Den nuvarande metoden för att behandla handledsfrakturer, specifikt reponeringen (återföring till rätt position) av enklare frakturer, kräver idag två till tre personer med en behandlingstid på cirka 20 minuter. 25 000 personer drabbas av handledsfrakturer varje år i Sverige, där majoriteten är just av den enklare sorten som inte kräver operation. Denna metod ansågs för tidskrävande och dessutom för smärtsam för patienten enligt Rami Elias, ortopedisk kirurg på Specialistcenter Scandinavia. Ett hjälpmedel utvecklades utifrån dessa problem och krav från uppdragsgivaren. En funktionell prototyp byggdes och blev testad. Det nya hjälpmedlet gav prov på en minskad tidsåtgång och skonsammare behandling för patienten. / The current method for treating wrist fractures, specifically reduction (repositioning the bones) of simple fractures, require two to three people with a treatment time of about 20 minutes. 25,000 people are affected by wrist fractures each year in Sweden, where the majority of these are of the simpler variety that does not require surgery. This method was considered too time consuming and also too painful for the patients according to Rami Elias, orthopedic surgeon at Specialistcenter Scandinavia. An assistance tool was developed based on these issues and demands of the client. A functional prototype was built and tested. The new tool showed evidence of providing reduced treatment time and being less harmful to the patients.

Bakgrund: Postoperativ smärta är en förväntad men oönskad konsekvens av ett kirurgiskt ingrepp. Trots kunskap, tillgång på effektiva smärtlindringsmetoder och tillgängliga riktlinjer finns fortfarande brister i den postoperativa smärtlindringsvården. Kvalitetsindikatorer för postoperativ smärtlindringsvård har utarbetats för att identifiera potentiella förbättringsområden där patienters uppfattning om kvalitén på smärtlindringsvården utgör en viktig del i processen. Syfte: Syftet med studien var att undersöka uppfattningen om postoperativ smärtlindringsvård hos patienter som genomgått ortopedisk kirurgi.Metod: Tvärsnittsstudie med deskriptiv design med mätinstrumentet, Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Mätinstrumentet administrerades vid utskrivning till patienter som vårdats vid två ortopediska enheter. Resultat: Totalt 110 enkäter returnerades (svarsfrekvens 87,3 %). Majoriteten av patienterna var ganska eller mycket nöjda med smärtlindringsvården. Tre påståenden bedömdes ha låg kvalitet: bedömning vid djupandning och mobilisering, personalens kunskap om tidigare smärta/smärtlindring och preoperativ information. Fyra påståenden bedömdes ha hög kvalitet: smärtupplevelsen togs på allvar, interprofessionellt samarbete, snabb hjälp vid smärta samt daglig smärtlindring. Långvarig preoperativsmärta och elektiv kirurgi bidrog till högre skattning av lägsta smärtnivå. Konklusion: Trots att majoriteten av patienterna är nöjda med den postoperativa smärtlindringsvården i samband med ortopedisk kirurgi, finns förbättringsområden. Speciellt fokus bör ligga på preoperativ information, bedömning vid djupandning och mobilisering samt personalens vetskap om tidigare smärtlindring.

Aim: The aim with this study is to compare different orthotic solutions for pediatric patients with congenital talipes equnivarus.  Method: A search in the databases MEDLINE, CINAHL, PubMed and Scopus were made, and studies was included after the predefined criteria. The included studies were reviewed for risk of bias and validity, relevant data was extract and analyzed with regards to the research question.  Result: The result was presented on 15 different orthotic interventions in 21 different articles. The reported outcome measures were compliance, recurrence of deformity, Pirani- and Dimeglio score, range of motion and functional outcomes.  Conclusion: Based on the results a recommendation cannot be made on what orthosis that gives the best result. Future research should focus on developing and designing an orthosis that satisfies the patient's needs. / Syfte: Syftet med detta arbete är att undersöka olika ortos-lösningar med dess inkluderade resultat för patienter med kongenital idiopatisk klumpfot. Metod: En systematisk sökning i databaserna MEDLINE, CINAHL, PubMed and Scopus genomfördes och väsentliga studier inkluderades utefter de förbestämda kriterierna. Inkluderade studiers validitet och möjliga partiskhet bedömdes samt att relevant data utifrån frågeställningen analyserades och besvarades.  Resultat: Resultatet presenterade 15 olika typer av ortoser, i 21 olika artiklar. De presenterade utfallsmåtten var inom komplians, återfall av deformationen, Pirani- och Dimeglio poäng, rörelseomfång samt inom funktionellt resultat. Slutsats: Baserat på resultat går det inte att presentera en övervägande slutsats om vilken ortos-lösning som ger bäst resultat. Framtida forskning måste utveckla och framställa ortoser som tillfredsställer och möter patienternas behov.

