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).

The aim of the thesis was to collect baseline data and to investigating suitable physical tests and a self-rapport questionnaire. Collected data was used to find a routine measurement when investigating foot health, function and mobility among clients suffering from diabetes in Samoa. Twenty-one participants suffering from diabetes were included in the study. Clients answered the Foot function index (FFI) questionnaire and performed physical tests, consisting of Bergs balance scale (BBS) and Time up and go (TUG). Results from the physical tests revealed a great balance disturbance and mobility limitations among the majority of the clients. General high weight and BMI was measured among both genders. Subjects with the highest BMI performed lowest time during TUG test. The statistic analyze revealed a strong correlation between the two physical tests, indicating that one of the tests could be applied as a routine measurement in the future, when evaluating function and mobility in Samoa. The compilation of self-report questionnaires indicated a general good foot health with a low amount of pain, disabilities and activity limitations. / Syftet med studien var att samla in grundata och att hitta ett lämpligt fysiskt test och ett självadministrativt formulär. Den insamlade grunddatan användes för att hitta ett rutinmässigt mätinstrument för undersökning av fothälsa, funktion och mobilitet hos klienter som lider av diabetes i landet Samoa. I undersökningen deltog 21 personer som lider av diabetes. Deltagarna fick besvara ett så kallat ”Foot Function Index formulär” (FFI) och utföra de två fysiska testerna ”Bergs Balance Scale” (BBS) och ”Time Up and Go” (TUG). Resultaten från de fysiska testerna påvisade såväl en stor balansrubbning som mobilitetsbegränsningar hos majoriteten av deltagarna. Ett generellt högt BMI-värde och stor vikt uppmättes hos båda könen. Personer med högst BMI-värde presterade kortast tid under TUG-testet. Den statistiska analysen påvisade en stark korrelation mellan de två fysiska testen, vilket indikerar att endast ett av testerna kan användas som mätinstrument i framtida undersökningar av funktion och mobilitet på Samoa. Sammanställningen av de självadministrativa formulären påvisade en generellt god fothälsa med begränsad smärta, oförmåga och aktivitetsbegränsning hos deltagarna i studien.

Syfte: Denna studie syftar till att undersöka vilken behandlingsmetod, plasticitetsgrundad eller icke-invasiv neuromodulering som presenterar bäst resultat av smärtlindring hos personer som upplever fantomsmärtor efter en amputation. Metod: Litteraturundersökningen utfördes i 3 databaser; MEDLINE, CINAHL och PsycINFO. Inkluderingskriterier användes för urval av studier. Bedömning av studiernas risk för bias gjordes med hjälp av mallar från Joanna Briggs Institut. Relevant data kopplad till frågeställningen extraherades och analyserades. Resultat: Totalt åtta artiklar inkluderades, där två presenterade resultat från icke-invasiv neuromodulering och sex studier inkluderade plasticitetsgrundade metoder. Smärtskalor mellan 0-10 användes för att mäta förändringen av smärtan. Den kritiska bedömningen drog slutsatsen att det saknades studier av hög kvalitet som inkluderar kontrollgrupper. Bevisen som analyserats i den aktuella studien indikerar att plasticitetsgrundade metoder tycks ge bättre smärtreduktion jämfört med icke-invasiv neuromodulering. Slutsats: Baserat på resultaten kan inte denna studie presentera bevis starka nog för att avgöra vilken grupp av metoder som har bäst smärtlindrande effekt. Brist av högkvalitativa studier inom området, i kombination med heterogenitet mellan inkluderade studier resulterar i att ingen slutsats kan dras. / Aim: This study aims to determine which treatment method, plasticity guided or non-invasive neuromodulation, presents the best result in reducing pain for amputees experiencing phantom limb pain. Method: Literature search was performed in 3 databases; MEDLINE, CINAHL and PsycINFO. Eligibility criteria were used for study selection. Critical appraisal tool by Joanna Briggs institute was used to assess the included articles’ risk of bias. Data relevant to the research question were extracted and analyzed. Result: A total of eight articles were included, where two presented results from non-invasive neuromodulation and six studies included plasticity guided methods. Pain scales ranging from 0-10 were applied as outcome measures to monitor improvements in phantom limb pain. The critical appraisal concluded lack of high-quality study designs including control groups. The evidence analysed in the present study indicate that plasticity guided methods appear to provide the best pain reduction when compared to non-invasive neuromodulation. Conclusion: Based on the results, this study does not present evidence strong enough to state which methods present the best pain reduction. Due to low amount of research within the field, combined with heterogeneity between included studies, no conclusion can be made.

