Maria Wilcke - Academia.edu (original) (raw)

Papers by Maria Wilcke

Research paper thumbnail of Closed Reduction and External Fixation or Open Reduction and Volar Internal Fixation: The Clinical Dilemma

Distal Radius Fractures, 2014

This chapter presents a discussion of the choice between external fixation (EF) and open reductio... more This chapter presents a discussion of the choice between external fixation (EF) and open reduction and internal, mainly volar, fixation (ORIF) in the everyday clinical situation. Both methods have a place in the treatment of distal radius fractures. Many times the choice between external fixation and open reduction and internal fixation for unstable fractures of the distal radius is not obvious. Looking for guidance in the literature does not make the decision easier. Few comparison studies have been done and there is no consensus on which technique is superior. The available evidence suggests that volar plating is advantageous compared with bridging external fixation in the short term, but after 1 year, the outcome is similar. In spite of this, there has been a shift from closed reduction and external fixation to open reduction and volar plating.

Research paper thumbnail of Finger fractures: Epidemiology and treatment based on 21341 fractures from the Swedish Fracture register

PLOS ONE

Background There is a lack of detailed epidemiological studies of finger fractures, the most comm... more Background There is a lack of detailed epidemiological studies of finger fractures, the most common fracture of the upper extremity. Methods Based on data of 21 341 finger fractures in the Swedish Fracture register, a national quality registry that collects data on all fractures, this study describes anatomical distribution, cause, treatment, age distribution, and result in terms of patient related outcome measures (PROMs). Results The most common finger fracture was of the base of the 5th finger, followed by the distal phalanx in the 4th finger. Open fractures were most common in the distal phalanges, especially in the 3rd finger. Intraarticular fractures were most frequent in the middle phalanges. Fall accidents was the most common cause of a fracture. The mean age at injury was 40 years (38 for men, 43 for women). 86% of finger fractures in adults were treated non-operatively. Men were more frequently operated than women. Finger fractures did not affect hand function or quality o...

Research paper thumbnail of Residual flexion deformity after scaphoid nonunion surgery: 7-year follow-up study

Journal of Hand Surgery (European Volume), Sep 27, 2022

Research paper thumbnail of Fractures of the distal radius: Epidemiology, treatment and outcome assessment

This thesis aims to increase scientific knowledge of the most common fracture, namely the distal ... more This thesis aims to increase scientific knowledge of the most common fracture, namely the distal radius. Our understanding of this fracture is still limited, but every year in Sweden over 20,000 patients suffer from this injury. The fracture may cause persistent pain and disability for the patients, not to mention substantial costs to society. Improvement in treatment will benefit a large group of patients. Specifically, the incidence and trends in surgical treatment were investigated, outcome measurements were evaluated and the most common surgical treatment techniques were compared. In Paper I, patient-rated outcome after a fracture of the distal radius was investigated in relation to radiological results, grip strength and range of movement (ROM). A retrospective assessment was conducted in 78 patients with a healed fracture of the distal radius. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to measure self-reported disability. Radiological malunion, ...

Research paper thumbnail of Evaluation of a Swedish version of the patient-rated wrist evaluation outcome questionnaire: Good responsiveness, validity, and reliability, in 99 patients recovering from a fracture of the distal radius

Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 2009

The patient-rated wrist evaluation (PRWE) form is an established outcome questionnaire designed t... more The patient-rated wrist evaluation (PRWE) form is an established outcome questionnaire designed to measure wrist pain and disabilities in activities of daily living. We translated and validated this score for use in Sweden. The original PRWE score was translated forwards and backwards, and then the responsiveness, validity, and reliability of the Swedish version were tested in 99 patients who were recovering from a fracture of the distal radius. The patients completed the PRWE questionnaire 7 weeks and 4 to 6 months after the injury. Responsiveness was assessed by Standard Response Mean and Effect Size. Content validity was evaluated by examining the proportion of best and worse possible scores. Construct validity was assessed by comparing scores twice after the injury and by comparing patients with fractures of different severity. Criterion validity was evaluated by correlating the PRWE with another upper extremity score: the disability of the arm, shoulder, and hand (DASH) score. Reliability was evaluated with a test-retest and by internal consistency. Responsiveness was excellent (SRM 01.4Á1.7, ES 01.3). Five patients reported the best possible result after 4 to 6 months but none at 7 weeks, and no patient reported the worst score at any time. The PRWE score corresponded well with improvement and showed good correlation with severity of fracture. The PRWE showed a strong correlation with DASH score (Spearman's rank coefficient 00.86). Intraobserver reliability of the test-retest and internal consistency was good (Kendall W coefficient 00.79, Spearman's rank coefficient 00.99, Cronbach's a00.94Á0.97). We found this Swedish version of the PRWE to be responsive, valid, and reliable for evaluating the patient-rated outcome after a fracture of the distal radius.

