Matrix metalloproteinases (MMPs), such as collagenases, are a family of enzymes capable of degrading most constituents of the extracellular matrix. MMPs are thought to be involved in the aetiopathogenesis of tendon rupture. Additionally, failure of healing has in some instances been associated with elevated levels of MMPs. We have studied (a) the effects of the MMP-inhibitor doxycycline on healing of tendons and intestines in experimental models and (b) systemic levels of MMPs and their endogenous inhibitors (TIMPs) in patients with tendon rupture. In the first study, systemic doxycycline treatment lead to weakened rat Achilles tendons during healing after injury. Subsequently, systemic doxycycline was shown to improve biomechanical properties of tendon suture fixation in the rat Achilles tendon. Sutures were also coated with doxycycline, leading to similar improvement in mechanical strength of the suture construct during healing. In the third study, doxycycline-coated sutures improved the strength of healing intestinal anastomoses in an experimental model. Finally, we showed that patients with a history of Achilles tendon rupture had elevated levels of MMP-2, MMP-7 and TIMP-2 in serum. In addition, MMP-7 correlated inversely to mechanical strength of the tendon during healing. In conclusion, MMP-inhibitors can be administered systemically and locally to manipulate healing of tendons and intestines. Generalised alterations in the MMP-TIMP system may be involved in the pathogenesis of Achilles tendon rupture and associated with differences in outcome of healing.

Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associated with postoperative complications, such as delayed healing of the wound, infections and decubitus ulcers. Arthroplasty is usually preferred procedure in displaced femoral neck fractures but is, however, controversial in patients with dementia due to the fear of dislocation of the prosthesis. The aims of this thesis are to identify risk factors for delirium and the impact of delirium on rehabilitation outcome, to evaluate whether a postoperative multi-factorial intervention program could reduce delirium, to investigate the effect of a nutritional intervention and to evaluate complications, functional outcome and mortality regarding two surgical methods, hemiarthroplasty (HAP) and internal fixation (IF), in old patients with femoral neck fracture. Thirty-eight out of 61 consecutive patients (62%) were delirious on admission to hospital or developed postoperative delirium. An increased risk of postoperative delirium was found among hip-fracture patients with dementia and/or depression. Delirious patients were hospitalized longer, were more dependent in their activities of daily living, had poorer psychological well-being and suffered more complications than non-delirious patients. A postoperative multi-factorial and multidisciplinary intervention program reduced the incidence, at 55% vs 75% (p=0.003), and number of days with delirium, 5 vs 10 days (p=0.009). Postoperative complications were also reduced; decubitus ulcers 9% vs 22% (p= 0.010), urinary tract infections 31% vs 51% (p=0.005), falls 12% vs 27% (p=0.007), and the mean hospitalization period was 10 days shorter in the intervention group (p=0.030). Malnutrition was common among all these patients (53 %) and associated with postoperative complications such as decubitus ulcers and delirium. However, the nutritional intervention had no effect on nutritional parameters at four months, nevertheless men had better nutritional outcomes than women. A higher proportion of patients with dementia operated on using HAP had regained their pre-fracture ability to walk independently at the one-year follow up compared with those operated on using IF. Six of 83 patients dislocated their HAP during hospitalization and during an episode of delirium, none had dementia. No difference in mortality between the surgical methods was seen. Dementia per se should not be a reason to disqualify patients from being treated with the most appropriate surgical method. It is clinically important to discriminate between dementia and delirium, since delirium can be prevented and treated even in patients with dementia. Old patients undergoing surgery have special needs that are not always catered for in ordinary orthopaedic or surgical wards. The special care for these patients should include: a combined nursing and medical care based on comprehensive geriatric assessments, systematic prevention, detection and treatment of postoperative complications such as delirium, hypoxemia, urinary tract infections, pain, malnutrition and an active rehabilitation. It is obvious that improved quality of care reduces patient suffering and seemingly the costs for society.

