One of the first surgeries young orthopaedic surgeons learn is the femoral neck fracture fixation with collum screws. A common theme is how to position the screws and as a young surgeon one often believe that everything depends on the screw position, especially if they’re parallel or not. It was therefore quite fun and liberating to read Nyholm et al’s study with the subtitle: “Minimal Effect of Implant Position on Risk of Reoperation” Continue reading
Category Archives: Research
And I thought we were done with the mid-shaft clavicle….
So… just a few days after my previous clavicle post, Ahrens et al released their multi-center study on 300 patients randomized to surgery. They found that operated clavicles have less pain early on, but that after 9 months they perform the same. The study was excellently performed with 20 centers, adequate patient selection, random block permutation for treatment allocation, and reasonable treatment options. Continue reading
The clavicle fracture – can the madness finally come to an end?
In the early 2000s Nowak et al.  shattered the belief that mid-shaft clavicle fractures always healed fine; even after 10 years almost half of the patients had remaining symptoms*. This common injury had also by in others  (with shorter follow-ups) been hinted as problematic, and within short we were showered with fancy new implants. After ≥ 7 RCTs ,  on the subjects it seems that these new implants failed do deliver. Can we finally start questioning if surgery is the solution? Continue reading
ASA as DVT prophylaxis gaining in popularity?
In a recent post I noted that there was a dissonance between what I’ve been taught in school and what is actually the case regarding thrombosis prophylaxis after orthopaedic surgery. A new study by Parvizi et. al. looks into different dosages of ASA as a thromboprophylaxis after joint arthroplasties. Coming from a country that has fully embraced LMWH this feels alien… regardless, there seems to be increasing evidence that challenges my point of view. Continue reading
Chochrane supports restrictive transfusions
I’ve previously written a two posts on blood transfusions from a surgeons perspective (End of the blood reign and A bloody mess) and I was therefore thrilled when I stumbled upon this [Cochrane review](https://www.ncbi.nlm.nih.gov/pubmed/27731885) that concludes:
The findings provide good evidence that transfusions with allogeneic RBCs can be avoided in most patients with haemoglobin thresholds above 7 g/dL to 8 g/dL.
Dealing with non-proportional hazards in R
Since I’m frequently working with large datasets and survival data I often find that the proportional hazards assumption for the Cox regressions doesn’t hold. In my most recent study on cardiovascular deaths after total hip arthroplasty the coefficient was close to zero when looking at the period between 5 and 21 years after surgery. Grambsch and Thernau’s test for non-proportionality hinted though of a problem and as I explored it there was a clear correlation between mortality and hip arthroplasty surgery. The effect increased over time, just as we had originally thought, see below figure. In this post I’ll try to show how I handle with non-proportional hazards in R. Continue reading
LMWH – a Big Pharma bluff?
Thromboprophylaxis is a given for patients operated due to lower limb injuries, at least if we believe Big Pharma-studies. This dogma is now challenged by a double-blind, multi-center, RCT by Selby et al. They found that the DVT rate was much lower than expected and had to pull the plug on the study as it would be practically impossible to show a difference between placebo and LMWH. Continue reading
Canakinumab – difficult to pronounce but useful for treating gout?
Gout can be incredibly painful where the main treatment option are nonsteroidal anti-inflammatory drugs (NSAID). Unfortunately NSAIDs are not the best alternative for elderly patients as it may induce heart & kidney failure. I was therefore thrilled to see that canakinumab recently was approved by Läkemedelsverket as a treatment alternative. Continue reading
The proximal humerus fracture – a lost cause?
Most orthopaedic surgeons have met patients with poor shoulder function after a proximal humerus fracture, and many of us have thought: if I’ve only done the other thing I was thinking of…. Unfortunately the outcome seems to be independent of what we do, at least according to Launonen et al’s meta-analysis and Rangan et al’s recent RCT on 250 patients. Continue reading
A bloody mess
In a recent RCT by Gregersen et al. they manage to complicate blood transfusions in orthopaedic patients even further. They suggest that orthopaedic patients from nursing homes fare better with liberal blood transfusions (> 113 g/L compared to >97 g/L). The concept is interesting, although the paper has some issues. Continue reading