Tendon healing is a slow process and the tendon may not regain its initial mechanical properties after rupture. Mechanical stimuli have shown to have positive effect on tendon healing. This study is the first to investigate the effect of vibration stimuli on healing tendons. Vibration was also compared to treadmill running, which has previously been used for mechanical stimuli.63 female Sprauge-Dawley rats were used. A 3 mm segment was removed from the Achilles tendon and the tendon was left to heal. The animals were subjected to 15 min of daily exercise, vibration or treadmill running or acted as controls without exercise. The study was divided into three experiments. Experiment 1; the animals had full time cage activity and was randomized into running, vibration and control group. Experiment 2; the animals were unloaded and randomized into vibration, running and control group. There was also a control group with full time cage activity in experiment 2. Experiment 3; the animals were unloaded and randomized into vibration and placebo group. 14 days after surgery the animals were killed and mechanical testing of the Achilles tendons was performed. The results showed no significant difference between the groups in experiment 1. Experiment 2 showed that controls with full time cage activity had higher peak load, stiffness and cross sectional area than unloaded running, vibration and control groups. In experiment 3, there was no significant difference between vibration and placebo group. In conclusion, this study shows that vibration, as applied here, does not affect tendon healing.

Bakgrund: Varierande styvhet mot dorsal-/plantarflektion i en ankel-fotortos (AFO)kan påverka kinematik och kinetik kring ankel och knä hos personer med cerebral pares eller post-stroke. Kunskap om huruvida skon påverkar styvheten i ett AFO-sko-benkomplex är begränsad. En tidigare studie har undersökt ämnet men använde bänktester för att adressera frågan. Syfte: Syftet var att, med funktionell analys, undersöka huruvida skor påverkar styvheten i ett AFO-sko-benkomplex, i sagittalplanet. Studiedesign: Överkorsningsstudie. Metod: Gånganalys genomfördes på fem friska individer. Deltagarna fick gå med tre olika AFO-skokombinationer. Data om ankelvinklar och ankelmoment extraherades för att beräkna styvheten för respektive AFO-skokombination. Styvheten för de olika kombinationerna jämfördes under fyra intervall. Resultat: Det fanns en skillnad i styvhet med olika skor. Styvheterna varierade mellan 0,0314–0,1652 Nm/° under de olika intervallen. Vilken AFO-skokombination som hade störst styvhet varierade beroende på vart i gångfasen de befann sig. Största skillnaden som uppmättes mellan två skor var 49,6%. Konklusion: Styvheten hos ett ben-AFO-sko-komplex kan variera beroende på vilken sko som används hos friska individer. Endast mindre skillnader kunde o mellan de olika AFO-skoalternativen varvid den kliniska relevansen av resultatet kan ifrågasättas. / Background: Variation in stiffness against dorsal- and/or plantarflexion in an ankle-foot orthosis (AFO) can affect the kinematics and kinetics of the knee and ankle in people with cerebral pares and post-stroke. The knowledge of whether the shoe influence the overall stiffness in a limb-AFO-shoe-complex is limited. A previous study has investigated the subject but used a bench-analysis to address the question. Objective: The objective of the study was to use functional-analysis to investigate the influence of shoe-choice on the overall stiffness in a limb-AFO-shoe-complex in the sagittal-plane. Study Design: Crossover study. Methods: Gait analysis was performed on five healthy participants who wore three different AFO-shoecombinations. Data about the ankleangle and anklemoment was extracted to calculate the stiffness of each AFO-shoecombination. The stiffness’ were compared in four different intervals. Results: There was a difference in stiffness between the AFO-shoecombinations. The stiffness’ varied between 0,0314–0,1652 Nm/° during the different intervals. Which AFO-shoecombination that had the highest stiffness also varied during the extracted phase. The biggest difference in stiffness between two shoes was 49,6%. Conclusions: Stiffness in a limb-AFO-shoe-complex may depend on the shoechoice in healthy individuals. Only small differences were observed between the different AFO-shoecombinations, thus the results’ clinical relevance can be questioned.