Transtibial amputation is a major surgical procedure where both short- and long-term perspectives are important. The surgical method can directly impact stump quality which can affect the prosthetic user’squality of life.  The aim of this scoping review is to summarize and give an overview of the research area of different incision types in relation to prosthetic rehabilitation, to help future researchers and potentially unveil areas where further research is needed. The research question: What is the data available for Different Transtibial Amputation Techniques in Prosthetic Rehabilitation, which was divided into three sub questions. The 6-step framework for scoping reviews by the Joanna Briggs Institute was used to structure the review. From a total of 736 studies screened, 28 were selected and mapped onto 12 different outcome measures. Extensive data were found regarding what amputation method has what surgical outcomes. Areas that appear to have research gaps are dressing types and contractures when contrasted with surgical methods. No study could be found regarding length of hospital stay and the Skew flap method. We conclude that there is a research gap when it comes to patient reported assessments, surveys and qualitative evaluations. / Transtibial amputation är ett större kirurgiskt ingrepp där både kort- och långsiktiga perspektiv är viktiga. Den kirurgiska metoden kan direkt påverka stumpkvalitet vilket kan vidare påverka protesanvändarens livskvalitet. Syftet med denna Scoping Review är att summera och ge en överblick över forskningsområdet inom olika typer av kirurgiska snittföringar i relation till protesrehabilitering för att hjälpa framtida forskare och eventuellt avslöja områden där vidare forskning behövs. Forskningsfrågan var: Vad finns det för data tillgänglig för olika transtibial amputationsmetoder i protesrehabilitering, vilket delades upp i tre delfrågor. Ett sex-stegs ramverk för Scoping Reviews från Joanna Briggs Institutet användes för att strukturera översikten.Av totalt 737 studier som granskades var 28 utvalda och kartlagda till 12 olika utfallsmått.  Omfattande data hittades om vilken amputationsmetod som har vilka kirurgiska resultat. Områden som verkar ha forskningsluckor är postoperativt förband och kontrakturer i kontrast till amputationsmetod. Ingen studie kunde hittas angående längden på sjukhusvistelsen med vriden sidolambå. Vi drar även slutsatsen att det finns en forskningslucka när det gäller patientrapporterade bedömningar, undersökningar och kvalitativa utvärderingar

A steady increase in parcel volume has put more pressure on the freight transportation industry and will only continue to do so in the future. The whole industry will continue to grow as the volume increases which in turn will put more pressure on the drivers responsible that the goods arrive safely to their destination. There are many reasons to try and facilitate their working environment. It is very common for delivery drivers nowadays to use different mapping services to help navigate. The maps have helped a lot since their arrival, but this does not mean that they are faultless, there is still room for improvement. This study examines how mapping services can be used and updated to help drivers save time while deliveries. It focuses on public, free-to-use maps. A survey was conducted where drivers in the industry were asked questions about their use of mapping services and where they got to give their opinion on possible improvements to these. Motivated by observations in the field and the literature, the survey presented two potential improvements to the maps to gather opinions from the drivers. The first one was a possible addition of loading zones and loading docks to the mapping services in order to help drivers find their destination’s drop-off area. Previous studies have shown that drivers lose time in the last mile of their trip. The second problem occurs when a map navigates so that you approach your destination from the wrong direction. The study showed that delivery drivers today use maps very frequently. All 33 respondents in the study use a mapping service for their work at least once a week, 29 of them using one at least once a day. The drivers were very positive about a possible addition of loading zones and docks to the maps, all of them thought it would facilitate their work. After analysing the data collected it could be seen that an average driver loses 20 minutes a day searching for a place to load. The drivers were overall frustrated with the maps despite using them very frequently. They agreed with the problems presented in the survey and gave further examples of how they are being held back by the maps.