Research paper thumbnail of Patient-perceived Outcome after Displaced Distal Radius Fractures

Journal of Hand Therapy, 2007

Outcome after distal radius fractures has traditionally been measured by radiological parameters ... more Outcome after distal radius fractures has traditionally been measured by radiological parameters and objective physical variables. To what extent these measurements reflect outcome as perceived by the patient has been questioned. We evaluated the association between radiological position, objective physical result (grip strength and range of movement), and the patient-perceived outcome, measured with the Disabilities of the Arm, Shoulder, and Hand outcome (DASH) score, in 78 patients with a healed unilateral distal radius fracture treated with either closed reduction and plaster splint or external fixation. Fifty-seven females and 21 males (median age 59 yr; range, 22e95) were retrospectively assessed after a mean of 22 months and the mean DASH score was 13 points. Linear correlations between final radiological and objective physical measurements and DASH score were weak or insignificant. However, radial shortening $2 mm, dorsal angulation .15 8 , and radial angulation .10 8 were each significantly associated with a poorer DASH score. Reduced grip strength, extension, and ulnar deviation correlated with a poorer DASH score. In conclusion, we found that better final radiological and objective physical results were associated with a better patient-perceived outcome, as measured by the DASH score, in this patient group.

Research paper thumbnail of Epidemiology and changed surgical treatment methods for fractures of the distal radius

Research paper thumbnail of Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year

Research paper thumbnail of Effects of intra-articular Platelet-Rich Plasma (PRP) injections on osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal joint

PLOS ONE

Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and im... more Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and improve function in knee osteoarthritis. There are few reports on the effect of PRP in the treatment of osteoarthritis in the hand. Our aim was to evaluate the effect of PRP-injections on pain and functional outcome in the short-term for osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal (STT) joint. A retrospective analysis was performed of 29 patients treated with intra-articular PRP injection for painful osteoarthritis in the thumb basal joint (21 patients) or STT joint (eight patients). The patients received two consecutive, radiologically guided PRP injections at an interval of 3–4 weeks. Pain at rest and on load (numerical rating scale (NRS) 0–10), Patient-rated Wrist and Hand Evaluation (PRWHE) score (0–100), grip strength (Jamar) and key pinch were recorded pre-injection and 3 months after the second injection. Mean age was 63 (range 34–86) years and 17 patient...

Research paper thumbnail of The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis

Journal of Hand Surgery (European Volume)

This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catas... more This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the outcome. Level of evidence: II

Research paper thumbnail of Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial

BMC Musculoskeletal Disorders

Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has in... more Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively. Methods Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (P...

Research paper thumbnail of The effects of partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function

Journal of Hand Surgery (European Volume), Mar 28, 2022

This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on p... more This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on patient-reported outcomes, quality of life and objective function in symptomatic wrist osteoarthritis during the first year after surgery. Sixty consecutive patients underwent an anterior and posterior interosseous neurectomy during 2018–2020. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, EuroQol-5D-3L, pain at rest and on load, and objective function were assessed preoperatively and 3, 6 and 12 months postoperatively. Generalized estimating equations were used to analyse the effect on the outcome variables. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation and pain scores improved significantly postoperatively with no decline over time, but no patient reported outcome measure reached the minimal clinically important difference. Quality of life, strength and range of motion did not improve. We found no complications. Seventeen patients needed further surgery during the study period. More studies are needed to evaluate whether denervation is truly effective or not. Level of evidence: II

Research paper thumbnail of Trapeziectomy with or without a tendon-based adjunct: a registry-based study of 650 thumbs

