Biomedical subjects

Magnus K Karlsson

Publications and source records attributed to Magnus K Karlsson.

28 records · Page 2Linked to original sources

PubMed2002

Posterior transpedicular stabilisation of the infected spine.

BACKGROUND: Six men and seven women, aged 62 years, bedridden due to back pain from a septic spondylitis in the thoracolumbar region and not responding to conservative treatment, were operated on with transpedicular stabilisation of the affected segments to enhance mobilisation. All patients experienced immediately reduced back pain, allowing them to leave their bed and start mobilisation during the first postoperative day. At follow-up after a mean of 29 months (range 13-60 months) only one was using analgesics. RESULTS: Nine of the 11 patients with pathological neurology at surgery had improved, none had deteriorated, and all were ambulatory without bladder or bowel disturbances. Seven had achieved a solid interbody fusion, with a continued radiographic decrease in the spondylitic change in the rest, indicating that a progressive interbody fusion was in progress. Three individuals had increased kyphosis, a mean of 11 deg compared with the postoperative radiographs.

Aged↗

PubMed2002

Non-participants differ from participants as regards risk factors for vertebral deformities: a source of misinterpretation in the European Vertebral Osteoporosis Study.

Interpretation of data in epidemiological cohort studies may be confounded if differences exist between non-participants and participants. In the Malmö part of the European Vertebral Osteoporosis Study (EVOS), which was designed to evaluate the prevalence of vertebral deformity in 50-80-year-old persons, we compared 74 men and 95 women who had been invited, but declined to participate with age- and gender-matched participants as regards alcohol abuse, previous fractures and subsequent mortality, factors known to affect the prevalence of vertebral deformity. We found more men with alcohol abuse, more men with a previous fragility fracture and a tendency to more men with a previous clinical vertebral fracture among the non-participants than in the male participants. In contrast, there were fewer female non-participants than female participants with a previous clinical vertebral fracture. The mortality rate during the decade after the baseline examination was higher among both male and female non-participants. The "true" prevalence of vertebral deformity in the whole male population at risk in Malmö seems to be underestimated in the EVOS study. In women, it is more difficult to estimate the combined result of the confounding factors. Conclusions based on the EVOS participants may not be applicable to the whole population at risk.

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PubMed2002

Fractures of the olecranon during growth: a 15-25-year follow-up.

Ten girls and 13 boys with mean age 11 years when sustaining a fracture of the olecranon were examined at a mean of 19 years after the injury. Ten fractures were displaced less than 2 mm, three 2-3 mm, eight more than 3 mm and two were multifragmental. The treatment consisted of mobilization in three cases, plaster treatment in nine and open reduction and internal fixation in 11 cases. At follow-up, 21 children had no subjective complaints while two had occasional mild pain. The upper arm circumference was thinner in the former injured extremities than in the uninjured (P<0.05). No other objective deficits were found. None had developed non-union or elbow osteoarthritis. Olecranon fractures during growth have an excellent long-term outcome.

Adolescent↗

PubMed2002

Ultrasound of the phalanges is not related to a previous fracture. A comparison between ultrasound of the phalanges, calcaneus, and DXA of the spine and hip in 75-year-old women.

Recently, an ultrasound (US) device for measurement of amplitude-dependent speed of sound in four proximal phalanges of the hand (DBM Sonic 1200, IGEA, Carpi, Mo, Italy) has been introduced but has not been thoroughly investigated in populations at most risk for fragility fractures (i.e., elderly women). As part of the Malmö Osteoporosis Prospective Risk Assessment study (OPRA), we investigated 1044 randomly selected women, all 75 yr of age, with US of the phalanges and, for comparison, also with two more established methods for bone mass measurement: US of the calcaneus and dual-energy X-ray absorptiometry (DXA) of the hip and spine, both methods having an ability to predict fracture. A self-assessment questionnaire was used to obtain information on previous fracture and age at fracture event. We found a low correlation between US of the phalanges and US of the calcaneus speed of sound (SoS) (r = 0.11, p < 0.01), US of the calcaneus (stiffness) (r = 0.09, p < 0.05), DXA of the femoral neck (r = 0.09, p < 0.05), and DXA of the spine (r = 0.10, p < 0.01) and no significant correlation between US of the phalanges and US of the calcaneus broadband ultrasound attenuation (BUA) and DXA trochanter. Also, no differences in US of the phalanges were found when comparing women without any fracture with women with at least one fracture, whereas US of the calcaneus (SoS, BUA, and stiffness) and DXA of the femoral neck, trochanter, and spine were all lower in the women with a fracture history (p < 0.0001). In addition, the precision of the US of the phalanges method was evaluated and found to be lower in these elderly women, compared to the precision reported by others and the manufacturer. In summary, the present data indicate that US of the phalanges is not a usable tool for estimating fracture risk in an elderly female population.

Absorptiometry, Photon↗

PubMed2002

Fractures of the olecranon: a 15- to 25-year followup of 73 patients.

The incidence of olecranon fractures in adults and the long-term outcome of closed olecranon fractures in 45 women and 28 men (mean age, 54 and 36 years at the time of fracture, respectively), were examined at a mean of 19 years after the fracture. The uninjured elbows served as controls. Thirteen percent of the original fractures were displaced less than 2 mm, 65% more than 2 mm, and 22% were multifragmental. Primary treatment consisted of mobilization in 4%, application of a plaster cast in 12%, and open reduction and internal fixation in 84% of the elbows. The incidence of an isolated fracture of the olecranon in individuals older than 16 years was 1.15 per 10,000 person-years. Eighty-four percent of the 73 patients had no complaints at followup, 12% had occasional pain, and 4% had daily pain. Ninety-six percent had an excellent or good outcome. Elbow flexion and extension were reduced but most patients had no or only occasional subjective complaints. Radiographic signs of degenerative changes were found in more than 50% of the formerly fractured elbows, which was more than in the uninjured (11%). Radiographic signs of osteoarthritis were found in 6% of the formerly fractured elbows versus zero percent in the uninjured, of which only two patients had a poor outcome. Isolated, closed fractures of the olecranon in adults have a favorable, long-term outcome.