The aim of this study was to explore the knowledge, practices, and the sources of knowledge that certified prosthetists/orthotists (CPOs) have experienced regarding early pressure injury assessment for different skin tones. This was examined across different contexts of skin tone demographics using qualitative semi-structured interviews with CPOs from different contexts. Seven participants from six different clinics were recruited using purposive sampling. Of the interviewed participants, five were from Scandinavia, one from South Africa, and one from Nigeria. The interviews were conducted to explore the participants’ own experience of this phenomenon using a phenomenological approach and an interpretivist paradigm. Qualitative content analysis was used to analyse the transcribed interviews inductively. The results consisted of five main categories: Assessment, Standardized Methods, Perceptions of Assessment regarding Skin Tones, Sources of Knowledge regarding Skin Tones, and Relevance of Knowledge Improvement, each with a number of subcategories. There were two main findings. Firstly, CPOs lack systematized knowledge of early pressure injuries irrespective of skin tones. Secondly, many CPOs lack assessment knowledge for darker skin tones as it is only learned from experience and is not taught in education or literature. In conclusion, the field of prosthetics and orthotics must develop to improve systematic early pressure injury knowledge and assessment differences between skin tones.

Chronic pain is common in western countries and entails considerable consequences for the afflicted individuals as well as for the society. Furthermore, chronic pain is complex including an advanced interplay between biological-, psychological- and social aspects. Treatment of chronic pain attempts to decrease pain intensity and increase physical-, psychological- and social functioning. However, the treatment of chronic pain is still not optimized. Different types of physical activity and exercise (PA&E) are commonly applied as non-pharmacological treatment strategies for chronic pain, but the most efficient type and dose of PA&E are unclear. In addition, adherence to prescribed PA&E is often troublesome, which further complicates the application of PA&E as treatment for chronic pain. The aim of this thesis is to increase the knowledge about PA&E as treatment for chronic pain regarding pain intensity, biochemical substances, adherence and attitudes. The findings of this thesis were that a long-term, home-based PA&E intervention comprising strength exercises as well as stretch exercises decreased pain intensity and increased function in women with chronic neck- and shoulder pain. Using microdialysis technique, differences in pain modulatory biochemical substances were found, before the intervention, in painful trapezius muscle compared to pain-free trapezius muscle. In addition, alterations in pain modulatory substances in painful trapezius muscle after the intervention were found, which possibly could imply peripheral physiological effects of PA&E. Furthermore, psychological factors could be associated to the effects of and adherence to the PA&E intervention. An intention to be physically active were expressed by patients with chronic pain, but a discordance between the intention and PA&E-behaviour were evident, even though the PA&E were experienced as valuable. In conclusion, this thesis strengthens the importance of PA&E as treatment for chronic pain. Especially, this thesis increases the knowledge about; possible peripheral pain inhibitory effects after long-term exercise; how psychological factors might affect the results of PA&E; and also about important behavioural aspects that might affect adherence to prescribed PA&E. This thesis highlights the need of more research on physiological pain inhibitory effects of long-term PA&E in chronic pain. Furthermore, improved methods for ensured adherence to prescribed PA&E are necessary in order to optimize the effect of PA&E as treatment for chronic pain.