Journal of Hand Surgery (European Volume), 2022

This study aimed to assess the outcomes after simple trapeziectomy and trapeziectomy with ligamen... more This study aimed to assess the outcomes after simple trapeziectomy and trapeziectomy with ligament reconstruction and/or tendon interposition based on data in the Swedish national healthcare quality registry for hand surgery (HAKIR). Six-hundred and fifty thumbs were included, and 265 were assessed up to 12 months after operation. There was significant and clinically relevant improvement in patient-reported measures (pain on load, pain on motion without load, pain at rest, stiffness, weakness, and ability to perform activities of daily living and the Quick Disabilities of the Arm, Shoulder and Hand score) and objective measures (strength and thumb mobility) at 3 and 12 months for all procedures. The use of the abductor pollicis longus tendon had better improvement in some respects compared with the use of flexor carpi radialis or extensor carpi radialis tendons. However, overall, the use of a tendon adjuncts yielded no better outcomes than simple trapeziectomy. Level of evidence: III

Research paper thumbnail of Supplemental material for The epidemiology of scaphoid fractures in Sweden: a nationwide registry study

Supplemental Material for The epidemiology of scaphoid fractures in Sweden: a nationwide registry... more Supplemental Material for The epidemiology of scaphoid fractures in Sweden: a nationwide registry study by Elin M. Swärd, Thorsten U. Schriever, Mikael A. Franko, Anders C. Björkman and Maria K. Wilcke in Journal of Hand Surgery (European Volume)

Research paper thumbnail of Additional file 1 of A registry based analysis of the patient reported outcome after surgery for trapeziometacarpal joint osteoarthritis

Additional file 1. HQ-8 questionnaire.

Research paper thumbnail of Triquetral motion is limited in vivo after lunocapitate fusion

Objectives/Interrogation: Lunocapitate fusion (LCF) and four-corner fusion (4CF) are motion-prese... more Objectives/Interrogation: Lunocapitate fusion (LCF) and four-corner fusion (4CF) are motion-preserving salvage procedures for painful wrist arthritis due to for e.g. scaphoid nonunion advanced collapse (SNAC) and scaphoid lunate advanced collapse (SLAC). In LCF, the fusion is limited to the capitate[for full text, please go to the a.m. URL]

Research paper thumbnail of A nationwide registry study on the epidemiology of scaphoid fractures in Sweden

Objectives/Interrogation: The epidemiology of scaphoid fractures is described only in limited pop... more Objectives/Interrogation: The epidemiology of scaphoid fractures is described only in limited populations and incidence reports are inconsistent. We investigated the nationwide incidence of scaphoid fractures in Sweden 2006-2015. Methods: Registry data on 34377 patients with a reported scaphoid[for full text, please go to the a.m. URL]

Research paper thumbnail of There is motion between the scaphoid and the lunate during the dart-throwing motion

Journal of Plastic Surgery and Hand Surgery, 2021

Scaphoid and lunate mobility has been suggested to be minimal during the dart-throwing motion in ... more Scaphoid and lunate mobility has been suggested to be minimal during the dart-throwing motion in studies based on serial computed tomography (CT) scans and cadaver studies. This study analyzes the direct motion between the scaphoid and the lunate during the dart-throwing motion in vivo. We examined nine individuals with standard CT scans of the wrist in radial extension and ulnar flexion. The paired CT scans were analyzed with a volume registration technique. The lunate was registered as fixed and the scaphoid as the mobile element. The motion of the scaphoid relative the lunate between the positions of radial extension and ulnar flexion was measured. There was considerable motion between the scaphoid and the lunate with both a distal to proximal translation and rotation during the dart-throwing motion, regardless of whether the scapholunate ligament was intact or not. These results suggest that aggressive dart-throwing exercises should not be implemented early on during rehabilitation following scapholunate repair.

Research paper thumbnail of Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?