Aim: The aim of this thesis is to evaluate patients’ satisfaction with prosthetic device and service on lower limb amputations in Danang, Vietnam and to implement comparisons between the subgroups gender, living area, amputation cause and level. Method: A cross-sectional study design was conducted using the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0 questionnaire to measure patients’ satisfaction. Fifty patients were recruited through the International Committee of the Red Cross (ICRC) and the data collection was performed in the patients own homes with an interpreter. The collected data was statistically analyzed with suitable tests using Statistical Package for the Social Sciences (SPSS). Result: The patients were quite satisfied with their prosthetic devices (mean 4.16 SD ± 0.561) and more or less satisfied with their given services (mean 2.83 SD ± 1.213). Significant differences were found between genders regarding the patients’ satisfaction with prosthetic device. There were no significant differences between the remaining subgroups; living area, amputation cause and amputation level. Conclusion: This thesis demonstrates that the patients in Danang appear to be quite satisfied with their prosthetic device, even though they reported problems with the durability of the device. Furthermore, the patients were more or less satisfied with their prosthetic services. The findings in this thesis also reveals that women were less satisfied compared to men regarding the prosthetic device. These conclusions should however be taken with caution, since the reliability and validity was lower than desired and it’s difficult to generalize the results to the population. / Syfte: Syftet med denna studie är att evaluera patienters nöjdhet med deras utgivna protes och service på nedre extremitetsamputerade i Danang, Vietnam och att implementera jämförelser mellan subgrupperna kön, bostadsområde, amputations- orsak och nivå. Metod: En cross-sectional studiedesign blev utförd genom användning av Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0 enkäten för att mäta patienters nöjdhet. Femtio patienter blev rekryterade genom International Committee of the Red Cross (ICRC) och datainsamlingen blev utförd i patienternas egna hushåll med en tolk. Den insamlade datan blev statistiskt analyserad med lämpliga tester genom användning av Statistical Package for the Social Sciences (SPSS). Resultat: Patienterna var ganska nöjda med deras utgivna proteser (medelvärde 4,16 SD ± 0,561) och mer eller mindre nöjda med deras utgivna service (medelvärde 2,83 SD ± 1,213). Signifikanta skillnader hittades mellan kön gällande patienters nöjdhet med deras utgivna protes. Det fanns inga signifikanta skillnader mellan de resterande subgrupperna; bostadsområde, amputationsorsak och amputationsnivå. Slutsats: Den här studien demonstrerar att patienterna i Danang verkar vara ganska nöjda med deras utgivna proteser, fastän de rapporterade problem med protesens hållbarhet. Dessutom var patienterna mer eller mindre nöjda med deras utgivna service. Fynden i denna studie påvisar också att kvinnorna var mindre nöjda gällande protesen jämfört med männen. Dessa slutsatser skall dock tas med aktsamhet, eftersom reliabiliteten och validiteten blev lägre än önskat och det var svårt att generalisera resultaten till populationen.