Displaced femoral neck fractures comprise more than a third of all hip fractures. There is controversy as to the optimal treatment. Despite attempts to improve the methods for internal fixation, complication rates have been almost unchanged: 20-40% non-union and late segmental collapse in another 10-20%. Internal fixation has been the preferred treatment in Scandinavia, whereas primary hemi- or total arthroplasty have been more prevalent in the rest of Europe and North America. In this study, patients 75 years or older, including those with mental impairment, were randomized to either internal fixation or cemented primary total hip arthroplasty (THA). A total of 146 hips in 143 patients were followed for two years. After one year 23% had died, and after two years 29%. Mortality was about the same in both groups. The accumulated mortality was pronounced among the mentally impaired patients. In the internal fixation group, 44% underwent further surgery. In the THA group, 18% dislocated. The dislocation rate was higher for the mentally impaired patients. The Harris hip scores were higher in the THA group, whereas pain was more common in the internal fixation group. The first 50 patients in each treatment group were studied concerning heterotopic ossification (HO), a well-known complication after THA. The incidence of HO in the THA group was similar to what is found after THA due to osteoarthritis. However, only 1/39 developed severe symptoms. A subgroup of 100 patients was included in a study concerning nutritional status and functional capacity using the Modified Norton scale, Katz index of ADL and a questionnaire measuring instrumental activities of daily living. The THA group fared better concerning weight change over time, locomotion and pain. The nutritional intervention did not show any measurable effects. All patients were followed until two years postoperatively and all fracturerelated hospital costs, including reoperations, were calculated. We found no difference in total costs between the treatment groups. Costs to the municipality were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. On the basis of our results, we recommend arthroplasty for patients in this age group with normal mental function and high functional demands.

This thesis, comprising 5 separate studies, is concerned with fixation of prosthetic components in total hip arthroplasty. The results and conclusions of the studies fol-low; The initial stability of femoral revision components, the long cementless PCA stem and the Exeter standard stem cemented in a bed of impacted bone graft, was com-pared in an experimental study. The PCA stem was more stable than the Exeter stem. However, for both stems initial stability may not be sufficient to allow bone ingrowth. Initial fixation is especially vulnerable to torsion. Identical femoral stems with or without HA-coating were compared in a prospec-tive randomized clinical trial. The long-term stable fixation of a cementless Link RS femoral component was improved by application of hydroxyapatite coating to the femoral stem. In a clinical study the method of extensive impaction of morsellized bone allograft and a hydroxyapatite-coated cementless Mallory-Head acetabular component was found to be advantageous for acetabular revision in the presence of contained or acetabular wall defects. The limited contact between the HA-coated implant and living host bone did not seem to compromise long-term stable fixation. Two different cup designs were compared in a prospective randomized RSA study. At 3 years after implantation the cemented low profile Lubinus FAL cup performed as well as the cemented Lubinus Standard cup in terms of migration and polyethyl-ene wear. In a study of the relationship between radiolucent lines and migration the Lubinus FAL cup displayed more radiolucent lines in the cement bone interface than the Lubinus Standard cup but no difference in migration was found. Early appearance of such radiolucent lines represents an unspecific finding without reliable correla-tion to 3-year migration of the acetabular component.

Reactive oxygen species (ROS) induce oxidative stress and although are primarily recognized for playing a deleterious biological role, they can be beneficial to cell systems. ROS are extremely short-lived and normally tightly regulated by antioxidant defence systems. Cells react to oxidative stress in different ways, which primarily depends on cell type, stress severity, or both. There is a general limitation in extrapolating to humans conclusions drawn from in vitro and animal studies because of important species-specific differences. Therefore, the general aim of this thesis was to study the influence of oxidative stress on human muscle and bone in vivo. In paper I we presented a one-step HPLC method optimized for the simultaneous determination of purine degradation products in small microdialysis samples. The clinical utility of the method was successfully tested in a patient with traumatic brain injury. In paper II we evaluated microdialysis as an in vivo method to characterize the relative kinetics of ROS-related metabolites in human skeletal muscle exposed to ischaemia-reperfusion. Results indicated that microdialysis was feasible and safe to use in monitoring metabolic events during tourniquet-assisted surgery. In paper III we investigated the association between an oxidative stress marker (urinary 8-iso-PGF2α) and bone mineral density (BMD) and whether α-tocopherol modified the association. The main finding was the negative association between 8-iso-PGF2α and BMD and that the association was further dependent on serum α-tocopherol level. In paper IV we performed a randomized controlled trial to evaluate the influence of Q10 supplementation on exercise performance and metabolites of muscular damage. We did not observe any effects on exercise capacity after 8 weeks of Q10 administration. Nor did we find a significant effect on serum markers related to oxidative stress. In conclusion we have studied the influence of oxidative stress on muscle and bone in vivo in humans. The oxidative stress was triggered by four different causes (trauma, ischemia-reperfusion, ageing, and exercise exhaustion).