attributed to Jan Tidermark.

14 recordsLinked to original sources
PubMed2006

Responsiveness of the EuroQol (EQ-5D) and the Nottingham Health Profile (NHP) in elderly patients with femoral neck fractures.

INTRODUCTION: The objective of this study was to evaluate the internal and external responsiveness of the EuroQol (EQ-5D) and the Nottingham Health Profile (NHP) and to evaluate the overlap of change scores from the two instruments. METHODS: Sixty patients with femoral neck fractures treated with internal fixation at a university hospital participated. Internal responsiveness was assessed using a paired t-test and the standardised response mean (SRM) for patients with displaced fractures hypothesised to deteriorate between baseline and the 6-month follow-up. In the analyses of external responsiveness, receiver operator characteristics (ROC) and logistic regression were employed to assess the correspondence between the chosen external criterion (EC) defining fracture displacement, i.e. displaced vs. undisplaced fractures, and the change scores from the EQ-5D and the NHP. The overlap in change scores for the overall scores and comparable subdimensions of the two instruments was evaluated by correlational analyses. RESULTS: The SRM were large and the change in HRQoL over time was statistically significant for both instruments in patients with displaced fractures. A correspondence was found between the EC and change scores for both questionnaires. The correlation coefficients between the change scores for the overall scores and comparable subdimensions of the two instruments ranged from relatively small to moderate. CONCLUSIONS: The results yielded support for the internal and external responsiveness of the EQ-5D and the NHP and indicated an advantage for the EQ-5D. The empirical overlap between change scores from the two instruments was limited.

Aged↗
PubMed2006

Skin protection underneath the pneumatic tourniquet during total knee arthroplasty: a randomized controlled trial of 92 patients.

BACKGROUND: The use of a pneumatic tourniquet to obtain a bloodless field during a total knee arthroplasty (TKA) allows the surgeon to work with greater technical precision in a safe, clear environment. Despite the benefits of surgical tourniquets and many advances in tourniquet equipment, their use is not without risk and complications may still occur. The primary aim of this study was to determine whether there are any differences between an elastic stockinette, cast padding, and no protective material at all regarding skin injuries after a primary TKA in a bloodless field using a pneumatic tourniquet. METHODS: 92 patients were randomized to 1 of 3 groups. In the first group, the limb underneath the pneumatic tourniquet was protected by a two-layer elastic stockinette (E). In the second group, it was protected by cast padding (C), and no protective material (N) was used in the third group. The presence of major skin injuries (blisters) was recorded when the tourniquet was removed after surgery. RESULTS: The two groups with skin protection had fewer skin injuries (p = 0.007). The elastic stockinette was significantly better than having no protective material and there was a trend towards better results in the elastic stockinette group than in the cast padding group. INTERPRETATIONS: Our findings indicate that protective material underneath the tourniquet cuff reduces the risk of skin injuries, i.e. blisters. An elastic stockinette appears to be best.

Adult↗
PubMed2006

Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients.

INTRODUCTION: Recent randomized controlled trials have shown that for the active and lucid elderly patient with a displaced femoral neck fracture, a primary total hip replacement (THR) is superior to internal fixation (IF) regarding the need for secondary surgery, hip function and health-related quality of life (HRQoL). Despite the high failure rate for IF, the method is still recommended for this patient cohort by some authors. One argument is that if IF fails, there is always the possibility of performing a secondary salvage THR. The main aim of our study was to determine whether a primary THR, as compared to a secondary THR after failed IF, gives a better outcome after 2 years. METHODS: We compared outcome for 43 patients with a primary THR to the outcome for 41 patients who were treated with a secondary THR after failed IF. All patients (mean age 80 years) were lucid and had a displaced femoral neck fracture. Hip function (Charnley score) and health-related quality of life (HRQoL, EQ5D) were assessed 2 years after the THR procedure. RESULTS: Hip function was better in the primary THR group: the mean Charnley score was 15/18 as compared to 13/18 in the secondary THR group (p < 0.001). The patients with failed IF who later underwent a secondary THR experienced a more pronounced decrease in HRQoL (EQ-5D index score) during the first year of treatment compared to patients in the primary THR group, with a difference of 0.25 in the EQ-5D index score at the 4-month follow-up (p = 0.02). INTERPRETATION: We found that a secondary THR after failed IF results in inferior hip function compared to a primary THR for a displaced femoral neck fracture in the active and lucid elderly patient. Moreover, the patients with failed IF had to undergo at least one re-operation and experienced a significant reduction in HRQoL before the salvage THR.

