[The Söderberg prize to Per-Ingvar Brånemark for osseointegrated implants].
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Awards and Prizes↗
Biomedical subjects
K G Thorngren
Publications and source records attributed to K G Thorngren.
Perceived health in hip-fracture patients: a prospective follow-up of 100 patients.
We report the impact of the treatment and rehabilitation in hip-fracture patients by using self-assessment instruments of perceived health and relate them to objective outcome assessments, such as ADL (personal hygiene/dressing), walking ability and technical complications. Subjective and objective status for 100 hip-fracture patients admitted from their own home, and rehabilitated in primary health care, were registered over 1 year after fracture. Mean age was 74, and 80% of the patients were women. Two self-assessment questionnaires: the Nottingham Health Profile (NHP part 1) and the Mood Adjective Checklist (MACL) were answered by the patients 6 and 12 months after fracture and compared with functional status (ADL, and walking ability) 4 months after fracture. Problems related to the hip fracture such as pain and physical mobility had most effect on the self-assessment questionnaire (NHP) and were in accordance with the district physiotherapists' evaluation of function. Patients with complications (resulting in nail extraction and total hip replacement) after the primary hip osteosynthesis and patients with a poor function 4 months after fracture had scores in the self-assessment questionnaires indicating a more pronounced and distressing impact of the disease. Small changes in subjective mood (MACL) were found. In an acute, curable, disease such as hip fracture the objective outcome seems as informative as the subjective evaluations of patients' self-assessment.
Activities of Daily Living↗
Treatment of hip fracture in Finland and Sweden. Prospective comparison of 788 cases in three hospitals.
A prospective population-based study of hip fracture treatment was performed during 1989 in the regional hospitals of Oulu (Finland) and Sundsvall and Lund (Sweden). For cervical fractures hemiarthroplasty was preferred in Oulu and osteosynthesis in Sundsvall and Lund. For trochanteric fractures screw-plate was preferred in Oulu and Lund and Ender-nailing in Sundsvall. A shorter mean time at the orthopedic department in Oulu (13 days) was compensated by a lower (14 percent) fraction of patients directly discharged to own home. A somewhat longer mean orthopedic hospitalization time in Sundsvall (19 days) and Lund (17 days) was combined with a higher discharge to own home (49 percent and 35 percent). Prospective multicenter comparisons of treatment combinations (both operation and rehabilitation) permit identification of programs that are optimal for both patient and society.
Activities of Daily Living↗
Femoral neck fracture fixation with hook-pins. 2-year results and learning curve in 626 prospective cases.
We performed a prospective 2-year follow-up study of 626 consecutive femoral neck fractures treated with closed reduction and hook-pin fixation in all cases. The woman:man ratio was 2.9:1, the displaced:undisplaced fracture ratio 2.6:1. Mean patient age was 78 (18-100) years. The first 476 fractures were operated on by one of six surgeons with special interest in the technique, while the remaining operations were performed by any of the 35 surgeons in the department, all specialists in orthopedic surgery. Mortality within two years was 31 percent. Healing complications (redisplacement, nonunion or segmental femoral head collapse) in the total material/survivors only were for undisplaced fractures 5/7 percent, for displaced fractures 30/41 percent and for the total material 23/32 percent. According to life-table analysis, the complication rate in the total material at two years was 24 percent. The rate of secondary arthroplasty for healing complications was 13/19 percent. For displaced fractures, as well as for the total material, the group of specially interested surgeons had better results than the department as a whole.
Adolescent↗
Bone morphogenetic protein induces bone in the squirrel monkey, but bone matrix does not.
Demineralized bone matrix (DBM) reproducibly induces extraskeletal bone formation in rodents, but its effects in dogs and primates are negative or uncertain. In previous studies on the squirrel monkey, DBM did not induce bone, although the same implants were effective in nude rats. In the present study, the DBM was augmented with recombinant human bone morphogenetic protein-2 (BMP-2). Bone was formed in 10 of 12 monkeys, as verified by histology and calcium content. However, in 4 monkeys, the induced bone mass appeared smaller than the original implant. DBM controls induced microscopic amounts of bone in 2 out of 10 monkeys. In the nude rats, all DBM controls and augmented implants induced bone. The difficulties in achieving bone induction in higher animals may be overcome, at least partially, by using a higher concentration of the inductive protein than is present in DBM.