Aim: According to Swedish and Danish law interventions must be based on evidence, and evidence related to rest orthoses in contracture management is limited and inconclusive, making justification of using rest orthoses difficult. The aim is to understand the clinicians’ perceptions of the benefit of rest orthoses when managing wrist and hand contractures, to shape a basis for clinical evidence.Method: A qualitative interview study was made and a total of 13 participants with 2 to 40 years of experience was included. Interviews were transcribed and translated into English. A thematic analysis was undertaken by two researchers. Three themes and seven subthemes were identified and discussed. Results: There was congruence among the participants that rest orthoses can maintain RoM when used but they need to be used at least 6 to 8 hours every day. Combination of botox and rest orthoses has a good effect in many patients with spasticity for maintaining RoM and some function. Many patients gain a benefit in maintaining hygiene, a reduction in pain and easier for patients getting dressed. Conclusion: The interviewed clinicians perceived that rest orthoses can impact pain and prevent contracture formation however evidence was inconclusive, but it merits further research. / Syfte: Enligt svensk och dansk lag måste insatser baseras på evidens, och evidensen relaterad till viloortoser i kontrakturhantering är begränsad och motsägelsefull, vilket gör det svårt att motivera användningen av viloortoser. Syftet är att förstå klinikernas uppfattningar om fördelarna med viloortoser vid hantering av hand- och handledskontrakturer, för att skapa en grund för klinisk evidens. Metod: En kvalitativ intervjustudie genomfördes och totalt 13 deltagare med 2 till 40 års erfarenhet inkluderades. Intervjuerna transkriberades och översattes till engelska varpå en tematisk analys utfördes av två forskare. Tre teman och sju underteman identifierades och diskuterades. Resultat: Det fanns samstämmighet bland deltagarna att viloortoser kan bibehålla rörelseomfång när de används, men de måste användas minst 6 till 8 timmar varje dag. Kombinationen av botox och viloortoser har god effekt hos många patienter med spasticitet för att bibehålla rörelseomfång och viss funktion. Många patienter får fördelar i form av bibehållen hygien, minskad smärta och det blir lättare för patienter att klä på sig.Slutsats: De intervjuade klinikerna ansåg att viloortoser kan påverka smärta och förhindra kontrakturbildning, men evidensen är ofullständiga och kräver ytterligare forskning.

Bakgrund: Stressfrakturer utgör 10–20 % av alla idrottsskador och 10% av alla ortopediska skador, av samtliga stressfrakturer lokaliseras upp till 49% i tibia. För att ställa diagnosen korrekt behövs en magnetröntgen, benskanning eller datortomografi. Syfte: Syftet med denna litteraturöversikt var att kartlägga tillförlitligheten hos kliniska tester för att diagnostisera stressfrakturer i tibia. Metod: En litteraturöversikt med narrativ design tillämpades, sökningen utfördes i Pubmed, Sportdiscus, Pedro & Cinahl, inklusionskriteriet var att studierna skulle ha minst ett radiologiskt referenstest. Kvalitén av studierna bedömdes med Quadas mätinstrument. Resultat: 17 artiklar inkluderades i översikten, totalt var det åtta olika tester som undersöktes. Tre studier valde att kombinera flera tester vid diagnostiseringen av stressfrakturer i tibia. Inget ensamt test eller testkombination hade både en hög specificitet och sensitivitet. Flertalet studier fick en hög sensitivitet vid palpation, även kombinerade tester gav en hög sensitivitet. Konklusion: Enbart kliniska tester verkar inte kunna diagnostisera stressfrakturer i tibia då testerna har en låg specificitet. Eventuellt kan en kombination av tester utesluta stressfrakturer i tibia och därav minska behovet av röntgenundersökning. Flertalet studier hade metodologiska brister därför behövs mer forskning för att kunna dra säkrare slutsatser gällande testernas tillförlitlighet. / Background: Stress fractures make up 10-20% of all sports injuries and 10% of all orthopedic injuries, of all stress fractures up to 49% are in the tibia. To make the diagnosis correctly, an MRI, bone scan or computed tomography is needed.  Aim: The purpose of this study was to investigate the reliability of different clinical tests in the diagnosis of stress fractures of the tibia.  Method: A literature review with narrative design was applied, the search was performed in Pubmed, Sportdiscus Pedro and Cinahl, the inclusion criteria was that the studies had at least one radiological reference test. The quality of the studies was assessed with Quadas measuring instrument.  Results: 17 articles were included in the review, a total of eight different test examined. Three studies chose to combine multiple tests in the diagnosis of tibial stress fractures. No single test or test combination had both a high specificity and sensitivity. Most studies obtained a high sensitivity on palpation, even combined test gave a high sensitivity. Conclusion: Clinical tests alone do not seem to be able to diagnose stress fractures in the tibia as the tests have a low specificity. Possibly, a combination of tests can rule out stress fractures in the tibia and therefore reduce the need for radiological examination. Most studies had methodological flaws therefore, more research is needed to be able to draw safer conclusions regarding the ability of the tests.