Activities of Daily Living↗
PubMed2006

Outcome after closed functional treatment of humeral shaft fractures.

OBJECTIVE: The aim of this study was to investigate the outcome after an isolated humeral shaft fracture treated primarily nonoperatively with a fracture brace. SETTING: University hospital. DESIGN: Descriptive study. Retrospective assessment of clinical and radiographic healing. Prospective assessment of functional outcome and health-related quality of life (HRQoL). PATIENTS: Seventy-eight patients (female, n = 45), mean age 58 (range, 16-91) years with isolated humeral shaft fractures. INTERVENTION: Closed functional treatment with a fracture brace. MAIN OUTCOME MEASUREMENTS: Fracture healing, need for revision surgery, Short Musculoskeletal Functional Assessment (SMFA), HRQoL according to the Short Form 36 (SF-36) and patient-reported recovery. RESULTS: Ninety percent of the fractures healed after nonoperative treatment, and nearly 90% of the nonunions healed after revision surgery. There was a trend toward more frequent nonunions in simple fractures, that is, type A according to the Orthopedic Trauma Association (OTA) classification (P = 0.08). The nonunion rate in type A fractures located in the proximal and middle part of the shaft was approximately 20%. Nearly 50% of the patients reported full recovery after successful nonoperative treatment, but none of the patients with a healed nonunion did after revision surgery (P < 0.05). The SMFA scores for arm/hand function were acceptable for the patients who healed after the primary fracture-brace treatment, but the values were worse for those with a healed nonunion after revision surgery. The SF-36 scores were generally slightly lower compared with a Swedish reference population. CONCLUSION: This study confirms the high overall rate of union of humeral shaft fractures and an acceptable functional outcome after successful fracture-brace treatment. However, in simple (type A) fractures, the nonunion rate seems to be higher, and patients with healed nonunions after revision surgery reported worse functional outcomes. Based on these findings, it seems reasonable to explore the use of plate fixation compared with nonoperative treatment for selected fracture types in a randomized controlled trial.

Adolescent↗
PubMed2006

Documenting the cognitive status of hip fracture patients using the Short Portable Mental Status Questionnaire.

AIMS AND OBJECTIVES: The aim of this study was to describe how nurses document their subjective assessment of the patients' cognitive status in the patients' records and to compare this documentation with an assessment made using a validated evaluation instrument in older patients with a hip fracture. BACKGROUND: There are indications that older people with a hip fracture and impaired cognitive ability do not receive optimal care and that they suffer from a disproportionately high number of complications. Preventing and rapidly detecting confusion is probably an effective strategy for improving care for these patients. To be able to prevent care-related complications and plan for future nursing and medical care, it is necessary to identify patients with impaired cognitive ability. DESIGN: Clinical trial including 362 patients. METHODS: The patients' cognitive function was assessed by a research nurse using a validated instrument, the Short Portable Mental Status Questionnaire, and an independent subjective assessment was made by a ward nurse. The agreement between these assessments was analysed. RESULTS: An assessment of cognitive function by the ward nurse was lacking in 12% of the patients. The assessment made by the nurses did not correspond to the level of orientation according to Short Portable Mental Status Questionnaire in 24% of the patients. In the vast of majority of these cases, the patients were documented as being cognitively alert although they were cognitively impaired according to the Short Portable Mental Status Questionnaire. Among the patients who were cognitively oriented according to the Short Portable Mental Status Questionnaire, the nurses' assessment identified 97% as oriented, but among the patients with impaired cognitive ability according to the Short Portable Mental Status Questionnaire, only 58% were identified as being cognitively impaired by the ward nurses. CONCLUSIONS: An assessment of cognitive function is still lacking in nursing records for a substantial number of older people with a hip fracture and cognitive dysfunction is frequently underdiagnosed in routine health care. RELEVANCE TO CLINICAL PRACTICE: Patient care could be improved if the patients' cognitive function was assessed regularly and objectively by means of a validated evaluation instrument.