Transtibial stump volume can change dramatically postoperatively and jeopardise prosthetic fitting. Differences between individuals make it hard to give general recommendations of when to fit with a definitive prosthesis. Measuring the stump volume on every patient could solve this, but most methods for volume assessments are too complicated for clinical use. The aim of this study was to evaluate accuracy and intra- and interrater precision of a method to estimate stump volume from circumferential measurements. The method approximates the stump as a number of cut cones and the tip as a sphere segment. Accuracy was evaluated theoretically on six scanned stump models in CAPOD software and manually on six stump models. Precision was evaluated by comparing measurements made by four CPOs on eight stumps. Measuring devices were a wooden rule and a metal circumference rule. The errors were estimated with intraclass correlation coefficient (ICC), where 0,85 was considered acceptable, and a clinical criterion that a volume error of ±5% was acceptable (5% corresponds to one stocking). The method was accurate on all models in theory but accurate on only four models in reality. The ICC was 0,95-1,00 for intrarater precision but only 0,76 for interrater precision. Intra- and interrater precision was unsatisfying when using clinical criteria. Variations between estimated tip heights and circumferences were causing the errors. The method needs to be developed and is not suitable for stumps with narrow ends. Using a longer rule (about 30 cm) with a set square end to assess tip heights is recommended to improve precision. Using a flexible measuring-tape (possible to disinfect) with a spring-loaded handle could improve precision of the circumferential measurements.

<p>Transtibial stump volume can change dramatically postoperatively and jeopardise prosthetic fitting. Differences between individuals make it hard to give general recommendations of when to fit with a definitive prosthesis. Measuring the stump volume on every patient could solve this, but most methods for volume assessments are too complicated for clinical use.</p><p>The aim of this study was to evaluate accuracy and intra- and interrater precision of a method to estimate stump volume from circumferential measurements. The method approximates the stump as a number of cut cones and the tip as a sphere segment.</p><p>Accuracy was evaluated theoretically on six scanned stump models in CAPOD software and manually on six stump models. Precision was evaluated by comparing measurements made by four CPOs on eight stumps. Measuring devices were a wooden rule and a metal circumference rule. The errors were estimated with intraclass correlation coefficient (ICC), where 0,85 was considered acceptable, and a clinical criterion that a volume error of ±5% was acceptable (5% corresponds to one stocking).</p><p>The method was accurate on all models in theory but accurate on only four models in reality. The ICC was 0,95-1,00 for intrarater precision but only 0,76 for interrater precision. Intra- and interrater precision was unsatisfying when using clinical criteria. Variations between estimated tip heights and circumferences were causing the errors.</p><p>The method needs to be developed and is not suitable for stumps with narrow ends. Using a longer rule (about 30 cm) with a set square end to assess tip heights is recommended to improve precision. Using a flexible measuring-tape (possible to disinfect) with a spring-loaded handle could improve precision of the circumferential measurements.</p>

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 2006. / Kaynakça var.

Background: Axis fractures are a common injury in the elderly population. Treatment is often complicated due to osteoporosis and patient comorbidity. Knowledge of the incidence of these fractures, as well as their treatment, outcome and mortality rate, will improve knowledge and decision-making processes for this fragile group of patients. Objectives: This thesis aims (1) to review the literature on the non-surgical and surgical treatment of odontoid fractures type 2 in the elderly population, (2) to provide an updated overview of axis fracture subtypes, their incidence and their treatment in a cohort in two university cities, (3) to map the incidence of fractures and the treatment of these patients in Sweden, (4) to investigate the effect on mortality of both the surgical and non-surgical treatment of axis fractures and (5) to present the protocol for a randomized controlled trial (RCT) on the treatment of odontoid fractures type 2 in the elderly population. Methods: A systematic review was performed using the MeSH keywords “odontoid AND fracture AND elderly”. The data for the cohort study were extracted from the regional hospital information system. The radiographs were reviewed retrospectively. Data were extracted from the Swedish National Patient Registry (NPR) and the mortality registry for the national registry studies. Finally, the RCT protocol was carried out according to the SPIRIT and CONSORT statements for clinical trial reporting. Results and conclusions: So far, there has been a scarcity of existing evidence on treatment of odontoid fractures type 2 in the elderly population. In this thesis, we found in two university cities an increased incidence, and a trend towards more surgical treatment of type 2 and 3 odontoid fractures 2002-2014. Between 1997 and 2014 in Sweden, there was an increasing incidence of C2 fractures, but the treatment trend went towards more non-surgical treatment. Surgically treated patients had a greater survival rate than non-surgically treated patients. Among those over 88 years of age, surgical treatment lost its effect on survival. In the RCT we will study the function of patients with odontoid fractures type 2 and by comparing non-surgical treatment with posterior C1-C2 fusion, the cost-effectiveness of the treatment options.