Animals↗
[Effects of guaranteed care for orthopedic patients].
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Health Priorities↗
[An orthopedic surgeon's views on waiting lists: structure rationalization for efficiency].
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Efficiency↗
Monkey bone matrix induces bone formation in the athymic rat, but not in adult monkeys.
Demineralized bone matrix from young and adult monkeys was implanted intramuscularly for 6 weeks in athymic rats and adult monkeys. Cartilage and bone induction was evaluated by histology and calcium content. In the athymic rat, most implants induced cartilage or bone. In the monkeys, cartilage was formed only on rare occasions and there was no sign of bone formation. We conclude that (a) adult monkey bone matrix contains bone inductive properties; (b) these properties are not sufficient to induce bone formation in adult monkey muscle sites.
Animals↗
Outcome after hip fracture in different health care districts. Rehabilitation of 837 consecutive patients in primary care 1986-88.
The social and functional outcome for 837 consecutive hip fracture patients rehabilitated in primary care was studied during 1986-1988. Of patients coming from their own home (59%) the majority (76%) were back at home four months after fracture and had a good functional status, while 9% were dead. Predictors of managing ADL (dressing/personal hygiene) four months after hip fracture were age, type of fracture, sex, and having regular social contacts outside the home before fracture. Health care districts differed in the incidence of hip fractures, the patients hospital stay, housing, type of fracture, and age. These differences had consequences on costs. Total costs per patient were lowest in districts where most of the patients were discharged to their own homes. No significant differences in fracture incidence were seen between rural and urban primary health care districts.
Activities of Daily Living↗
Osteonecrosis of the knee. Diagnosis and outcome in 40 patients.
Clinically suspected primary osteonecrosis of the knee was studied in 40 patients with repeated plain radiography and scintimetry, and the patients were followed for 1-7 years. Thirty-three patients had typical scintimetric and radiographic signs of osteonecrosis of either one of the femoral condyles, whereas 7 patients had only typical scintimetric findings, but never developed an osteonecrosis based on plain radiography. Because the scintimetric findings were identical to the other 33 knees and because there is no other well-known localized disease in this region of the femoral condyle, we deemed that these 7 patients had probable osteonecrosis, but in an abortive form. The scintimetries were prognostic during the second half year after onset. Thirty knees had a poor outcome--29 because of development of arthrosis, of which eight were treated with a knee arthroplasty and four with a proximal osteotomy.
Adult↗
Costs of hip fracture. Rehabilitation of 180 patients in primary health care.
Costs related to functional status were calculated for 180 consecutive hip fracture patients (mean age 78 years) who were admitted from their own home and rehabilitated in primary health care. Within 4 months after the fracture, 75 percent of the patients had been discharged to their own home, 9 percent were dead, and the short-term medical treatment costs per patient were SEK 43,000, whereas the total costs including communal help and costs for living accommodations after discharge were twice as high. The total costs per patient for long-term medical treatment (from 4 months up to 3 years after fracture) were 7 percent of the short-term medical treatment costs. Patients with a cervical fracture discharged to their own home and with good functional status consumed only one fifth of the resources that patients with a trochanteric fracture discharged to institutional care and who had reduced functional status consumed. A substantial part of the costs can be saved by improved organization of rehabilitation after discharge from the hospital. A further cost reduction would require a combination of technologic, social, and organizational changes aimed at early discharge and continued follow-up in primary health care.
Aged↗
Standing balance in hip fracture patients. 20 middle-aged patients compared with 20 healthy subjects.
Twenty hip fracture patients aged 50-64 years were compared with healthy, age- and sex-matched controls concerning balance capacity in standing and in walking. As a whole, the hip fracture patients had many concomitant diseases and low functional capacity. The patients studied did not differ from their controls as regards reported vision, hearing, and other characteristics. However, the patients deemed their balance to be worse and had a lower maximal walking speed than the controls. The patients also showed, in many aspects, more postural sway (i.e., lower balance capacity) on a computerized force platform especially when blindfolded. Patients with cervical fractures had less postural sway and smaller differences compared with their controls than when compared with the total group. About 2 years after the accident, hip fracture patients still perceived their balance to be more impaired, and showed more postural sway than the healthy controls. These factors may force us to emphasize more balance training after and, preferably, before the fracture.
Biomechanical Phenomena↗
Dose-dependent stimulation of bone induction by basic fibroblast growth factor in rats.