Adult↗

PubMedDate not supplied

Displaced Mason type I fractures of the radial head and neck in adults: a fifteen- to thirty-three-year follow-up study.

Undisplaced radial head and neck fractures are consistently described with no long-term deficits. The aim of this study was to evaluate specifically the long-term outcome of displaced Mason type I fractures, which have not previously described. Twenty women and twelve men, with a mean age of 46 years (range, 22-69 years) when they sustained a displaced Mason type I fracture, were reexamined at a mean of 21 years (range, 15-33 years) after injury. All were treated nonoperatively. Twenty-nine individuals had no subjective complaints, whereas three had occasional elbow pain. There was no objective impairment, and none had elbow osteoarthritis, defined as reduced joint space, whereas there was more radiographic degeneration in the formerly fractured elbow than in the uninjured elbow (85% vs 4%, P < .001). We conclude that the long-term results of nonoperatively treated displaced Mason type I fractures of the radial head and neck are predominantly favorable.

Adult↗

PubMedDate not supplied

Comparison of tension-band and figure-of-eight wiring techniques for treatment of olecranon fractures.

Two different internal fixation techniques for closed displaced fractures of the olecranon were evaluated at a mean of 18 years after injury. Thirty-two of the patients received tension-band wiring, and 35 received figure-of-eight wiring. There were 41 women (mean age, 52 years) and 26 men (mean age, 32 years) included. The results revealed that 80% of the patients had no subjective complaints, 16% had occasional pain, and 4% had daily pain. Comparison of the injured and uninjured elbows demonstrated a 3 degrees reduction of flexion (P <.05) and a 5 degrees loss of extension (P <.01). More than 50% of the fractured elbows had degenerative changes (joint space narrowing, subchondral cysts, subchondral sclerosis, and osteophytes) (P <.001), and 4 had osteoarthritis (P <.05). No subjective, objective, or radiographic differences were found when the two techniques were compared. Removal of the hardware was performed in 81% of the patients with tension-band wiring and in 43% of the patients with figure-of-eight wiring (P <.01). The figure-of-eight technique can, therefore, be recommended, as it is associated with less frequent secondary procedures for hardware removal.

Adolescent↗

PubMedDate not supplied

Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms.

BACKGROUND: Although the exact cause of medial tibial stress syndrome is unclear, changes in bone metabolism are likely to be involved. HYPOTHESIS: Localized low bone mineral density at the junction of the middle and distal thirds of the tibia in patients with medial tibial stress syndrome develops in conjunction with the symptoms; these changes are reversible and are not inherited. STUDY DESIGN: Prospective cohort study. METHODS: Bone mineral density in 14 adult male athletes with long-standing medial tibial stress syndrome was measured when they were symptomatic and after recovery (mean follow-up, 5.7 years). Repeat measurements were also made prospectively in 13 nonathlete control subjects and single measurements were made in 18 healthy athletes. RESULTS: Bone mineral density was 9% +/- 11% higher in the proximal tibia but 11% +/- 12% lower in the tibial region corresponding to pain in patients when compared with nonathlete control subjects. It increased by 19% +/- 11% in the region of pain after recovery from symptoms and, at follow-up, was no lower than in nonathlete control subjects. CONCLUSION: Athletes with medial tibial stress syndrome and increased scintigraphic uptake regain normal tibial bone mineral density after recovery from symptoms. Initially localized low bone mineral density is not an inherited condition, but instead may develop in conjunction with the symptoms.

Adult↗

PubMedDate not supplied

[Pregnancy and lactation are not risk factors for osteoporosis or fractures].

Observational and case control studies infer that a pregnancy and a period of lactation are followed by loss in bone mass of up to 5%. The reason for this loss is virtually impossible to conclude as so many factors known to influence the bone mass undergo changes during a pregnancy and lactation. The increased calcium demand, changed nutritional habits, reduced smoking and alcohol consumption seen in many women during these periods, the changes in body weight and fat content, the changed level of physical activity and the changed levels of hormones with potential to influence the bone metabolism could all influence the bone mass. Most studies also report that the deficit in "bone mass" normalises after weaning. Multiple pregnancies and long total duration of lactation can not be regarded as risk factors for osteoporosis and fragility fractures as most reports indicate that women with multiple pregnancies have similar or higher bone mass and similar or lower fracture incidence than their peers with no children.

Adult↗

PubMedDate not supplied

[Treatment of osteoporotic vertebral compression. Explosive interest for vertebroplasty and kyphoplasty].

During the last 15 years, two new treatment strategies have gained worldwide attention in the treatment of osteoporotic vertebral fractures. The exponential increase in the use of percutaneous vertebro- or kyphoplasty has up to now not been supported by scientific sound evidence-based data. There exist no prospective randomised controlled trials (RCT) that support the efficacy of the treatments, not even adequate controlled studies. Instead we have to rely on prospective and retrospective uncontrolled short-term observational studies and case-control studies. These studies consistently indicate that the short-term results after the procedures in the treatment of osteoporotic vertebral fractures are favourable, regarding both pain relief and functional status. However, if a vertebro- or a kyphoplasty produces a better outcome than conservative treatment, and if the long-term results are as favourable as the short-term results in the treatment of osteoporotic vertebral fractures, is currently unknown.

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