Bakgrund: Livsstilssjukdomar som diabetes och hjärt- och kärlsjukdomar ökar i samhället vilket medför en ökad risk för komplikationer. I västvärlden är diabetes och ateroskleros den vanligaste orsaken till amputation. Sjuksköterskans roll i samband med en amputation är att stötta patienten i utmaningarna som kan uppkomma och ge möjlighet till god återhämtning. Välbefinnande är en individuell upplevelse och som begrepp flerdimensionellt. Syfte: Studiens syfte är att belysa vuxna personers upplevelser av välbefinnande efter en amputation av extremitet orsakad av kärlinsufficiens. Metod: Studiedesignen är en litteraturstudie med kvalitativ induktiv ansats. Databassökningen gjordes i CINAHL och PubMed. Totalt inkluderades 12 vetenskapliga artiklar som analyserades i tre steg inspirerad av innehållsanalys. Resultat: I analysen skapades tre kategorier: Välbefinnandets påverkan av psykologiska omständigheter, Omgivningens påverkan på välbefinnande, Ambivalens &amp; avgörande. Välbefinnandets påverkan av psykologiska omständigheter beskriver att självbilden och självständigheten förändrades efter en amputation, och hur amputationen påverkade deras psykiska hälsa. Omgivningens påverkan på välbefinnande skildrar vilken roll familj, närstående och vårdpersonal hade för individens välbefinnande. Ambivalens &amp; avgörande beskriver hur personerna såg tillbaka på sitt beslut om amputation och tankar på framtiden. Under kategorierna återfinns totalt sju underkategorier. Konklusion: Amputation var en stor omställning på personen och hade en påverkan på välbefinnandet, såväl positivt som negativt. Upplevelsen av välbefinnande efter en amputation och vilka faktorer som ger välbefinnande är individuellt därav är personcentrerad omvårdnad av betydelse.

CREDNE är en modulär kosmetisk armprotes med mål av att få användaren att vilja visa upp sin protes, känna sig bekväm och stolt över den. I samarbete med Teamolmed har värdefulla bidrag gjorts från både handledaren och studenten för att komma ett steg närmare till att förverkliga denna vision. Genom forskning, intervjuer och användartester har två viktiga insikter upptäckts. Förutom att användarna har ett behov av en protes som ser bra ut, så har de också ett lika stort behov av en hylsa som löser de problem som uppkommer med värme och kyla. Andra insikten är att eftersom vi som människor gillar att uttrycka oss visuellt genom olika kläder och accessoarer så kan man inte bara ha en enkel design och stil som passar alla, utan att det ska finnas en katalog/ samling som anpassar sig efter användarens estetiska behov. Konceptet bakom Credne besvarar dessa behov.   Konceptet kan beskrivas genom tre huvudpunkter. Konceptet är en katalog av kosmetiska armskal temat utefter olika intressen, konceptet är en modulär protes som tillåter användaren att byta ut dessa skal enkelt som en sko och slutligen är konceptet också en protes med en bekväm hylsa som andas och som ger en naturlig övergång samt belastning mellan arm och protes.