Bakgrund: För att uppnå en god barnanpassad vård inom ortopedteknik krävs information om hur barn uppfattar mötet på en ortopedteknisk avdelning. Genom att ta del av barns tankar, åsikter och förslag kan verksamheter i framtiden lättare argumentera för exempelvis hur lokaler bör inredas och hur man bör bemöta barn.   Syfte: Syftet med denna studie är att undersöka hur barn upplever mötet på en ortopedteknisk avdelning i avseendet vårdmiljö och möte med ortopedingenjören.   Metod: En kvalitativ metod där deltagarna får rita och berätta kallad “Draw and tell” och åtta intervjuer med barn mellan 6 till 12 år om deras upplevelse efter besöket hos en ortopedingenjör genomfördes. Intervjuerna transkripterades och en innehållsanalys genomfördes.   Resultat: Vissa gemensamma faktorer hittades i intervjuerna så som att det ansågs att det samtalades för mycket utan att engagera barnet samt att aktiviteter som fanns sågs som bra då det kunde bli lite väntan under besöket. Det fanns flera förslag på andra aktiviteter som önskades under väntan och speglade barnens egna intressen så som datorspel och böcker.   Slutsats: Denna studie visar att det som ortopedingenjören är viktigt att engagera barnen vid mötena samt att aktiviteter finns till hands under långa väntetider.   Nyckelord: Barns upplevelser, ortopedteknik, ortopedingenjör, bemötande, miljö / Background: To achieve good child centered care in the field of prosthetics/orthotics, information about how children perceive a meeting with a prosthetist/orthotist is needed. Knowing children’s thoughts, opinions and suggestions about the situation can help increase knowledge about how to set up the environment and meetings. Aim: The aim of this study is to investigate how children experience the interactions with health professionals and the environment when meeting a prosthetist or orthotist. Method: A qualitative method called “draw and tell” was used. Eight children aged between 6 to 12 years were interviewed after a meeting with a prosthetist/orthostist. The interviews were transcribed and a content analysis was performed. Result: Too much talk without engaging the child and long waiting times were found as negative factors and activities such as books and toys and that the prosthetist/orthotist was kind were found as positive factors during the meeting. Multiple suggestions were given about what kinds of activity could be available to children when waiting these included computer games and books. Conclusion:  This study shows that it is important for a prosthetist/orthoptist to engage children in the meetings and that possibilities for activities are available when children are waiting to see the clinician.   Keywords: Children’s experience, Prosthetics, Orthotics,  Enviroment, Consultation

Bakgrund: I Sverige är den generella uppfattningen att det vid val av vardagssko är rekommenderat att välja en sportsko framför en canvas tennissko. Tidigare studier har jämfört hur olika skomodeller påverkar gången, men ingen har studerat skillnader mellan sportskor och canvas tennisskor. Syfte: Undersöka hur en sko med instabil läst och platt bindsula (canvas tennissko) samt en sko med en stadig läst, en sula med bra stötdämpning och avrullning (sportsko) påverkar den mediolaterala stabiliteten olika under stödfasen. Metod: Gånganalys på fem kvinnliga deltagare. Kinetisk och kinematisk data samlades in med hjälp av ett 3D-rörelseanalyssystem. Resultat: Rörelseomfånget skiljer sig mer mellan deltagare än skomodeller. Sportskor har ett försumbart lägre rörelseomfång än canvas tennisskor. Sportskor ger mer inverterad gång än Canvas tenniskor. Steglängden och stödfasen (stance time) skiljer inte mellan de två skomodellerna. Slutsats: Fotens rörelseomfång i frontalplanet skiljer sig inte mellan canvas tennisskor och sportskor under stödfasen, men sportskon har en mer inverterad rörelse. / Background: In Sweden it is a general perception that a sports shoe is a better choice than a canvas tennis shoe for everyday use. Previous studies have investigated how different shoe models affect the gait, but none have studied the differences between sport shoes and canvas tennis shoes. Aim: Investigate how a shoe with unstable last and a flat insole (canvas tennis shoe) and a shoe with steady last, a sole with good shock absorbing and roll off (sport shoe) affect the mediolateral stability differently during stance. Methods: Gait analysis on five female participants. Kinetic and kinematic data collected with3D-modionanalysis system. Results: The range of motion differs more between participants than between shoe models. The sport shoe have a negligible lower range of motion than the canvas tennis shoe. Walking in sport shoe shows a more inverted gait than gait in canvas tennis shoe. Step length and stance time are the same in both shoe models. Conclusion: The range of motion and motion pattern of the foot in the coronal plane does not differ between canvas tennis shoes and sport shoes during stance phase, but the sport shoe has a more inverted motion.