Implantation of demineralized bone matrix in rodents elicits a series of cellular events leading to the formation of new bone inside and adjacent to the implant. This process is believed to be initiated by an inductive protein present in bone matrix, and local growth factors may further regulate the process. We have previously shown that local application of recombinant human basic fibroblast growth factor (bFGF) in a carboxymethyl cellulose gel to demineralized bone matrix implants increases the bone yield as measured by calcium content 3 weeks after implantation in rats. We now report that this increase was seen at 3 and 4 weeks, but not earlier or later. Further, the stimulatory effect was seen with doses from 3 to 75 ng per implant. A dose of 0.6 or 380 ng did not increase the bone yield, and 1,900 ng had a marked inhibitory effect. This narrow dosage optimum may reflect the complex actions of the growth factor.
Abdominal Muscles↗
Optimal treatment of hip fractures.
At the orthopedic departments in Sweden, the hip fracture patients continuously occupy up to one third of the bed resources. Hip fractures in Sweden consume more hospital days than all the cancer patients together. In the middle of the 1980s, the annual number of hip fractures amounted to 6,500 in Denmark, 4,500 in Finland, 260 in Iceland, 6,000 in Norway and 14,000 in Sweden. The calculated number of hip fractures in the year 2000 is dependent on if the prognosis is based solely on the increasing number of elderly in the population or if also the increasing incidence during the last decades is included. An increase up to the year 2000 of 50-100 percent is prognosticated for Scandinavia. The proportions cervical/trochanteric fractures varies. In Norway and Sweden it is close to 1/1, whereas Iceland and Finland have more cervical than trochanteric fractures. In Iceland, however, trochanteric fractures are increasing. Finally, in all of Scandinavia, 3 out of 4 hip fracture patients are women.
Activities of Daily Living↗
Cost comparison in hip fracture treatment.
A residency analysis of 3,053 patients treated for cervical hip fractures either at surgical or orthopedic departments was made. Accumulated costs during and after treatment at surgical departments were almost twice as high as those accrued after treatment in orthopedic units.
Costs and Cost Analysis↗
Statistical evaluation of the diagnostic criteria for meniscal tears.
The accuracy of diagnosis was tested in a prospective study of 145 patients who were arthroscoped because a meniscal tear was suspected clinically. Multiple variate analysis was used to evaluate 68 different clinical parameters. The clinical accuracy was 61% as a tear was demonstrated in 88 knees; 73 of these tears were associated with other intraarticular abnormalities. Thirteen knees were entirely normal at arthroscopy. It was possible to predict a meniscal tear in 8 out of 10 patients.
Adolescent↗
Dose-dependent reduction of bone inductive properties by ethylene oxide.
Sterilisation of demineralised bone matrix with ethylene oxide has been claimed to destroy the ability of bone matrix to induce new bone formation on intramuscular implantation. Other workers have routinely used ethylene oxide sterilised bone matrix for assays in rodents without detrimental effects. We studied the effects of various lengths of exposure to ethylene oxide gas, and found that bone induction properties are destroyed in a dose-dependent manner. After a short exposure, bone induction properties were moderately diminished. However, this short ethylene oxide treatment did not kill Bacillus subtilis spores. A sterilisation procedure that killed these spores rendered the implants incapable of bone-induction.
Animals↗
Spontaneous osteonecrosis of the knee: value of MR imaging in determining prognosis.
Sixteen patients with early and late stages of spontaneous osteonecrosis of the knee were studied to evaluate if MR imaging can be used to determine the prognosis of the disease. All patients had sequential conventional radiographs and clinical examinations, one or more 99mTc-methylene diphosphonate bone scintigrams, and an MR examination. The duration of the disease at the time of the MR examination ranged from 1 to 58 months (mean, 18 months). A relationship was identified between the pattern of bone marrow alteration noted on long TR/TE MR sequences and the scintigraphic stage and clinical course of the disease. The dimensions of the osteonecrotic region could be identified as well or better on the short TR/TE MR images than on the radiographs in all patients. MR imaging also afforded evaluation of the hyaline cartilage overlying the osteonecrotic lesion, revealing secondary osteoarthrosis in seven patients. We conclude that MR imaging in patients with spontaneous osteonecrosis of the knee may provide information of value for determining the prognosis of the disease.
Adult↗