Introduktion: Preoperativ fasta är sedan många år tillbaka vedertaget inför kirurgi. Bakgrunden är bland annat att förhindra aspiration hos sövd patient som inte kan försvara sin luftväg. Fastan medför emellertid negativa konsekvenser för patienten. För att minska de negativa konsekvenserna har tidigare forskning kunnat påvisa positiva effekter av preoperativ kolhydratladdning i form av exempelvis minskad opioidanvändning och minskat antal vårddygn. Forskning beträffande patientens upplevelse av preoperativ kolhydratladdning är dock begränsad. Syfte: Att belysa upplevelsen av preoperativ kolhydratladdning hos patienter som genomgår elektiv höft- och knäledsplastik. Metod: Semistrukturerade telefonintervjuer med 12 patienter som analyserades med manifest kvalitativ innehållsanalys. Resultat: Hur information gavs från vårdpersonal hade en avgörande betydelse för patienters motivation att dricka preoperativ kolhydratdryck. Även viljan att må så bra som möjligt efter operationen var en stor motivator. Patienter beskrev känslan av att bli pigga och få en kick efter att ha druckit dryckerna, samt att de skulle rekommendera dryckerna till anhöriga. Diskussion: Resultatet visade att informationens utformning var av avgörande betydelse för patientens uppfattning av preoperativ kolhydratladdning och att intaget av dryckerna i många fall gav positiva känslor och förbättrat mående. Slutsats: Informationens ursprung har stor betydelse och preoperativ kolhydratdryck bidrar till känslan av förbättrat mående hos patienter som genomgår elektiv ortopedkirurgi.

This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures. Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI). The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p<0.01), one-leg stance balance with the eyes closed and coordination tests (p<0.05), and aerobic capacity (p<0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p<0.01), standing on the right leg (p<0.01) and on the left leg (p<0.05) while turning the head, and walking 30 metres (p<0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p<0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p<0.05) (III). In both sexes, reported moderate (p<0.05) and high (women p<0.05 and men p<0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI). A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period. / On the day of the public defence the statuses of articles IV and V were Submitted and VI was Manuscript

