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Christersson, Albert
Publications (8 of 8) Show all publications
Christersson, A., Larsson, S. & Sandén, B. (2018). Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study. Scandinavian Journal of Surgery, 107(1), 82-90
Open this publication in new window or tab >>Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study
2018 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 107, no 1, p. 82-90Article in journal (Refereed) Published
Abstract [en]

Introduction: this study aimed to evaluate clinical results after plaster cast fixation for 10 days versus 1 month of moderately displaced and reduced distal radius fractures.Material and Methods: in a prospective randomized study, 109 patients with moderately displaced and conservatively treated distal radius fractures (age ≥50 years) were randomized 10 days after reduction to either removal of the plaster cast and immediate mobilization (active group) or to continued plaster cast fixation for another 3 weeks (control group). Grip strength, pincer strength, range of motion, and pain were assessed at 1, 4, and 12 months after reduction. Clinical outcome was evaluated using three functional assessment scores at 12 months.Results: treatment failed in 3/54 (6%) patients in the active group. one of these patients had the plaster cast reinstituted because of feelings of instability. the fractures in the other two patients displaced severely after mobilization and were therefore treated surgically. for the remaining 51 patients in the active group, the range of wrist motion was slightly better at 1 month compared with the controls, but there were no differences in grip or pincer strength or pain at the 1-month follow-up. there were no differences between the active and control group in any outcome at 4 or 12 months, including functional assessment scores at 12 months.Conclusion: treatment with mobilization 10 days after reduction of moderately displaced distal radius fractures resulted in a few treatment failures compared with none among controls. the only functional benefit for the remaining patients was a small and transient increase in range of motion at the 1-month follow-up. plaster cast removal 10 days after reduction in moderately displaced distal radius fractures is therefore not recommended.

National Category
Orthopaedics Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-334618 (URN)10.1177/1457496917731184 (DOI)000429935400013 ()
Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2018-07-18Bibliographically approved
Christersson, A., Larsson, S. & Sörensen, J. (2018). Presurgical localization of infected avascular bone segments in chronic complicated posttraumatic osteomyelitis in the lower extremity using dual-tracer PET/CT.. EJNMMI Research, 8, Article ID 65.
Open this publication in new window or tab >>Presurgical localization of infected avascular bone segments in chronic complicated posttraumatic osteomyelitis in the lower extremity using dual-tracer PET/CT.
2018 (English)In: EJNMMI Research, ISSN 2191-219X, E-ISSN 2191-219X, Vol. 8, article id 65Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Localizing and removing the infected sequestrum in long-standing trauma-related chronic osteomyelitis remains a clinical challenge. PET/CT with 18F-fluorodeoxyglucose (FDG-PET) has a high sensitivity for chronic osteomyelitis and 18F-sodium-fluoride PET/CT (NaF-PET) has a high specificity for identifying non-viable bone. Combining both, high signal on FDG-PET in the bone without signal on NaF-PET could potentially guide surgery to become more precise with curative intent. Eight patients with long-standing (average 22 years) posttraumatic (n = 7) or postoperative (n = 1) chronic osteomyelitis in the lower extremity and with multiple futile attempts for curative surgery were recruited in this prospective pilot study. FDG-PET and NaF-PET were performed within a week in between using standard scanning protocols. The most likely location of the culprit sequestrum was identified and was surgically removed. Based on perioperative tissue cultures, antibiotics were given for 6-8 months. Dual-tracer (FDG- and NaF-PET/CT) was performed again after 12 months to rule out persisting signs of infection.

RESULTS: A likely culprit sequestrum could preoperatively be identified by dual-tracer PET in all eight cases and in four cases an additional sequestrum was identified at a location with no clinical sign of infection. The infected necrotic tissue was removed during surgery. Follow-up dual-tracer PET revealed no signs of persistent infection. All patients recovered with no clinical signs of recurrence for a follow-up of mean 4.5 (SD 1.3) years.

CONCLUSIONS: Dual-tracer PET/CT with FDG and NaF allows successful precise surgery with curative intent in patients with long-standing complicated posttraumatic chronic osteomyelitis with severely deranged anatomy.

Keywords
Chronic osteomyelitis, FDG-PET/CT, NaF-PET/CT, Preoperative planning, Surgical treatment
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-357426 (URN)10.1186/s13550-018-0426-0 (DOI)000439318100002 ()30032355 (PubMedID)
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-10-03Bibliographically approved
Christersson, A. (2017). Fractures of the distal radius: Factors related to radiographic evaluation, conservative treatment and fracture healing. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Fractures of the distal radius: Factors related to radiographic evaluation, conservative treatment and fracture healing
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Distal radius fractures (DRFs) are one of the most common injuries encountered in orthopaedic practise. Such fractures are most often treated conservatively, but surgical treatment has become increasingly common. This trend is not entirely scientifically based

The aims of this thesis were threefold: to increase measurement precision in dorsal angulation (DA) on radiographs and computer tomographies (CTs); to assess the results after shortened plaster cast fixation time in reduced DRFs; and to evaluate the feasibility and safety of applying Augment® (rhPDGF-BB/β-TCP) in DRFs.

