Introduction. Wrist (Colles') and forearm fractures commonly occur when a person falls on the outstretched forearm and the force exceeds bone strength. There is lack of experimental evidence testing the available force prediction models and assessing factors that determine forearm forces during a fall.<p> Objective. The primary objective was to compare experimentally measured force peaks (F1max-E and F2max-E) to the force peaks that were predicted by an engineering based force prediction model (F1max-M and F2max-M), at heights greater than 5cm. The second objective was to describe the relationships between the experimentally measured peak forces and forearm bone and muscle strength properties, body mass, and stature as a function of fall height.<p> Methods. Using 3D motion tracking, we assessed the first (F1max) and second (F2max) peak forces from 10 young adults (5 male; 5 female) who volunteered to fall from heights up to 25cm onto a foam covered force plate. Peripheral QCT was used to determine the bone strength index (BSIc), strength-strain index (SSIp), and muscle cross sectional area (MCSA) of each participant. Two 2x8 between-within factorial ANOVAs determined the difference between the experimental and model force peaks, with post hoc analyses at all fall heights. Pearson's correlation was used to determine the relationship between the pQCT-derived bone and muscle strength indices and the force peaks.<p> Results. There was no significant differences between F1max-E and F1max-M across all fall heights, but the model significantly over-predicted the F2max-E across all fall heights. After controlling F1max-E and F2max-E for body mass, the force peaks appeared to be weakly related to the anthropometric as well as bone and muscle strength outcomes (r=0.2-0.7, p>0.05). The relationship between bone and muscle strength outcomes appeared to have a tendency to get stronger at higher fall heights.<p> Conclusion. The model predicted experimental F1max, but not experimental F2max. This study presents preliminary pilot results. Larger sample size is needed to confirm whether incorporating bone and muscle strength estimates into fall force prediction models could enhance forearm fracture risk assessments.

Introduction. Wrist (Colles') and forearm fractures commonly occur when a person falls on the outstretched forearm and the force exceeds bone strength. There is lack of experimental evidence testing the available force prediction models and assessing factors that determine forearm forces during a fall.<p> Objective. The primary objective was to compare experimentally measured force peaks (F1max-E and F2max-E) to the force peaks that were predicted by an engineering based force prediction model (F1max-M and F2max-M), at heights greater than 5cm. The second objective was to describe the relationships between the experimentally measured peak forces and forearm bone and muscle strength properties, body mass, and stature as a function of fall height.<p> Methods. Using 3D motion tracking, we assessed the first (F1max) and second (F2max) peak forces from 10 young adults (5 male; 5 female) who volunteered to fall from heights up to 25cm onto a foam covered force plate. Peripheral QCT was used to determine the bone strength index (BSIc), strength-strain index (SSIp), and muscle cross sectional area (MCSA) of each participant. Two 2x8 between-within factorial ANOVAs determined the difference between the experimental and model force peaks, with post hoc analyses at all fall heights. Pearson's correlation was used to determine the relationship between the pQCT-derived bone and muscle strength indices and the force peaks.<p> Results. There was no significant differences between F1max-E and F1max-M across all fall heights, but the model significantly over-predicted the F2max-E across all fall heights. After controlling F1max-E and F2max-E for body mass, the force peaks appeared to be weakly related to the anthropometric as well as bone and muscle strength outcomes (r=0.2-0.7, p>0.05). The relationship between bone and muscle strength outcomes appeared to have a tendency to get stronger at higher fall heights.<p> Conclusion. The model predicted experimental F1max, but not experimental F2max. This study presents preliminary pilot results. Larger sample size is needed to confirm whether incorporating bone and muscle strength estimates into fall force prediction models could enhance forearm fracture risk assessments.