<p> </p><p>In orthopaedic practice, fractures are usually stabilised with metal screws or rods. This is done in order to keep the fracture parts in place during the rather slow healing process. The healing time can potentially be reduced by local- or systemic treatment with different bone promoting drugs. In later years, lithium, otherwise used to treat bipolar disease, has shown promise to be such a drug.</p><p> </p><p>The aim of this master thesis was to find a way to coat metal bone screws with lithium and to characterise the coating. The coating was to be designed in such a way that it could release lithium to the surrounding bone tissue.</p><p> </p><p>Lithium chloride was incorporated into a titanate sol-gel and attached to silicon wafers and stainless steel screws by dip coating. Wafers were used for initial <em>in vitro</em> studies of how lithium changed coating characteristics. This was studied using ellipsometry, AFM and SEM. Lithium is most probably physisorbed and not incorporated into the network building up the sol-gel. Coating structure is changed as more lithium is incorporated. For large amounts of lithium, the nanoparticles normally formed when curing the sol-gel are inhibited. One effect of this is reduced bioactivity, seen as a reduced ability for calcium phosphate crystals to nucleate on the coating when immersed in simulated body fluid.</p><p>Lithium release was investigated using AAS. Lithium is released from the coating, showing a burst effect. By changing the number of coating layers used, the release profile can be partly altered. The coating was also applied to screws, showing good attachment, and the lithium release profile was similar to the one seen from wafers.</p><p>Finally, a screw model was used in rats to assess the effect of local lithium treatment from screws and systemic lithium treatment on fracture healing. In the model, a screw was inserted in tibia, mimicking a fracture. When the bone around the screw was healed, a pullout test was performed, giving information about the strength of the bone surrounding the screw. No significant difference could be found for either local- or systemic lithium treatment compared to control. However, when evaluating the strength of intact bone in a similar way, a positive effect of systemic lithium treatment could be seen. Therefore, it is still likely that lithium has a positive effect on bone and further studies are needed to fully evaluate its role in fracture healing.</p><p> </p> / <p><p>Vid behandling av benbrott stabiliseras vanligtvis frakturen internt med metallskruvar och</p><p>metallstavar. Detta görs för att hålla brottbitarna på plats under den relativt långsamma läkprocessen. Det är möjligt att minska tiden för frakturläkning genom att lokalt eller systemiskt behandla med olika läkemedel som främjar bentillväxt. På senare år har det presenterats bevis för att litium, som annars används som psykofarmaka, fungerar som ett sådant läkemedel.</p><p> </p><p>Syftet med detta examensarbete var att hitta en metod för att fästa litium på benimplantat. Litium skulle fästas på ett sådant sätt att frisläppning till omgivande vävnad blev möjlig.</p><p> </p><p>Litiumklorid inkorporerades i en titanat-solgel och lager av detta lades på kiselytor och rostfria skruvar genom s.k. ”dip-coating”. Kiselytorna användes för initiala <em>in vitro</em>-studier av hur litium ändrade beläggningens egenskaper. Litium sitter antagligen fast på ytan av det tredimensionella nätverk som utgör solgelen, istället för att sitta inbundet i nätverket. Lagerstrukturen ändras ju mer litium som inkorporeras och vid stora mängder skapas inte de nanopartiklar som vanligtvis finns i en solgel-baserad beläggning. En följd av detta är reducerad bioaktivitet för beläggningen, dvs. en minskad förmåga för kalciumfosfatkristaller att bildas på ytan. Litium frisläpps från beläggningen, dock sker denna frisläppning snabbt. Genom att belägga ytan med flera lager av solgel kan frisläppningskinetiken delvis ändras. Solgelen kunde också med god vidhäftning appliceras på skruvar och frisläppningskinetiken från en skruv är liknande den från en kiselyta.</p>Slutligen användes en skruvmodell i råtta för att undersöka vilken effekt lokal respektive systemisk litiumbehandling har på frakturläkning. I modellen efterliknas ett benbrott genom att en skruv sätts in i skenbenet.  När benvävnaden runt skruven har läkt görs ett utdragstest på skruven vilket ger information om benets styrka. Ingen signifikant skillnad i skruvens utdragskraft kunde ses mellan de båda försöksgrupperna och kontrollgruppen. Däremot hade gruppen som fick systemisk litiumbehandling fått starkare ben totalt, vilket indikerar att litium har effekt på <em>intakt</em> ben. På grund av dessa resultat finns det fortfarande skäl att tro att litium har en positiv påverkan på ben, varför dess effekt på frakturläkning bör undersökas ytterligare. </p>

The overall aim of this thesis on congenital clubfoot was to estimate the incidence with a national perspective, analyse residual deformities and their management, and evaluate patient reported long-term quality of life and foot function. Paper I was a prospective, nationwide sampling of 280 children with congenital clubfoot during 1995-96. The average incidence was 1.4‰. There was regional heterogeneity but no seasonal variation. Paper II evaluated ultrasonography on 54 newborn, prospectively followed up to 12 months of age. Significant increase of medial malleolus to navicular distance (MM-N-distance) and of soft tissue thickness with increasing age was seen and with acceptable reliability. Paper III assessed 35 children (47 feet) after previous posterior release, mean age of 4.5 years, and the MM-N-distance was shorter in unilateral clubfeet (21 patients) than in contralateral normal feet. No association between navicular position and forefoot adduction (FFA) was determined. Smaller FFA yielded better subjective and functional outcome. Paper IV reviewed distraction treatment with Ilizarov External Fixator in seven patients (10 feet), 6-15 years of age, with relapsed deformities. All patients, except one, reported satisfaction with the overall result but less stiffness was experienced in only 4/10 feet. Paper V evaluated self-estimated outcome in 83 patients (63 males, 20 females), mean age of 64 years, through SF-36 and EQ-5D, and through AAOS foot and ankle score. Age and gender adjusted norm groups were used. Female patients scored worse than male patients did. Both males and females reported negative influence on foot and ankle function. Conclusion: The incidence of congenital clubfoot in Sweden is higher than in previous Scandinavian studies. Ultrasonography is reliable for describing pathoanatomy of the talo-navicular joint in clubfeet and can detect "spurious" (false) correction. Distraction treatment with the Ilizarov External Fixator yields subjective improvement but stiffness remains. Long-term influence on daily life activities is limited to foot and ankle function for both genders, but only female patients report negative influence on physical aspects of quality of life.