Journal of Plastic Surgery and Hand Surgery, 2021

Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pa... more Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pain after trapeziectomy for trapeziometacarpal joint osteoarthritis. The aim of this study was to investigate if proximal migration after trapeziectomy is associated with a poorer long-term outcome in terms of pain and objective physical variables. We retrospectively examined 91 thumbs in 65 patients after a mean of 10 years following trapeziectomy with or without ligament reconstruction and tendon interposition. Proximal migration of the thumb metacarpal was measured on plain lateral radiographs of the thumb and correlated to visual analogue pain scale (VAS), thumb range of motion and strength. Most thumbs had a severe proximal migration of the first metacarpal, the mean scaphoid metacarpal distance was 2.7 mm. Most patients reported no or little pain, median VAS was 0 at rest and 1 after load. There were no differences in reported VAS pain at rest or after load between patients with severe (<2 mm scaphoid metacarpal joint space) or less severe (!2 mm metacarpal joint space) proximal migration. Patients that reported more pain (VAS >2) did not exhibit more migration than patients reporting less or no pain. Thumbs with severe migration had weaker key pinch (3.4 vs. 4.6 kg, p ¼ 0.008) and grip strength (15 vs. 21 kg p ¼ 0.002). We conclude that proximal migration most likely does not cause residual or recurrent pain after trapeziectomy.

Research paper thumbnail of Triquetral Motion Is Limited In Vivo After Lunocapitate Arthrodesis

Journal of Hand Surgery Global Online, 2019

Purpose: Lunocapitate arthrodesis is a motion-preserving salvage procedure for painful wrist oste... more Purpose: Lunocapitate arthrodesis is a motion-preserving salvage procedure for painful wrist osteoarthritis. Because the arthrodesis is limited to the capitate and the lunate, the adaptive motion of the triquetrum is theoretically maintained. We aimed to examine whether triquetral motion is sustained in vivo after lunocapitate arthrodesis. Methods: We examined 7 patients after lunocapitate arthrodesis at least 1 year earlier, with computed tomography at 2 wrist positions: maximal radial extension and maximal ulnar flexion. Triquetral motion in vivo was analyzed using volume registration technique of the paired computed tomography scans and compared with the contralateral side. Results: The triquetrum moved in all patients, but the degree of motion was small compared with the nonsurgical wrist. A minor degree of motion of the hamate relative to the fused lunocapitate could also be demonstrated. Conclusions: Triquetral motion is limited after lunocapitate arthrodesis. Type of study/level of evidence: Therapeutic IV.

Research paper thumbnail of Closed Reduction and External Fixation or Open Reduction and Volar Internal Fixation: The Clinical Dilemma

Distal Radius Fractures, 2014

This chapter presents a discussion of the choice between external fixation (EF) and open reductio... more This chapter presents a discussion of the choice between external fixation (EF) and open reduction and internal, mainly volar, fixation (ORIF) in the everyday clinical situation. Both methods have a place in the treatment of distal radius fractures. Many times the choice between external fixation and open reduction and internal fixation for unstable fractures of the distal radius is not obvious. Looking for guidance in the literature does not make the decision easier. Few comparison studies have been done and there is no consensus on which technique is superior. The available evidence suggests that volar plating is advantageous compared with bridging external fixation in the short term, but after 1 year, the outcome is similar. In spite of this, there has been a shift from closed reduction and external fixation to open reduction and volar plating.

Research paper thumbnail of Finger fractures: Epidemiology and treatment based on 21341 fractures from the Swedish Fracture register

PLOS ONE

Background There is a lack of detailed epidemiological studies of finger fractures, the most comm... more Background There is a lack of detailed epidemiological studies of finger fractures, the most common fracture of the upper extremity. Methods Based on data of 21 341 finger fractures in the Swedish Fracture register, a national quality registry that collects data on all fractures, this study describes anatomical distribution, cause, treatment, age distribution, and result in terms of patient related outcome measures (PROMs). Results The most common finger fracture was of the base of the 5th finger, followed by the distal phalanx in the 4th finger. Open fractures were most common in the distal phalanges, especially in the 3rd finger. Intraarticular fractures were most frequent in the middle phalanges. Fall accidents was the most common cause of a fracture. The mean age at injury was 40 years (38 for men, 43 for women). 86% of finger fractures in adults were treated non-operatively. Men were more frequently operated than women. Finger fractures did not affect hand function or quality o...

