Tuomas T. Huttunen

Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland.

BACKGROUND Studies from the United States report a large increase in the surgical treatment of distal radius fractures with open reduction and internal fixation using locked plates. The aim of the present study was to determine whether the same trend has occurred in a Scandinavian country by assessing the number, incidence, and surgical methods of all surgically treated distal radius fractures in Finland over a recent 11-year period. METHODS The study covered the whole adult population (aged >19 years) in Finland during the 11-year period from January 1, 1998, to December 31, 2008. Data on surgically treated distal radius fractures were obtained from the nationwide National Hospital Discharge Registry. RESULTS During the 11-year study period, a total of 14,514 surgical operations (external fixation, percutaneous pinning, or plating) for adult distal radius fractures were performed in Finland. There was a dramatic shift toward internal fixation with plating; the incidence and number of platings more than doubled between 2006 and 2008. The incidence and number of external fixations decreased correspondingly. Percutaneous pinning was used in 13% of the surgical procedures during the study period. CONCLUSIONS A striking shift from external fixation to plating in the treatment of distal radius fractures has occurred in Finland over the past few years, despite the fact that the scientific literature does not support plating over external fixation. In addition, the incidence and number of surgeries for distal radius fractures doubled between 1998 and 2008. The reasons for these changes are not known.

Acute Achilles Tendon Ruptures Incidence of Injury and Surgery in Sweden Between 2001 and 2012

Background: Population-based incidence rates and trends of acute Achilles tendon ruptures are not known. It is also not known whether recent high-quality randomized controlled trials not favoring surgery have had an effect on treatment protocols. Purpose: To assess the incidence of acute Achilles tendon ruptures in Sweden and to examine the trends in surgical treatment. Study Design: Descriptive epidemiology study. Methods: We conducted a nationwide registry-based study including all adult (≥18 years of age) inpatient and outpatient hospital visits because of an acute Achilles tendon rupture in Sweden between 2001 and 2012. Results: We identified a total of 27,702 patients (21,979 men, 79%) with acute Achilles tendon ruptures between 2001 and 2012. In 2001, the sex-specific incidence of acute Achilles tendon ruptures was 47.0 (per 100,000 person-years) in men and 12.0 in women. In 2012, the corresponding values were 55.2 in men and 14.7 in women, with an increase of 17% in men and 22% in women. The proportion of surgically treated patients declined from 43% in 2001 to 28% in 2012 in men and from 34% in 2001 to 22% in 2012 in women. Conclusion: The incidence of acute Achilles tendon ruptures in Sweden is increasing. The most probable reason for this increase is the rise in the number of older adults participating in high-demand sports. The proportion of surgically treated patients is decreasing most likely because of recent high-quality randomized controlled trials and their meta-analyses supporting similar results between surgical and nonsurgical approaches.

Trends in the surgical treatment of proximal humeral fractures – a nationwide 23-year study in Finland

BackgroundProximal humeral fractures are common osteoporotic fractures. Most proximal humeral fractures are treated non-surgically, although surgical treatment has gained popularity. The purpose of this study was to determine changes in the surgical treatment of proximal humeral fractures in Finland between 1987 and 2009.MethodsThe study covered the entire adult (>19 y) population in Finland over the 23-year period from 1st of January 1987 to 31st of December 2009. We assessed the number and incidence of surgically treated proximal humeral fractures in each year of observation and recorded the type of surgery used. The cohort study was based on data from Finnish National Hospital Discharge Register.ResultsDuring the 23-year study period, a total of 10,560 surgical operations for proximal humeral fractures were performed in Finland. The overall incidence of these operations nearly quadrupled between 1987 and 2009. After the year 2002, the number of patients treated with plating increased.ConclusionAn increase in the incidence of the surgical treatment of proximal humeral fractures was seen in Finland in 1987–2009. Fracture plating became increasingly popular since 2002. As optimal indications for each surgical treatment modality in the treatment of proximal humeral fractures are not known, critical evaluation of each individual treatment method is needed.

Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study

Objectives Acute Achilles tendon ruptures are common among highly active people. Recently published studies have provided increasing evidence to support non-surgical treatment. This study aimed to assess the incidence trends of surgically treated, acute Achilles tendon ruptures. Our hypothesis, based on the recent literature showing no difference in functional results between surgical and non-surgical treatment, was that the incidence of surgery would be declining. Methods We conducted a nationwide hospital register-based study. All patients 18 years of age or older with a diagnosis of acute Achilles tendon injury, and treated with Achilles tendon repair from 1987 to 2011 in Finland were included in the study. Results During the 25-year study period in Finland, a total of 15 252 patients received surgical treatment for an acute Achilles tendon rupture. The incidence of surgical treatment of acute Achilles tendon rupture in men was 11.1/100 000 person-years in 1987 and 20.5/100 000 person-years in 2011. The corresponding figures in women were 2.5/100 000 person-years in 1987 and 4.2/100 000 person-years in 2011. The highest rates occurred in 2008 in men and 2007 in women, and since then the decrease has been 42% in men and 55% in women. Conclusions During the past few years, the rate of surgically treated acute Achilles tendon ruptures has declined remarkably. The findings of the present study indicate that orthopaedic surgeons have chosen more often non-surgical treatment option for acute Achilles ruptures. This can be considered as an example, how high-quality scientific evidence can lead to a rapid change in clinical practice.

Surgical treatment of humeral-shaft fractures: A register-based study in Finland between 1987 and 2009

INTRODUCTION Humeral-shaft fractures are not uncommon osteoporotic fractures. While most of the humeral-shaft fractures can be treated conservatively, some need surgical treatment. The purpose of this study was to assess the trends of the surgical treatment of humeral-shaft fractures. The study determined whether surgical treatment of humeral-shaft fractures has changed in Finland between 1987 and 2009. We assessed the number and incidence of surgically treated humeral-shaft fractures in each year and recorded the type of surgery used. PATIENTS AND METHODS The study covered the entire adult (>18 years) population in Finland over the 23-year period from 1 January 1987 to 31 December 2009. Data on surgically treated humeral-shaft fractures were obtained from the nationwide National Hospital Discharge Registry. RESULTS During the 23-year study period, a total of 4469 surgical operations of the humeral shaft were performed in Finland. The male patients were markedly younger (49 years) than their female counterparts (63 years). The incidence of surgical treatment nearly doubled in men and over tripled in women. Between 1987 and 2009, there occurred a clear shift towards plating in the surgical treatment of humeral-shaft fractures. CONCLUSIONS A marked increase in the surgical treatment of humeral-shaft fractures was seen in Finland in 1987-2009. Fracture plating increased during the first decade of the millennium. Since high-quality evidence for treatment of humeral-shaft fractures is absent, critical evaluation of the chosen treatment options is needed.

Pertrochanteric fracture of the femur in the Finnish National Hospital Discharge Register: validity of procedural coding, external cause for injury and diagnosis

BackgroundHospital discharge data is routinely collected in Finland and it is an invaluable source of information when assessing injury epidemiology as well as treatment. The database can be used when planning injury prevention and redirecting resources of the health care system. Most recently our hospital discharge register has been used to assess the incidence of surgical treatment of common fractures. This study was aimed to evaluate the coverage and accuracy of the Finnish National Hospital Discharge Register (NHDR) focusing on hip fractures. In other words, patients hospitalized for a pertrochanteric hip fracture were used to assess the validity of the NHDR.MethodsThe validity of the NHDR was assessed by comparing the data in hospital discharge register with the original patient records and radiographs in three separate hospitals; Tampere University Hospital, Hatanpää City Hospital of Tampere, and the Central Hospital of Kanta-Häme. The study analysis included 741 patients hospitalized due to pertrochanteric hip fracture between 1st January 2008 and 31st December 2010.ResultsThe diagnosis was correctly placed on 96% (95% CI: 94 to 97%) of the 741 patients when radiographs were used as golden standard. The procedural coding had coverage of 98% (95% CI: 96 to 98%) and an accuracy of 88% (95% CI: 85 to 90%). The coverage of the external cause for injury was found to be 95% (95% CI: 94 to 97%) with an accuracy of 90% (95% CI: 87 to 92%).ConclusionsOur results show that the validity of the Finnish NHDR is excellent as determined by accuracy of diagnosis and both accuracy and coverage of procedural coding and external cause for injury. The database can be used to assess injury epidemiology and changes in surgical treatment protocols.

Trends in the Incidence of Clavicle Fractures and Surgical Repair in Sweden: 2001-2012