In Paper I and Appendix 1 and 2, a semi-automatic CT-based three-dimensional method was developed to measure change in DA over time in DRFs. This approach proved to be a better (more sensitive) method than radiography in determining changes in DA in fractures of the distal radius.

In Paper II, a CT model was used to simulate lateral radiographic views of different radial directions in relation to the X-ray. Using an alternative reference point on the distal radius, precision and accuracy in measuring DA was increased.

Paper III and IV are based on a prospective and randomised clinical study (the GitRa trial) that compares clinical and radiographic outcomes after plaster cast removal at 10 days versus 1 month in 109 reduced DRFs. Three patients in the early mobilised group were excluded because of fracture dislocation (n=2) or a feeling of fracture instability (n=1). For the remaining patients in the early mobilised group (51/54) a limited but temporary gain in range of motion, but a slight increase in radiographic displacement were observed. Our results suggest that plaster cast removal at 10 days after reduction of DRFs is not feasible.

Paper V is based on a prospective, randomised clinical study (the GEM trial) in which 40 externally fixated DRFs were randomised to rhPDGF-BB/β-TCP into the fracture gap or to the control group. Augment® proved to be convenient and safe during follow-up (24 weeks). However, because of the nature of the study design, the effect on fracture healing could not be determined. A decrease in pin infections was seen in the Augment® group, a finding we could not explain.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. p. 124
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1290
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-312931 (URN)978-91-554-9796-5 (ISBN)
Public defence
2017-03-03, Rosénsalen, Ing 95/96, Akademiska Sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-02-09 Created: 2017-01-15 Last updated: 2018-01-13
Christersson, A., Nysjö, J., Berglund, L., Malmberg, F., Sintorn, I.-M., Nyström, I. & Larsson, S. (2016). Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures. Skeletal Radiology, 45(6), 763-769
Open this publication in new window or tab >>Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures
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2016 (English)In: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 45, no 6, p. 763-769Article in journal (Refereed) Published
Abstract [en]

Objective The aim of the present study was to compare the reliability and agreement between a computer tomography-based method (CT) and digitalised 2D radiographs (XR) when measuring change in dorsal angulation over time in distal radius fractures. Materials and methods Radiographs from 33 distal radius fractures treated with external fixation were retrospectively analysed. All fractures had been examined using both XR and CT at six times over 6 months postoperatively. The changes in dorsal angulation between the first reference images and the following examinations in every patient were calculated from 133 follow-up measurements by two assessors and repeated at two different time points. The measurements were analysed using Bland-Altman plots, comparing intra- and inter-observer agreement within and between XR and CT. Results The mean differences in intra- and inter-observer measurements for XR, CT, and between XR and CT were close to zero, implying equal validity. The average intra- and inter-observer limits of agreement for XR, CT, and between XR and CT were +/- 4.4 degrees, +/- 1.9 degrees and +/- 6.8 degrees respectively. Conclusions For scientific purpose, the reliability of XR seems unacceptably low when measuring changes in dorsal angulation in distal radius fractures, whereas the reliability for the semi-automatic CT-based method was higher and is therefore preferable when a more precise method is requested.

National Category
Orthopaedics Medical Image Processing
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-297776 (URN)10.1007/s00256-016-2350-6 (DOI)000374476200003 ()26922189 (PubMedID)
Available from: 2016-02-27 Created: 2016-06-28 Last updated: 2018-05-14Bibliographically approved
Christersson, A., Larsson, S., Östlund, B. & Sandén, B. (2016). Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study. Journal of Orthopaedic Surgery and Research, 11, Article ID 145.
Open this publication in new window or tab >>Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study
2016 (English)In: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 11, article id 145Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results.

METHODS: In a prospective randomised study, 109 patients (mean age 65.8 (range 50-92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8-13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group).

RESULTS: For three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02).

CONCLUSIONS: Early mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures.

TRIAL REGISTRATION: ClinicalTrail.gov, NCT02798614 . Retrospectively registered 16 June 2016.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-312927 (URN)10.1186/s13018-016-0478-7 (DOI)000391332600001 ()27871284 (PubMedID)
Available from: 2017-01-15 Created: 2017-01-15 Last updated: 2018-01-13Bibliographically approved
Christersson, A., Sandén, B. & Larsson, S. (2015). Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures. Journal of Orthopaedic Surgery and Research, 10, Article ID 37.
Open this publication in new window or tab >>Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures
2015 (English)In: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 10, article id 37Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with an osteoconductive scaffold (β-TCP) has been demonstrated to increase bone formation, but rhPDGF-BB has not been studied in human fractures. The purpose of this study was to evaluate the safety and potential use of locally administered rhPDGF-BB/β-TCP (Augment®) in acute wrist fractures.

METHODS: Forty patients with unstable distal radial fracture were randomized to closed reduction and external fixation alone (n = 20) or combined with injection of rhPDGF-BB/β-TCP (Augment®) into the fracture (n = 20). All patients were followed for 24 weeks. Outcome was based on adverse events, fracture displacement on radiographs, fracture healing, range of motion, grip strength, pain, and the disability of the arm, shoulder and hand (DASH) score.