Activities of Daily Living↗
PubMed2006

The influence of cognitive function on outcome after a hip fracture.

BACKGROUND: Previous studies have indicated that patients with a hip fracture who have impaired cognitive function have an increased risk for complications, poor long-term outcome, and an increased mortality rate. An assessment of cognitive function is often lacking in nursing and medical records. We investigated whether an assessment of cognitive function obtained with use of a validated instrument would be a useful patient management adjunct. METHODS: We studied 213 patients with a hip fracture who had a mean age of eighty-four years and were entered in a prospective trial with a follow-up evaluation at four and twelve months. On admission to the orthopaedic ward, the patients were evaluated with use of the Short Portable Mental Status Questionnaire to assess their cognitive function. The outcome for patients with severe cognitive dysfunction, i.e., those with a score of <3 on the questionnaire, was compared with the outcome for patients with higher scores. The main outcome measurements were the Charnley hip score, activities of daily living status, health-related quality of life, and mortality. RESULTS: A Short Portable Mental Status Questionnaire score of <3 and male gender were associated with an increased mortality rate during the first twelve months. Moreover, patients with a score of <3 had a significantly worse outcome with regard to the ability to walk and to perform the activities of daily living, with 36% of these patients confined to a wheelchair and almost 39% totally dependent with regard to daily living functions at the time of the final follow-up (p < 0.001). CONCLUSIONS: The systematic use of the Short Portable Mental Status Questionnaire upon admission to the orthopaedic ward identifies patients with a hip fracture who have severe cognitive dysfunction and effectively predicts their outcome with regard to the ability to walk, ability to perform the activities of daily living, and mortality, and it can be recommended for use in the care of elderly patients with a hip fracture.

Aged↗
PubMed2005

Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years.

BACKGROUND: Recent randomized, controlled trials performed at two years postoperatively have shown that a primary total hip replacement is superior to internal fixation for the treatment of a displaced femoral neck fracture in a relatively healthy, mentally competent, elderly patient. The primary aim of the present study was to evaluate the outcomes at four years. METHODS: One hundred and two patients (mean age, eighty years) who had an acute displaced femoral neck fracture were randomly allocated to be treated with total hip replacement or internal fixation. The inclusion criteria were an age of at least seventy years, absence of severe cognitive dysfunction, an independent living status, and the ability to walk independently. The main outcome measurements were hip complications, reoperations, hip function, and health-related quality of life. RESULTS: The mortality rate was 25% in both groups. At the forty-eight-month follow-up evaluation, the rate of hip complications was 4% in the patients treated with total hip replacement and 42% in those treated with internal fixation (p < 0.001) and the reoperation rates were 4% and 47%, respectively (p < 0.001). The arthroplasty group had no additional hip complications or reoperations between the twenty-four and forty-eight-month follow-up visits. In the fixation group, the percentage of hip complications increased from 36% to 42% and the percentage of reoperations increased from 42% to 47% during the same period. The hip function was significantly better and the decline in health-related quality of life was less pronounced in the arthroplasty group than it was in the fixation group at the four, twelve, and twenty-four-month follow-up evaluations. Ninety-seven percent of the patients in the arthroplasty group and 57% of the patients in the fixation group who were available for follow-up at forty-eight months had no hip complications (p < 0.001). CONCLUSIONS: Compared with internal fixation, primary total hip replacement provides a better outcome for mentally competent elderly patients with a displaced femoral neck fracture. The complication and reoperation rates were significantly lower and hip function and health-related quality of life were at least as good at four years after the surgery.

Aged↗
PubMed2004

Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures.