Research paper thumbnail of Residual flexion deformity after scaphoid nonunion surgery: 7-year follow-up study

Journal of Hand Surgery (European Volume), Sep 27, 2022

Research paper thumbnail of Fractures of the distal radius: Epidemiology, treatment and outcome assessment

This thesis aims to increase scientific knowledge of the most common fracture, namely the distal ... more This thesis aims to increase scientific knowledge of the most common fracture, namely the distal radius. Our understanding of this fracture is still limited, but every year in Sweden over 20,000 patients suffer from this injury. The fracture may cause persistent pain and disability for the patients, not to mention substantial costs to society. Improvement in treatment will benefit a large group of patients. Specifically, the incidence and trends in surgical treatment were investigated, outcome measurements were evaluated and the most common surgical treatment techniques were compared. In Paper I, patient-rated outcome after a fracture of the distal radius was investigated in relation to radiological results, grip strength and range of movement (ROM). A retrospective assessment was conducted in 78 patients with a healed fracture of the distal radius. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to measure self-reported disability. Radiological malunion, ...

Research paper thumbnail of Evaluation of a Swedish version of the patient-rated wrist evaluation outcome questionnaire: Good responsiveness, validity, and reliability, in 99 patients recovering from a fracture of the distal radius

Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 2009

The patient-rated wrist evaluation (PRWE) form is an established outcome questionnaire designed t... more The patient-rated wrist evaluation (PRWE) form is an established outcome questionnaire designed to measure wrist pain and disabilities in activities of daily living. We translated and validated this score for use in Sweden. The original PRWE score was translated forwards and backwards, and then the responsiveness, validity, and reliability of the Swedish version were tested in 99 patients who were recovering from a fracture of the distal radius. The patients completed the PRWE questionnaire 7 weeks and 4 to 6 months after the injury. Responsiveness was assessed by Standard Response Mean and Effect Size. Content validity was evaluated by examining the proportion of best and worse possible scores. Construct validity was assessed by comparing scores twice after the injury and by comparing patients with fractures of different severity. Criterion validity was evaluated by correlating the PRWE with another upper extremity score: the disability of the arm, shoulder, and hand (DASH) score. Reliability was evaluated with a test-retest and by internal consistency. Responsiveness was excellent (SRM 01.4Á1.7, ES 01.3). Five patients reported the best possible result after 4 to 6 months but none at 7 weeks, and no patient reported the worst score at any time. The PRWE score corresponded well with improvement and showed good correlation with severity of fracture. The PRWE showed a strong correlation with DASH score (Spearman's rank coefficient 00.86). Intraobserver reliability of the test-retest and internal consistency was good (Kendall W coefficient 00.79, Spearman's rank coefficient 00.99, Cronbach's a00.94Á0.97). We found this Swedish version of the PRWE to be responsive, valid, and reliable for evaluating the patient-rated outcome after a fracture of the distal radius.

Research paper thumbnail of Patient-perceived Outcome after Displaced Distal Radius Fractures

Journal of Hand Therapy, 2007

Outcome after distal radius fractures has traditionally been measured by radiological parameters ... more Outcome after distal radius fractures has traditionally been measured by radiological parameters and objective physical variables. To what extent these measurements reflect outcome as perceived by the patient has been questioned. We evaluated the association between radiological position, objective physical result (grip strength and range of movement), and the patient-perceived outcome, measured with the Disabilities of the Arm, Shoulder, and Hand outcome (DASH) score, in 78 patients with a healed unilateral distal radius fracture treated with either closed reduction and plaster splint or external fixation. Fifty-seven females and 21 males (median age 59 yr; range, 22e95) were retrospectively assessed after a mean of 22 months and the mean DASH score was 13 points. Linear correlations between final radiological and objective physical measurements and DASH score were weak or insignificant. However, radial shortening $2 mm, dorsal angulation .15 8 , and radial angulation .10 8 were each significantly associated with a poorer DASH score. Reduced grip strength, extension, and ulnar deviation correlated with a poorer DASH score. In conclusion, we found that better final radiological and objective physical results were associated with a better patient-perceived outcome, as measured by the DASH score, in this patient group.