Stipinkaulio distalinės dalies lūžiai yra vienas iš dažniausių kaulų ir raumenų sistemos pažeidimų. Literatūroje nurodoma, kad distalinės stipinkaulio dalies lūžiai yra 1/10 visų lūžių, kuriuos patiria vyresni nei 35 metų amžiaus asmenys. Apie 3 % pacientų, po šios traumos išlieka ilgalaikė negalia. Siekiant optimizuoti stipinkaulio distalinės dalies lūžių gydymą, buvo atliktas tyrimas, kuriame buvo iškelti trys uždaviniai. Vertinome 2 savaičių imobilizacijos įtaką rankos funkcijai, po stipinkaulio distalinės dalies lūžio ir osteosintezės delnine rakinama plokštele. Taip pat vertinome,radiologinio lūžio tipo, pagal AO klasifikaciją, įtaką rankos funkcijai. Sugijus kaului, tirta metalinių konstrukcijų pašalinimo įtaka rankos funkcijai. Vertinant rezultatus, nustatyta, kad riešo judesių amplitudė ir rankos funkcija tarp pacientų, patyrusių stipinkaulio distalinės dalies lūžį su poslinkiu ir operuotų delnine rakinama plokštele, kuriems buvo taikyta pooperacinė 2 savaičių riešo imobilizacija ir kuriems pooperacinė riešo imobilizacija nebuvo taikyta, nesiskyrė. Tiriamiesiems, patyrusiems C tipo lūžį pagal AO radiologinę klasifikaciją nustatyta prastesnė funkcija. Riešo judesių amplitudė ir rankos funkcija po delninės rakinamos plokštelės pašalinimo nepakito. / Distal radius fracture is one of the most common injuries of the skeletal and muscular system. It has been reported in literature that distal radius fractures account for one-tenth of all the fractures experienced by people older than 35 years. Long-term disability remains in approximately 3% of patients after a distal radius fracture. In order to optimise treatment of distal radius fractures, a study with three objectives was performed. We evaluated the effect of immobilisation for the period of 2 weeks on the hand function after a distal radius fracture and osteosynthesis with a volar locking plate. The effect of the fracture type according to the AO classification on the hand function was also assessed. After the bone has healed, the effect of the removal of metal constructions on the hand function was evaluated. The analysis of the results demonstrated that there were no differences in the range of wrist motions and the hand functionbetween the patients after a displaced distal radius fracture operated with a volar locking plate and post-surgery immobilisation of the wrist applied for the period of 2 weeks and the patients who did not have post-surgery wrist immobilisation applied. A worse function was determined in the patients after type C fracture according to the AO radiological classification. The range of wrist motions and the hand function after the removal of a volar locking plate did not differ.

Bakgrund: Distal radiusfraktur (DRF) är en vanligt förekommande fraktur med en incidens i Sverige på 31-32 per 10000 personår. Många personer upplever kvarstående besvär efter utläkt fraktur och i dagsläget saknas evidens kring optimal behandling och rehabilitering. Fler studier har konstaterat kvarstående symtom som nedsatt greppstyrka och rörlighet samt smärta. Syfte: Syftet med aktuell studie varatt undersöka specifik rörlighet 6 månader efter distal radiusfraktur. Jämförelser gjordes med andra utfallsmått på rörlighet, styrka och funktion. Metod:Utifrån en tvärsnittsdesign undersöktes 11 personer över 18 år som ådragit sig en DRF och behandlats för den under mars-maj 2016. Utfallsmått var specifik ledrörlighet testat utifrån Kaltenborns metod för ledundersökning. Detta jämfördes med uppmätt greppstyrka, angulär aktiv och passiv rörlighet samt subjektiv funktionsskattning DASH och PRWE. Sensomotorik och upplevelse av denna adresserades också. Resultat:Hos samtliga personer sågs hög grad av funktionsinskränkningar i samtliga utfallsmått, förutom hos de två av deltagarna som uppgav att de i princip var återställda. Hos dessa personer noterades inga nedsättningar i specifik ledrörlighet trots att även de hade nedsatt greppstyrka och inskränkt angulär rörlighet. Slutsats:Trots ett litet deltagarantal fanns en indikation på att specifik ledrörlighet kan vara en faktor i kvarstående funktionsinskränkning. Inget samband noterades mellan funktion, rörlighet och greppstyrka. Fler studier bör framöver utforska detta samband samt undersöka effekten av specifik behandling av rörelseinskränkningarna. Personer som ådragit sig en DRF bör följas upp närmare avseende rörelseförutsättningar och behandlingen därefter behöver vara mer specifik än idag. Här bör fysioterapeuter med utbildning inom OMT vara en självklar del i vårdkedjan.

Die vorliegende Arbeit befasst sich mit therapierelevanten Faktoren bei distalen Radiusfrakturen. Auf der Grundlage der nach AO klassifizierten, distalen Radiusfrakturen werden sowohl verletzungsbedingte, als auch therapiebedingte Einflußfaktoren hinsichtlich des klinisch-radiologischen Ergebnisses untersucht. Es erfolgt die Darstellung der Komplikationshäufigkeit bei operativ und konservativ versorgten distalen Radiusfrakturen. Diese wird in Zusammenhang mit unfall-und patientenbezogenen Faktoren, Begleitverletzungen und therapiebezogenen Einflußfaktoren untersucht und am klinisch-radiologischen Ergebnis gemessen. Zur Objektivierung der klinisch-radiologischen Nachuntersuchung dienen der DASH-Score, der Gartland und Werley-Score (modifiziert nach Sarmiento) und der Stewart Score.