AIM: To evaluate the effects of a protein-rich liquid supplementation, alone or in combination with the anabolic steroid nandrolone decanoate, on body composition, activities of daily living (ADL) status and the health-related quality of life (HRQoL) after a femoral neck fracture. METHODS: Sixty women, aged 83 +/- 5 years (mean +/- SD), BMI < 24 kg/m2 (20.4 +/- 2 kg/m2 ) and capable of co-operating, with a femoral neck fracture treated with internal fixation, were randomised to open treatment during 6 months with a protein-rich liquid formula alone (PR, Fortimel, 200 ml/day, 20 g protein/day) or in combination with nandrolone decanoate (PR/N, Deca-Durabol 25 mg i.m./3 weeks) or to a control group (C). The patients were re-examined after 6 and 12 months regarding body weight (BW), lean body mass (LBM, DXA), ADL status according to Katz, HRQoL according to EQ 5-D and fracture healing. RESULTS: LBM decreased in the C (-1.2 +/- 2 kg) and PR groups (-1.2 +/- 1 kg) but remained the same in the PR/N group (0.3 +/- 1 kg) (P < 0.05 between groups). ADL remained at a high level in the two intervention groups but declined significantly in the C group (P < 0.005 between groups). The decline in HRQoL was least pronounced in the PR/N group at 6 months (P < 0.05 between groups). Patients with fracture healing complications lost more BW (P < 0.05) and LBM (P < 0.01) than patients with uneventful fracture healing. CONCLUSION: Protein-rich liquid supplementation in combination with nandrolone given for 6 months to lean elderly women after a femoral neck fracture may positively affect LBM, ADL and HRQoL.

Activities of Daily Living↗
PubMed2003

Primary total hip arthroplasty with a Burch-Schneider antiprotrusion cage and autologous bone grafting for acetabular fractures in elderly patients.

OBJECTIVES: To investigate the clinical and functional outcome in an elderly population with acetabular fractures after low-energy trauma treated acutely with a total hip arthroplasty supported by a reinforcement ring (Burch-Schneider antiprotrusion cage) and autologous bone grafting of the acetabulum. SETTING: University hospital. DESIGN: Retrospective clinical study. PATIENTS: Ten patients (7 males) available for follow-up, with a mean age at the time of surgery of 73 years (range 57-87). The mean time to follow-up was 38 months (range 11-84). INTERVENTION: Primary total hip arthroplasty supported by a reinforcement ring (Burch-Schneider Antiprotrusion Cage) and autologous bone grafting of the acetabulum. MAIN OUTCOME MEASUREMENTS: Surgical data, complications, radiographic assessment, pain, walking ability, Harris Hip Score, activities of daily living, health-related quality of life according to EuroQol (EQ-5D). RESULTS: The mean operating time was 159 minutes (range 125-185). The mean intraoperative blood loss was 1100 mL (700-1600 mL). The reinforcement ring was stable and there were no signs of loosening of the acetabular component or stem in any of the patients. The bone graft was completely incorporated in all cases. Four patients presented slight (Brooker I-II) heterotopic bone formation. All patients were still independent walkers at follow-up but with a slightly increased need for walking aids. The mean Harris Hip Score was 85 (range 69-99). The mean EQ-5D(index) score was 0.62. CONCLUSION: Primary total hip replacement with a reinforcement ring and bone grafting of the socket seems to be a promising treatment alternative in displaced acetabular fractures in elderly patients with osteoporotic bone, except in those with an increased risk of dislocation.

Acetabulum↗
PubMed2003

Quality of life and femoral neck fractures.