Research paper thumbnail of Epidemiology and changed surgical treatment methods for fractures of the distal radius

Research paper thumbnail of Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year

Research paper thumbnail of Effects of intra-articular Platelet-Rich Plasma (PRP) injections on osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal joint

PLOS ONE

Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and im... more Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and improve function in knee osteoarthritis. There are few reports on the effect of PRP in the treatment of osteoarthritis in the hand. Our aim was to evaluate the effect of PRP-injections on pain and functional outcome in the short-term for osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal (STT) joint. A retrospective analysis was performed of 29 patients treated with intra-articular PRP injection for painful osteoarthritis in the thumb basal joint (21 patients) or STT joint (eight patients). The patients received two consecutive, radiologically guided PRP injections at an interval of 3–4 weeks. Pain at rest and on load (numerical rating scale (NRS) 0–10), Patient-rated Wrist and Hand Evaluation (PRWHE) score (0–100), grip strength (Jamar) and key pinch were recorded pre-injection and 3 months after the second injection. Mean age was 63 (range 34–86) years and 17 patient...

Research paper thumbnail of The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis

Journal of Hand Surgery (European Volume)

This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catas... more This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the outcome. Level of evidence: II

Research paper thumbnail of Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial

BMC Musculoskeletal Disorders

Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has in... more Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively. Methods Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (P...

Research paper thumbnail of The effects of partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function

Journal of Hand Surgery (European Volume), Mar 28, 2022

This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on p... more This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on patient-reported outcomes, quality of life and objective function in symptomatic wrist osteoarthritis during the first year after surgery. Sixty consecutive patients underwent an anterior and posterior interosseous neurectomy during 2018–2020. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, EuroQol-5D-3L, pain at rest and on load, and objective function were assessed preoperatively and 3, 6 and 12 months postoperatively. Generalized estimating equations were used to analyse the effect on the outcome variables. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation and pain scores improved significantly postoperatively with no decline over time, but no patient reported outcome measure reached the minimal clinically important difference. Quality of life, strength and range of motion did not improve. We found no complications. Seventeen patients needed further surgery during the study period. More studies are needed to evaluate whether denervation is truly effective or not. Level of evidence: II

Research paper thumbnail of Trapeziectomy with or without a tendon-based adjunct: a registry-based study of 650 thumbs

Journal of Hand Surgery (European Volume), 2022

This study aimed to assess the outcomes after simple trapeziectomy and trapeziectomy with ligamen... more This study aimed to assess the outcomes after simple trapeziectomy and trapeziectomy with ligament reconstruction and/or tendon interposition based on data in the Swedish national healthcare quality registry for hand surgery (HAKIR). Six-hundred and fifty thumbs were included, and 265 were assessed up to 12 months after operation. There was significant and clinically relevant improvement in patient-reported measures (pain on load, pain on motion without load, pain at rest, stiffness, weakness, and ability to perform activities of daily living and the Quick Disabilities of the Arm, Shoulder and Hand score) and objective measures (strength and thumb mobility) at 3 and 12 months for all procedures. The use of the abductor pollicis longus tendon had better improvement in some respects compared with the use of flexor carpi radialis or extensor carpi radialis tendons. However, overall, the use of a tendon adjuncts yielded no better outcomes than simple trapeziectomy. Level of evidence: III

Research paper thumbnail of Supplemental material for The epidemiology of scaphoid fractures in Sweden: a nationwide registry study

Supplemental Material for The epidemiology of scaphoid fractures in Sweden: a nationwide registry... more Supplemental Material for The epidemiology of scaphoid fractures in Sweden: a nationwide registry study by Elin M. Swärd, Thorsten U. Schriever, Mikael A. Franko, Anders C. Björkman and Maria K. Wilcke in Journal of Hand Surgery (European Volume)

Research paper thumbnail of Additional file 1 of A registry based analysis of the patient reported outcome after surgery for trapeziometacarpal joint osteoarthritis

Additional file 1. HQ-8 questionnaire.