Introduction: Distal radius fractures (DRF’s) are one of the most common types of fractures,especially in elderly women. In the last decade, there has been a shift in the treatment methodemployed for DRF’s from the traditional non-operative to an operative method using plates andscrews even though there is no evidence to suggest that this method has superior outcomes. Aim: The primary objective of this study was to identify risk factors for complications and reoperationsin the treatment of DRF’s. Method: The study was designed as a retrospective cohort study. Patients treated for DRF’sbetween 2016-2017 were included through the Swedish Fracture Register and complementedwith the patients’ charts and classification of X-Ray Images from The Orthopedic Clinic at TheCentral Hospital in Karlstad. The risk for re-operation was valued through treatment methodsand fracture classification and presented as Odds Ratio. Result: Positive ulnar variance was correlated to having an increased risk for re-operation, OR4.8 (95% CI 1.7-13.8). Those who had volar comminution in their fracture had a greater risk forre-operation, OR 12.4 (95% CI 4.6-34.1, p&lt;0.001), but also a greater risk for correctiveosteotomy, OR 12.6 (95% CI 1.4-113.9, p=0.024). Conclusion: Volar comminution and positive ulnar variance are associated with an increasedrisk for re-operation. However, the degree of the risk is difficult to measure due to the lowincidence of re-operations.

<p><strong>Objective: </strong>The objective of this thesis is to identify the approaches to patient-centered care provision currently employed by clinicians and to identify patient perspectives of patient-centeredness in relation to pain and disability following distal radius fracture. This thesis includes a scoping review of patient-centered care frameworks and models, as well as a prospective cohort study.</p> <p><strong>Rationale: </strong>Patient-centered care provision has been linked with positive health outcomes, improved patient satisfaction, and reduced health costs. A uniform approach to patient-centered care in rehabilitation has yet to be developed primarily due to the breadth and scope of practice. Understanding current approaches to patient-centered care and patient perspectives on this care can serve as a foundation to future discussions on the development of a rehabilitation-specific approach to patient-centered care provision.</p> <p><strong>Data sources: </strong>Frameworks and models of patient-centered care provision were located via electronic database searches. The extracted frameworks and models were compared based on how they described strategies on achieving the three tenets of patient-centered care: communication, partnership, and health promotion. A prospective cohort study provided patient perspectives on patient-centeredness, pain, and disability following distal radius fracture at baseline and at three months post distal radius fracture in 129 patients.</p> <p><strong>Methods: </strong>Frameworks and models on patient-centered care provision were extracted from articles and placed in data summary tables for comparison and review. Information on how these frameworks and models described strategies for communication, partnership, and health promotion was collated and reviewed. The patients’ perceptions of patient-centeredness, pain, and disability were determined from responses to the Patient Perceptions of Patient-Centeredness Questionnaire and the Patient Rated Wrist Evaluation. Outcome measure responses were analyzed to measure change over time (Wilcoxon Rank Sum and T-Test analyses) and to identify relationships (Pearson correlations).</p> <p><strong>Results: </strong>The scoping review found 19 articles, from which 25 patient-centered care frameworks or models were identified. All frameworks and models reported strategies on achieving effective communication, partnership, and health promotion. The prospective cohort study revealed significant correlations between patient perspectives of patient-centeredness and pain and disability following distal radius fracture. This suggests that positive experiences with patient-centered care provision are correlated with reduction in pain and improvement in function following an acute orthopaedic injury.</p> <p><strong>Implications: </strong>Until a rehabilitation-specific approach to patient-centered care provision is developed, rehabilitation clinicians can be confident that selection of one of the currently employed frameworks or models of patient-centered care will reflect the three tenets of patient-centered care provision. Adopting one of these patient-centered approaches to care provision likely will result in positive health outcomes.</p> / Master of Science Rehabilitation Science (MSc)