The worldwide increase in hip fractures is a major challenge to the health care system and society. The proper treatment of femoral neck fractures in the elderly is still controversial, and even more so from an international perspective. Optimising the treatment for improved outcomes and a reduced need for secondary surgery is mandatory for humanitarian and economical reasons. The importance of incorporating the patient's perspective of the outcome in clinical trials has been acknowledged and there are now numerous instruments for assessing the quality of life. We evaluated two quality of life instruments, the EQ-5D and the SF-36, in patients with femoral neck fractures and also measured the quality of life two years after different interventions. The EQ-5D was validated in two prospective studies and it appeared to be an appropriate quality of life instrument in elderly patients with femoral neck fractures. There was a good correlation between the quality of life (EQ-5Dindexscores) and other outcome measures such as pain, mobility and independence in activities of daily living (ADL). The results also showed high responsiveness, i.e., ability to capture clinically important changes, for both the EQ-5D and the SF-36. The questionnaire response rate for both instruments was high. The rated prefracture EQ-5Dindexscores showed good correspondence with the scores of an age-matched Swedish reference population. The quality of life in patients with femoral neck fractures treated with internal fixation (IF) decreased, particularly in patients with fracture healing complications. The fracture healing complications rate at two years in patients with displaced femoral neck fractures treated with IF was 36% compared with 7% in patients with undisplaced fractures. The quality of life of patients with uneventfully healed fractures at two year was lower in patients with primary displaced fractures than in patients with primary undisplaced fractures. In a prospective randomised trial, patients with displaced femoral neck fractures were randomised to IF or total hip replacement (THR). IF resulted in more complications than THR, 36% versus 4%, and necessitated more reoperations, 42% versus 4%. Hip function and quality of life (EQ-5D) were generally better in the THR group. In summary, THR yielded a better outcome than IF for an elderly, relatively healthy, lucid patient with a displaced femoral neck fracture. In a study of elderly women with femoral neck fractures, nearly half of the patients displayed signs of protein-energy malnutrition. Underweight was associated with muscle fatigue, cognitive dysfunction and a low quality of life (Nottingham Health Profile). In a prospective randomised trial, protein-rich liquid supplementation in combination with an anabolic steroid given for 6 months to lean elderly women after a femoral neck fracture was shown to positively affect lean body mass, ADL and quality of life (EQ-5D). Fracture healing complications had a negative impact on body weight, lean body mass and quality of life.

Aged↗
PubMed2002

Femoral neck fractures in the elderly: functional outcome and quality of life according to EuroQol.

The main purpose of this prospective study was to investigate the functional outcome and health-related quality of life according to EuroQol (EQ-5D) after a femoral neck fracture treated with internal fixation in relatively healthy elderly patients. We also aimed to validate the use of the EQ-5D in routine clinical follow-ups of this group of patients. The inclusion criteria were more than 65 years of age, absence of severe cognitive dysfunction, living independently, and unhindered walking ability preoperatively. The mean follow-up period was 17 months. The rated prefracture EQ-5Dindex scores showed good correspondence with the scores of an age-matched Swedish reference population. The EQ-5Dindex scores decreased from 0.78 before the fracture (based on recall) to 0.59 at 4 months and 0.51 at 17 months after surgery. The decrease was significantly larger among patients with fracture healing complications. There was a good correlation between the EQ-5Dindex scores and other outcome measures such as pain, mobility, independence in ADL and independent living status. The questionnaire response rate (EQ-5D) was 89-100% on different follow-up occasions. The EQ-5D appears to be an easy-to use instrument even for elderly patients with femoral neck fractures. Changes in the quality of life may be useful to identify patients who might benefit from reoperation, i.e. arthroplasty. The EQ-5D also appears to be a relevant clinical end-point in outcome studies.

Activities of Daily Living↗
PubMed2002

Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation.

OBJECTIVE: To determine differences in outcome between undisplaced (Garden I and II) and displaced (Garden III and IV) femoral neck fractures in elderly patients treated with internal fixation. SETTING: University hospital. DESIGN: Prospective clinical study. PATIENTS: Ninety patients with an acute femoral neck fracture after a fall. The inclusion criteria were age older than sixty-five years, absence of severe cognitive dysfunction, independent living, and unhindered walking capability preoperatively. The mean follow-up was twenty-six months. INTERVENTION: The patients were treated with closed reduction and percutaneous internal fixation with two cannulated screws. MAIN OUTCOME MEASUREMENTS: Fracture healing complications, pain (visual analogue scale), walking capability, activities of daily living, and quality of life according to EuroQol. RESULTS: The rate of fracture healing complications in displaced femoral neck fractures in patients available at the final follow-up was 36 percent compared with 7 percent in patients with undisplaced fractures. The quality of life, according to EuroQol, of patients with uneventfully healed fractures was significantly lower in patients with primarily displaced fractures (0.51) than in patients with undisplaced ones (0.76). CONCLUSION: There was a major difference in outcome on comparing undisplaced and displaced femoral neck fractures in elderly patients treated with internal fixation. The rate of fracture healing complications in patients with undisplaced fractures was low, and patients with healed fractures regained their prefracture quality of life level. The rate of fracture healing complications and reoperations in patients with displaced fractures was high, and even in patients with uneventfully healed fractures, there was a substantial decrease in the quality of life.

Age Factors↗