Bakgrund: Djup ventrombos (DVT) är en allvarlig komplikation efter kirurgiska och ortopediska ingrepp. Detta leder till ökat lidande för patienten, längre vårdtider och därav ökade kostnader för samhället. För att förebygga DVT krävs kunskap om vilka preventiva omvårdnadsåtgärder som har effekt och hur de ska användas. Syfte: Syftet med studien var att genom en systematisk litteraturstudie se vad kunskapsläget säger om preventiva omvårdnadsåtgärder mot DVT samt vad som ser mest effektivt ut. Syftet var också att genom en enkät ta reda på hur sjuksköterskor arbetar kliniskt för att förebygga DVT. Metod: Litteraturstudie som baserades på tio orginalartiklar. Som komplement till litteraturstudien gjordes även en enkätstudie som inkluderade tio sjuksköterskor. Resultat: Tidig mobilisering tillsammans med mekanisk profylax ses som effektivt för att förebygga DVT. I många av studierna som granskats gavs patienterna lågmolekylärt heparin (LMH). Det var dock ingen lägre frekvens av DVT hos dessa patienter jämfört med de som ej fick LMH. Det var vid införandet av profylaktiska omvårdnadsåtgärder som tidig mobilisering, kompressionsstrumpor och kompressionspumpar som frekvensen av DVT sjönk. Sjuksköterskorna arbetar aktivt med förebyggande omvårdnadsåtgärder men det finns dock inga specifika riktlinjer för dessa omvårdnadsåtgärder i den kliniska verksamheten. Slutsats:  Studien visar att ett behov finns för utvecklandet av att arbeta med individanpassad profylax då patienterna utifrån olika riskgrupper har olika behov av profylaxtyper. Stor vikt bör läggas på att utveckla och implementera riktlinjer för tidig mobilisering då detta utifrån denna studies resultat har god effekt för att förebygga uppkomsten av DVT. / Background: Deep vein thrombosis is a serious complication during surgical and orthopaedic procedures. This leads to increased patient suffering, longer hospital stays and thereby also higher cost for society. To prevent DVT requires knowledge about preventive care measures that are effective, and how they will be used. Aim: The aim of this study was to examine the current state of knowledge about preventive care measures against DVT and how effective they are. The aim was also, by conducting a survey, to find out how nurses work clinically for the prevention of DVT. Study design: A literature study was conducted. The study was based on ten original articles. As a complement to the literature study a questionnaire was created and handed out to ten surgical and orthopaedic nurses. Results: Early mobilization in combination with mechanical prophylactics is seen as effective for preventing DVT. In many of the included studies patients were given low molecular weight heparin (LMH). However the frequency of DVT in these patients was not lower compared to those who did not get LMH. Instead it was at the introduction of prophylactic care measures such as early mobilization, compression stockings and compression pumps as the frequency of DVT fell. The questionnaires showed that clinical nurses worked actively with care measures. However, there were no specific guidelines for the measures in the organisation. Conclusion: The study shows that there is a need for developing methods for individual prophylactic care as patients from different risk groups have different needs. There should also be focus on developing and implementing guidelines for early mobilization as this study has shown it is effective in preventing DVT.

Proximal humeral fractures requiring surgical stabilization remain a therapeutic challenge, and a fully functioning joint is rarely the outcome after traumatic proximal humeral fractures. A systematic review was conducted to present the current state of knowledge concerning the postoperative rehabilitation. Tree databases was searched (PubMed, PEDro and the Cochrane library), presenting 25 publications eligible for further review and assessment. The literature was evaluated using PEDro and The Swedish Council on Health Technology, SBUs, evaluation grading system GRADE. The main functional impairments were pain and reduced range of motion in the shoulder joint, and were measured by several different scoring systems for functional outcome. Reported results were contradictory and inconsistent, and current studies typically lack randomization, and independent evaluation, with a resultant inability to produce clinical conclusions. According the post-operative rehabilitation procedure, only careful conclusions can be drawn from the literature reviewed which does not focus on, emphasize or explore the physiotherapeutic interventions at any length. It was therefore not possible to compare or connect the Axelina rehabilitation regimen with the literature. The Axelina rehabilitation program of the shoulder joint, are the most commonly used regimen at the physiotherapeutic ward at Uppsala University hospital. Neither was it possible to determine if the post-operative treatment should be different according to classification of fracture or method of stabilization. The results from this systematic review suggest that the data from the published literature are inadequate for evidence-based decision making as regards the treatment and post-operative rehabilitation for complex proximal humeral fractures.