Osteoporosis is a disease characterized by low bone mineral density (BMD), which compromises bone tissue increasing fragility and susceptibility to fracture. It affects nearly 50% of women and 20% of men over the age of 50, and fractures resulting from osteoporosis cause significant morbidity and mortality. Therefore, patients with or at risk for osteoporosis should be identified before rather than after a fracture occurs. The gold standard in diagnosing patients with osteoporosis is dual X-ray absorptiomerty (DXA). The purpose of this study is to evaluate the usefulness of assessing BMD at various parts of the distal radius (ultra-distal, mid-point, one third, and total) compared to the conventional sites (lumbar vertebrae and proximal femur) using DXA to diagnose osteoporosis. This was a retrospective study on 1,641 male patients over the age of 50 who had undergone bone densitometry (DXA scans) of at least one hip, lumbar vertebrae and distal radius. Ordinary regression and correlation analysis was used to assess the association between the lowest of the bone density scores of the hip or lumbar vertebrae and scans at the various sites on the radius. Comparing standardized scores from the radius method with the lowest standardized scores from the hip or lumbar vertebrae, a highly significant correlation was found, R = 0.59, p < 0.001 for the left UD radius, R =0.59, p < 0.001 for left MD radius, R =0.54, p < 0.001 for the left 1/3 radius, and R =0.60, p < 0.001 for the total left radius. The results indicate that the left radius total is the most accurate in diagnosing osteoporosis in our study population. The results of this study can have far-reaching psychosocio-economic implications showing that DXA scans of the distal radius can be used to effectively diagnose osteoporosis by using inexpensive, low-technology, portable scanners. These findings are particularly relevant to the needs of the undeserved rural populations of Central Appalachia.

In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor questionnaire, tests on dynamic and static balance and a one-leg rise test could identify those, who have osteopenia or osteoporosis, and run a risk of new falls. Moreover, in a three-year follow-up, mortality, the need for in- and outpatient care, and health-related quality of life after radius fracture were investigated and compared between the patients and matched controls. Finally, the effect of a preventive intervention program including patient education and self-training was evaluated. Falls were reported in a risk factor questionnaire and in a fall diary. The patients aged 45-64 years showed lower, although not statistically significant, BMD, compared with the controls of the same age, but there was no difference concerning their history of falls. In contrast, the patients aged 64 years or older had a history of falling more often than the corresponding controls, but no difference in BMD was found. For all other risk factors, except falls, no differences were found between the patients and the controls. The results of the one-leg rise test were associated with those of dynamic and static balance, but none of the functional tests were associated with the number of falls. Decreased height and cigarette smoking were the only risk factors, which predicted osteopenia and osteoporosis. Five patients, although none of the controls, died during the study time. The patients needed statistically significantly more episodes as inpatients than the controls. The patients also had lower SF-36, Role Physical scores, than the controls at three months. This difference disappeared by the time of the follow-up. Both the patients, who participated in a four-week intervention program, “the osteoporosis school” followed by a one-year home-based exercise program, and the controls showed statistically significantly improved dynamic and static balance, ability to walk backwards and to stand on one leg with eyes open and closed at the end of the study. However, no significant differences were found between the patients and the controls in any of the tests, in BMD or in the number of the falls. The thesis shows that, except for the falls in patients aged over 64 years, there were no significant differences between patients and controls with respect to BMD and other risk factors related to osteoporosis. Consequently, in patients aged 45-64 years and older, the underlying cause of a distal radius fracture is more related to falls than to osteoporosis. Furthermore, the thesis shows that the functional tests and the risk factor questionnaire seem to be of limited value for identifying 8 people with a radius fracture, who are at risk of falling or have osteopenia or osteoporosis. If, in spite of this, functional tests on musculoskeletal function are considered for testing of functional ability in patients with a recent radius fracture, the one leg-rise test may be sufficient. There seems to be an increased mortality and morbidity necessitating inpatient care among patients with a recent radius fracture. The osteoporosis school had no significant effect on BMD, balance, muscle strength or falls in this thesis. Therefore, the lack of proven efficacy of the osteoporosis school for the secondary prevention of distal radius fractures highlights the need for more and long-term randomised controlled follow-up studies in this specific population.

Fractures of the distal radius are the most common fractures treated at our clinics . It accounts for around 16 % of all fractures. Most often we meet them in two age groups - children and especially in postmenopausal women. In this group the fractures are frequently associated with osteoporosis. The most common cause of fracture is a fall on the outstretched extremity. Together with fractures of the proximal humerus, proximal femur and vertebral fractures they are the most common gerontotraumatologic fractures. The frequency of fractures of the distal radius gradually increasing. The reason is the increasing average age of the population and their active way of life. Our group consists of 5,359 patients treated for a fracture of the distal radius in 1998 and from 2001 to 2013 . During this time , the frequency of fractures increased by 19,7%. For women with distal radius fractures occur 3 times more frequently, the average age of treated was 59,1 years. About 80 % of distal radius fractures are treated conservatively. The surgical treatment of seniors decide not only the type and stability of the fracture, bone quality, but especially the overall condition of the patient and his claims to a final functional outcome. Long-term functional results after conservative treatment in the elderly are nearly the...