BACKGROUND Clavicle fractures are common injuries causing substantial morbidity. Recent literature suggests that the incidence of surgically treated clavicle fractures has increased. However, it is unknown whether the increase is caused by more surgeons choosing operative over nonoperative treatment for the injury or an increase in the actual incidence of clavicle fractures. The aim of this study was to assess both the national incidence of clavicle fractures and the rate of surgical treatment of those fractures in Sweden. METHODS We assessed the incidence and trends of clavicle fractures and rates of surgery in Sweden. The validated Swedish Hospital Discharge Register offers a unique opportunity to assess both outpatient and inpatient visits and was used to conduct a national register-based study including all adults (≥18 years of age) with a diagnosis of clavicle fracture in Sweden between 2001 and 2012. RESULTS A total of 44,609 clavicle fractures occurred in Sweden between 2001 and 2012. The incidence of clavicle fractures increased from 35.6 per 100,000 person-years in 2001 to 59.3 per 100,000 person-years in 2012. Interestingly, the highest incidence rates were observed in the oldest age groups. The increase in the rate of surgically treated clavicle fractures (705%) was greater than the increase in the actual fracture incidence (67%). Most (77%) of the surgically treated patients were men. Open reduction and plate fixation was the most common surgical procedure. Overall, the proportion of surgically treated clavicle fractures increased markedly. CONCLUSIONS Although the incidence of clavicle fractures increased in Sweden between 2001 and 2012, the rate of surgical treatment of clavicle fractures increased much more than could be expected solely based on the increase in the fracture incidence. The observed changes in the rates of surgery require additional studies since there is still controversy regarding the indications for surgical treatment.

Surgical treatment of clavicular fractures in Finland – A register based study between 1987 and 2010

BACKGROUND Clavicle fractures are among the most common upper extremity injuries. Traditionally most clavicle fractures have been treated non-surgically, but during recent decades the surgical treatment of clavicle fractures has increased. The purpose of this study was to assess the numbers and trends of surgically treated clavicle fractures in Finland between 1987 and 2010. METHODS The study covered the entire adult (>18 years) population of Finland over the study period. Data on surgically treated clavicle fractures was collected from the Finnish National Hospital Discharge Register. We assessed the number and incidence of surgically treated clavicle fractures annually. RESULTS A total of 7073 surgically treated clavicle fractures were identified in the register over the study period. Three-fourths of the surgically treated patients were men and one-fourth was women. The incidence of surgical treatment increased nearly ninefold from 1.3 per 100,000 person years in 1987 to 10.8 per 100,000 person years in 2010. The increase in the rate of surgical treatment was especially notable in men. CONCLUSIONS A striking increase in incidence of surgically treated clavicle fractures was seen from 1987 to 2010. Although the actual incidence of clavicle fractures is not known, we assume that the proportion of patients receiving surgical treatment has increased markedly without high-quality evidence. Since recent reports have suggested similar functional results between operative and conservative treatment critical evaluation of the treatment policy of clavicle fractures is warranted.

The incidence and trauma mechanisms of acetabular fractures: A nationwide study in Finland between 1997 and 2014

PURPOSE Information on the incidence of acetabular fractures of the pelvis is limited. Epidemiological data is often based on specific trauma registers, individual trauma centres or on trends of all pelvic fractures grouped together. The primary aim of this study was to determine the incidence and trends of hospital-treated acetabular fractures in the Finnish population from 1997 to 2014. The secondary aim was to assess the trauma mechanisms involved. METHODS The Finnish National Hospital Discharge Register collects inpatient data from all public and private medical institutions in Finland and covers the entire Finnish population of 5.5 million. For this study, we selected all persons 18 years of age or older who were admitted to hospital for the treatment of an acetabular fracture between 1997 and 2014. The main outcome variable was the annual number of patients hospitalised with a main or secondary diagnosis of acetabular fracture of the pelvis. RESULTS The overall crude incidence of acetabular fractures increased slightly (from 6.4/100 000 persons/year to 8.1/100 000 persons/year) from 1997 to 2014 while the age-standardised incidence rate remained at a similar level (7.1/100 000/persons/year in 1997 and 7.2/100 000/persons/year in 2014). An incidence increase was observed in the elderly population, whereas the incidence of acetabular fractures in the younger population (mostly high energy traumas) remained stable. The most frequent trauma mechanism for acetabular fractures was fall on the same level (47%). CONCLUSIONS The incidence of acetabular fractures increased slightly in Finland between 1997 and 2014. This increase was observed especially in the elderly population and the ageing of the population largely explains the rise. The incidence of acetabular fractures in the younger population decreased. The most common trauma mechanism was falling on the same level.

Rising incidence of scaphoid fracture surgery in Finland

The aim of the present study was to investigate the incidence of scaphoid fracture surgery by obtaining data from the national discharge register in Finland, a country of 5 million inhabitants, for the period from 1997 to 2014. A total of 1380 patients with scaphoid fracture were treated surgically. Half of the patients were aged under 28 years and 84% were men. The surgical treatment of scaphoid fractures was classified into two groups. There were 640 (46%) primary fracture fixations and 740 (54%) treatments of fracture nonunion. The overall incidence of all scaphoid fixations increased twofold (from 14.8 to 30.1 per 1,000,000 person-years) and threefold in the primary fixation group (from 5.5 to 17.8 per 1,000,000 person-years) during the study period. Level of evidence: III