In orthopaedic practice, fractures are usually stabilised with metal screws or rods. This is done in order to keep the fracture parts in place during the rather slow healing process. The healing time can potentially be reduced by local- or systemic treatment with different bone promoting drugs. In later years, lithium, otherwise used to treat bipolar disease, has shown promise to be such a drug.   The aim of this master thesis was to find a way to coat metal bone screws with lithium and to characterise the coating. The coating was to be designed in such a way that it could release lithium to the surrounding bone tissue.   Lithium chloride was incorporated into a titanate sol-gel and attached to silicon wafers and stainless steel screws by dip coating. Wafers were used for initial in vitro studies of how lithium changed coating characteristics. This was studied using ellipsometry, AFM and SEM. Lithium is most probably physisorbed and not incorporated into the network building up the sol-gel. Coating structure is changed as more lithium is incorporated. For large amounts of lithium, the nanoparticles normally formed when curing the sol-gel are inhibited. One effect of this is reduced bioactivity, seen as a reduced ability for calcium phosphate crystals to nucleate on the coating when immersed in simulated body fluid. Lithium release was investigated using AAS. Lithium is released from the coating, showing a burst effect. By changing the number of coating layers used, the release profile can be partly altered. The coating was also applied to screws, showing good attachment, and the lithium release profile was similar to the one seen from wafers. Finally, a screw model was used in rats to assess the effect of local lithium treatment from screws and systemic lithium treatment on fracture healing. In the model, a screw was inserted in tibia, mimicking a fracture. When the bone around the screw was healed, a pullout test was performed, giving information about the strength of the bone surrounding the screw. No significant difference could be found for either local- or systemic lithium treatment compared to control. However, when evaluating the strength of intact bone in a similar way, a positive effect of systemic lithium treatment could be seen. Therefore, it is still likely that lithium has a positive effect on bone and further studies are needed to fully evaluate its role in fracture healing. / Vid behandling av benbrott stabiliseras vanligtvis frakturen internt med metallskruvar och metallstavar. Detta görs för att hålla brottbitarna på plats under den relativt långsamma läkprocessen. Det är möjligt att minska tiden för frakturläkning genom att lokalt eller systemiskt behandla med olika läkemedel som främjar bentillväxt. På senare år har det presenterats bevis för att litium, som annars används som psykofarmaka, fungerar som ett sådant läkemedel.   Syftet med detta examensarbete var att hitta en metod för att fästa litium på benimplantat. Litium skulle fästas på ett sådant sätt att frisläppning till omgivande vävnad blev möjlig.   Litiumklorid inkorporerades i en titanat-solgel och lager av detta lades på kiselytor och rostfria skruvar genom s.k. ”dip-coating”. Kiselytorna användes för initiala in vitro-studier av hur litium ändrade beläggningens egenskaper. Litium sitter antagligen fast på ytan av det tredimensionella nätverk som utgör solgelen, istället för att sitta inbundet i nätverket. Lagerstrukturen ändras ju mer litium som inkorporeras och vid stora mängder skapas inte de nanopartiklar som vanligtvis finns i en solgel-baserad beläggning. En följd av detta är reducerad bioaktivitet för beläggningen, dvs. en minskad förmåga för kalciumfosfatkristaller att bildas på ytan. Litium frisläpps från beläggningen, dock sker denna frisläppning snabbt. Genom att belägga ytan med flera lager av solgel kan frisläppningskinetiken delvis ändras. Solgelen kunde också med god vidhäftning appliceras på skruvar och frisläppningskinetiken från en skruv är liknande den från en kiselyta. Slutligen användes en skruvmodell i råtta för att undersöka vilken effekt lokal respektive systemisk litiumbehandling har på frakturläkning. I modellen efterliknas ett benbrott genom att en skruv sätts in i skenbenet.  När benvävnaden runt skruven har läkt görs ett utdragstest på skruven vilket ger information om benets styrka. Ingen signifikant skillnad i skruvens utdragskraft kunde ses mellan de båda försöksgrupperna och kontrollgruppen. Däremot hade gruppen som fick systemisk litiumbehandling fått starkare ben totalt, vilket indikerar att litium har effekt på intakt ben. På grund av dessa resultat finns det fortfarande skäl att tro att litium har en positiv påverkan på ben, varför dess effekt på frakturläkning bör undersökas ytterligare.