RESULTS: There were no serious adverse events in the study, but the pin tract infection rate was significantly lower in the Augment® group. There was no difference between the groups in fracture healing time, based on number of healed cortices or fracture displacement. The Augment® group had an early temporary significant decrease in wrist flexion, but no difference in range of motion at 24 weeks. There were no differences between the two treatment groups for any other outcome variables.

CONCLUSION: rhPDGF-BB/β-TCP (Augment®) is safe and convenient for local administration into wrist fractures. In this pilot study, we could not detect any reduced healing time in the Augment® group although potential efficacy should be addressed in larger studies.

CLINICAL TRIAL REGISTRATION NUMBER: The clinical trial registration number for the study protocol is BMPI-2014-02-E.

Keywords
Distal radius fracture; External fixation; PDGF; Calcium phosphate; Radiographic evaluation; Clinical evaluation; Prospective; Randomized
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-266609 (URN)10.1186/s13018-015-0174-z (DOI)000369737900001 ()25888774 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2018-01-10Bibliographically approved
Nysjö, J., Christersson, A., Sintorn, I.-M., Nyström, I., Larsson, S. & Malmberg, F. (2013). Precise 3D Angle Measurements in CT Wrist Images. In: Image Analysis and Processing – ICIAP 2013: Part II. Paper presented at 17th International Conference on Image Analysis and Processing (ICIAP), Naples, Italy, September 9-13, 2013 (pp. 479-488). Springer Berlin/Heidelberg
Open this publication in new window or tab >>Precise 3D Angle Measurements in CT Wrist Images
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2013 (English)In: Image Analysis and Processing – ICIAP 2013: Part II, Springer Berlin/Heidelberg, 2013, p. 479-488Conference paper, Published paper (Refereed)
Abstract [en]

The clinically established method to assess the displacement of a distal radius fracture is to manually measure two reference angles,the dorsal angle and the radial angle, in consecutive 2D X-ray images of the wrist. This approach has the disadvantage of being sensitive to operator errors since the measurements are performed on 2D projections of a 3D structure. In this paper, we present a semi-automatic system for measuring relative changes in the dorsal angle in 3D computed tomography (CT) images of fractured wrists. We evaluate the proposed 3D measurement method on 28 post-operative CT images of fractured wrists and compare it with the radiographic 2D measurement method used in clinical practice. The results show that our proposed 3D measurement method has a high intra- and inter-operator precision and is more precise and robust than the conventional 2D measurement method.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2013
Series
Lecture Notes in Computer Science, ISSN 0302-9743 ; 8157
Keywords
Wrist fractures, CT, angle measurements, bone segmentation, interactive mesh segmentation, surface registration
National Category
Medical Image Processing
Research subject
Computerized Image Analysis; Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-211749 (URN)10.1007/978-3-642-41184-7_49 (DOI)000329811200049 ()978-3-642-41183-0 (ISBN)
Conference
17th International Conference on Image Analysis and Processing (ICIAP), Naples, Italy, September 9-13, 2013
Available from: 2013-11-30 Created: 2013-11-30 Last updated: 2016-09-06Bibliographically approved
Nysjö, J., Christersson, A., Malmberg, F., Sintorn, I.-M. & Nyström, I. (2012). Towards User-Guided Quantitative Evaluation of Wrist Fractures in CT Images. In: Bolc, Leonard; Tadeusiewicz, Ryszard; Chmielewski, Leszek J; Wojciechowski, Konrad (Ed.), Computer Vision and Graphics: ICCVG 2012. Paper presented at ICCVG 2012, September 24-26, 2012, Warsaw, Poland (pp. 204-211). Springer Berlin/Heidelberg
Open this publication in new window or tab >>Towards User-Guided Quantitative Evaluation of Wrist Fractures in CT Images
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2012 (English)In: Computer Vision and Graphics: ICCVG 2012 / [ed] Bolc, Leonard; Tadeusiewicz, Ryszard; Chmielewski, Leszek J; Wojciechowski, Konrad, Springer Berlin/Heidelberg, 2012, p. 204-211Conference paper, Published paper (Refereed)
Abstract [en]

The wrist is the most common location for long-bone fractures in humans. To evaluate the healing process of such fractures, it is of interest to measure the fracture displacement, particularly the angle between the joint line and the long axis of the fractured long bone. We propose to measure this angle in 3D computed tomography (CT) images of fractured wrists. As a first step towards this goal, we here present a fast and precise semi-automatic method for determining the long axis of the radius bone in CT images. To facilitate user interaction in 3D, we utilize stereo graphics, head tracking, 3D input, and haptic feedback.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2012
Series
Lecture Notes in Computer Science, ISSN 0302-9743 ; 7594
National Category
Medical Image Processing
Research subject
Computerized Image Analysis
Identifiers
urn:nbn:se:uu:diva-185557 (URN)10.1007/978-3-642-33564-8_25 (DOI)000313005700025 ()978-3-642-33563-1 (ISBN)
Conference
ICCVG 2012, September 24-26, 2012, Warsaw, Poland
Available from: 2012-11-26 Created: 2012-11-26 Last updated: 2016-09-06Bibliographically approved
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