Höftfrakturer hos äldre kommer att bli ett stort globalt hälsoproblem på grund av den snabbt växande åldrande befolkningen. En höftfraktur kan medföra en rad negativa konsekvenser i det dagliga livet, därmed är det viktigt att belysa hur de äldre upplever livet efter höftfrakturen. Syftet med denna studie var att belysa de äldres upplevelse av dagligt liv efter höftfraktur. Studien är en litteraturöversikt med induktiv ansats genom manifest innehållsanalys och består av tio vetenskapliga artiklar med både kvalitativa och kvantitativa ansatser. Resultatet presenteras i tre huvudkategorier: upplevda förändringar i dagligt liv, upplevelser av behov av rehabilitering, upplevelser av behov av socialt stöd. De äldre upplever förändringar i det dagliga livet efter höftfrakturen från ett fysiskt och psykiskt samt socialt perspektiv. De behöver olika former av stöd för att kunna återvända till sin fungerande vardag. Vidare forskning bör lägga fokus på könsspecifik kunskap om förändringar i det dagliga livet hos de äldre med höftfrakturer. / Hip fractures in the elderly will be a major global health problem due to the rapidly growing elderly population. A hip fracture can result in several negative consequences in daily life, thus it is important to highlight how the elderly experience life after the hip fracture. The aim of this study was to illuminate the elderly’s experience of daily life after hip fracture. The study is a literature review with inductive approach through manifest content analysis and consists of ten scientific articles with both qualitative and quantitative approaches. The result is presented in three main categories: experienced changes in daily life, experiences of need of rehabilitation, experiences of need of social support. The elderly experience changes in the daily life after the hip fracture from a physical and mental as well as social perspective. They need different forms of support to be able to return to their functional daily life. Further research should focus on gender-specific knowledge regarding changes in the daily life of the elderly with hip fractures.

För att förebygga komplikationer vid kirurgiska ingrepp är den preoperativa fasen viktig. Sjuksköterskans roll innebär bland annat att försöka skapa trygghet samt ge adekvat information till patienten. Syftet med studien var att undersöka följsamheten gällande preoperativa riktlinjer och allmänna omvårdnadsåtgärder. Vid datainsamlingen utfördes totalt nio observationer på sju sjuksköterskor i deras arbetsmiljö. Studien utgör en kvalitets¬säkring och sammanställdes med stöd av innehållsanalys. Resultatet visade att tiden var en påverkande faktor, mer tid och resurser hade kunnat öka följsamheten ytterligare. Trots det speglar resultatet en god följsamhet gällande de praktiska preoperativa riktlinjerna, men det saknades fullgod kommunikation för att se till patientens inre behov. Slutsatserna visar på att det behövs fortlöpande utbildning gällande patientundervisning. Det är av stor vikt att lyssna på patienten, inte endast vad hon eller han säger, utan vad hon eller han egentligen förmedlar, med bland annat sitt kroppsspråk. / The preoperative phase is important to prevent complications during surgical procedures. The nursing role is to create safety and to give adequate information to the patient. The aim of the study was to examine the compliance regarding the preoperative guidelines and general caregiving procedures. During the data collection, nine observations were made on seven nurses in their working environment. The study can be applied as a quality assurance and was analysed by content analysis. The result shows that time was an influencing factor, and more time and resources would make it easier to increase the compliance. The result also shows that the compliance was good regarding practical preoperative guidelines. However complete communication skills were missing, to see the inner needs of the patient. The conclusion shows that there is a continuing need to develop the nurses skill regarding patient education. It is important to listen to the patient, not only to what is being said, but to what he or she really means, including body language.

Background: The number of people with diabetes is rising globally, and they are at higher risk of foot complications that can ultimately result in lower limb amputation. Additionally, individuals with diabetes whoundergo amputation are more likely to lose the contralateral limb. Consistent care and preventive measuresare crucial for reducing the risk of further amputations. Aim: This study aims to explore the current experience of certified prosthetist and orthotist in Denmarkconcerning the assessment of the contralateral limb in individuals with diabetes who utilize a lower limbprosthesis. Method: A qualitative study with an exploratory research design was conducted. Thematic analysis, using aninductive approach was employed to analyze data from eight semi-structured interviews with CPOs from Denmark. Findings: The analysis of the interview results revealed three main themes - responsibility, prioritization,and barriers - which frequently overlap. Each theme had multiple sub-themes which highlights the variationin the participants’ experiences. Conclusion: The variation in responses gathered from the interviews unveiled diverse perspectives on responsibility, prioritization, and barriers which points to a lack of clear guidelines in the Danish healthcaresystem regarding this assessment of the contralateral limb in this patient group. This study offers novel insightsinto the diverse experiences and decision-making processes of Danish CPOs when it comes to the contralaterallimb assessment in diabetic foot care. / <p></p><p></p>