Research paper thumbnail of Triquetral motion is limited in vivo after lunocapitate fusion

Objectives/Interrogation: Lunocapitate fusion (LCF) and four-corner fusion (4CF) are motion-prese... more Objectives/Interrogation: Lunocapitate fusion (LCF) and four-corner fusion (4CF) are motion-preserving salvage procedures for painful wrist arthritis due to for e.g. scaphoid nonunion advanced collapse (SNAC) and scaphoid lunate advanced collapse (SLAC). In LCF, the fusion is limited to the capitate[for full text, please go to the a.m. URL]

Research paper thumbnail of A nationwide registry study on the epidemiology of scaphoid fractures in Sweden

Objectives/Interrogation: The epidemiology of scaphoid fractures is described only in limited pop... more Objectives/Interrogation: The epidemiology of scaphoid fractures is described only in limited populations and incidence reports are inconsistent. We investigated the nationwide incidence of scaphoid fractures in Sweden 2006-2015. Methods: Registry data on 34377 patients with a reported scaphoid[for full text, please go to the a.m. URL]

Research paper thumbnail of There is motion between the scaphoid and the lunate during the dart-throwing motion

Journal of Plastic Surgery and Hand Surgery, 2021

Scaphoid and lunate mobility has been suggested to be minimal during the dart-throwing motion in ... more Scaphoid and lunate mobility has been suggested to be minimal during the dart-throwing motion in studies based on serial computed tomography (CT) scans and cadaver studies. This study analyzes the direct motion between the scaphoid and the lunate during the dart-throwing motion in vivo. We examined nine individuals with standard CT scans of the wrist in radial extension and ulnar flexion. The paired CT scans were analyzed with a volume registration technique. The lunate was registered as fixed and the scaphoid as the mobile element. The motion of the scaphoid relative the lunate between the positions of radial extension and ulnar flexion was measured. There was considerable motion between the scaphoid and the lunate with both a distal to proximal translation and rotation during the dart-throwing motion, regardless of whether the scapholunate ligament was intact or not. These results suggest that aggressive dart-throwing exercises should not be implemented early on during rehabilitation following scapholunate repair.

Research paper thumbnail of Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?

Journal of Plastic Surgery and Hand Surgery, 2021

Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pa... more Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pain after trapeziectomy for trapeziometacarpal joint osteoarthritis. The aim of this study was to investigate if proximal migration after trapeziectomy is associated with a poorer long-term outcome in terms of pain and objective physical variables. We retrospectively examined 91 thumbs in 65 patients after a mean of 10 years following trapeziectomy with or without ligament reconstruction and tendon interposition. Proximal migration of the thumb metacarpal was measured on plain lateral radiographs of the thumb and correlated to visual analogue pain scale (VAS), thumb range of motion and strength. Most thumbs had a severe proximal migration of the first metacarpal, the mean scaphoid metacarpal distance was 2.7 mm. Most patients reported no or little pain, median VAS was 0 at rest and 1 after load. There were no differences in reported VAS pain at rest or after load between patients with severe (<2 mm scaphoid metacarpal joint space) or less severe (!2 mm metacarpal joint space) proximal migration. Patients that reported more pain (VAS >2) did not exhibit more migration than patients reporting less or no pain. Thumbs with severe migration had weaker key pinch (3.4 vs. 4.6 kg, p ¼ 0.008) and grip strength (15 vs. 21 kg p ¼ 0.002). We conclude that proximal migration most likely does not cause residual or recurrent pain after trapeziectomy.

Research paper thumbnail of Triquetral Motion Is Limited In Vivo After Lunocapitate Arthrodesis

Journal of Hand Surgery Global Online, 2019

Purpose: Lunocapitate arthrodesis is a motion-preserving salvage procedure for painful wrist oste... more Purpose: Lunocapitate arthrodesis is a motion-preserving salvage procedure for painful wrist osteoarthritis. Because the arthrodesis is limited to the capitate and the lunate, the adaptive motion of the triquetrum is theoretically maintained. We aimed to examine whether triquetral motion is sustained in vivo after lunocapitate arthrodesis. Methods: We examined 7 patients after lunocapitate arthrodesis at least 1 year earlier, with computed tomography at 2 wrist positions: maximal radial extension and maximal ulnar flexion. Triquetral motion in vivo was analyzed using volume registration technique of the paired computed tomography scans and compared with the contralateral side. Results: The triquetrum moved in all patients, but the degree of motion was small compared with the nonsurgical wrist. A minor degree of motion of the hamate relative to the fused lunocapitate could also be demonstrated. Conclusions: Triquetral motion is limited after lunocapitate arthrodesis. Type of study/level of evidence: Therapeutic IV.