Syftet med denna litteraturöversikt var att beskriva knäfunktionen och idrottsdeltagandet hos bollsportsutövare på elitnivå som drabbats av korsbandsskada, med fokus på skillnader mellan de som genomgått operation och de som valt konservativ behandling. För att besvara syftet användes tre frågeställningar. En syftade till att svara på om det fanns skillnader i knäfunktionen hos de som blir opererade och de som genomgått konservativ behandling. De två andra frågeställningarna fokuserade på om bollsportsutövarna kom tillbaka på samma nivå som innan skadan, gällande båda behandlingsmetoderna. Den systematiska artikelsökningen utfördes i två databaser, MEDline och PubMed, där utfallet blev 11 inkluderade artiklar. Några av inklusionskriterierna var att artiklarna skulle innehålla bollsportsutövare på elitnivå som haft en korsbandsskada och genomgått antingen operation eller konservativ behandling. Innehållet analyserades genom granskningsmallar och riktlinjer för kvalitetsgranskning. Resultatet visade att knäfunktionen skiljde sig mellan opererade och konservativt behandlade bollsportsutövare på elitnivå. I uppföljningsstudier 1-2 år efter behandling visade denna litteraturöversikts resultat att de konservativt behandlade har bättre knäfunktion än de opererade. Vid längre uppföljningar (&gt;2 år) visade däremot resultaten på att de opererade elitidrottarna har bättre knästabilitet än de konservativt behandlade. Gällande återgång till idrott kom bollsportsutövarna på elitnivå tillbaka till samma nivå som innan skadan både efter operation och konservativ behandling. Slutsatsen blev att det inte fanns någon betydande skillnad mellan opererade och konservativt behandlade elitidrottare gällande återgång till idrott och knäfunktion. Med kunskapen som denna litteraturöversikt har bidragit med, bör det finnas större förtroende för konservativ behandling.

The purpose of this study on hand injury from powered wood splitters was to describe injury epidemiology and anatomy, to rate injury severity, to evaluate the outcome after injury and to describe factors of possible importance for the occurrence of injury. By searching a computerized patient registry, 131 patients injured by wood splitters from 1995 to 2001 were identified. Information was obtained from hospital records and radiographs, a written questionnaire and a structured telephone interview. Injury severity was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). Outcome was evaluated with the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (DASH) and, in 26 of the most severely injured patients, with the Sollerman test. Forty-six percent of the injuries occurred during April or May. Wedge splitters caused 82 % of all injuries and most often injured the index finger, while screw splitters caused 18 % of all injuries and most often injured the metacarpus. Screw splitters caused palmar perforation and thumb avulsion. Sixty-three percent of all patients had an amputation or devascularising injury. The reliability of HISS rating was good. The mean Hand Injury Severity Score (HISS) was 63 which is equivalent to a severe hand injury. The mean ISS was 3.7. Nineteen percent of patients had minor, 31 % had moderate, 23 % had severe and 27 % had major injury according to the HISS system. Children had more severe injuries than adults. There was no significant difference regarding HISS or DASH scores between wedge and screw splitter injuries. The mean DASH score was 15, indicating moderate residual sequelae, but patients without sequelae and patients with grave sequelae were found in all HISS severity grades. There was a weak but significant correlation between the HISS and DASH scores. The mean Sollerman score in the injured hand was 66, indicating significantly impaired hand function. Twenty-nine percent of splitters were home-made. Very few machines had the safety measures required by European Standards. Children were present during splitting in at least 15 % of cases. Not being alone at the machine was one cause of wedge splitter injury. Glove use was one cause of screw splitter injury. Hand injury from powered wood splitters is a significant problem. Many of the injuries are severe, and cause long term sequels and impairment of hand function. Prevention is essential and should focus on unsafe machines and dangerous patterns of use.