Frede Frihagen

• Andersen, Mathias; Tollefson, Luke V.; Ngobi, Jacob; Carlson, Mitchell R.; LaPrade, Christopher M. & Fladberg, Bjørge [Show all 9 contributors for this article] (2026). Effect of Multiple Centralization Sutures on Meniscal Extrusion and Contact Pressures in a Cadaveric Model of Medial Meniscus Root Repair. American Journal of Sports Medicine. ISSN 0363-5465. 54(12), p. 2972–2980. doi: 10.1177/03635465261475396. Full text in Research Archive
• Velde, Nathalie van der; Seppala, Lotta J.; Bahat, Gulistan; Blain, Hubert; Herrero, Alvaro Casas & Harvey, Nicholas C. [Show all 60 contributors for this article] (2026). Position paper: a coordinated approach to fracture and fall prevention from seven international organizations. European Geriatric Medicine. ISSN 1878-7649. doi: 10.1007/s41999-026-01596-7. Full text in Research Archive Show summary

  Fragility fractures constitute a major global health burden and often result from falls. However, clinical care for fragility fractures is currently organized separately from fall prevention services leading to gaps in integrated care delivery. This joint position paper from the European Geriatric Medicine Society, the Fragility Fracture Network, the World Falls Prevention Society, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, the International Osteoporosis Foundation, the European Union of Medical Specialists-Geriatric Medicine Section, and the International Association of Gerontology and Geriatrics–European Region highlights the critical need for integrated falls and fracture prevention, with a focus on evidence-based clinical practice, knowledge dissemination, education, policy strategies, and research. We outline existing guidelines on fall and fracture prevention, with particular emphasis on how fracture risk assessment can be incorporated into fall prevention services and on integrating fall assessment into fracture prevention services. We advocate that future implementation guidelines place greater emphasis on fully integrated models of care. Moreover, training and education programs should be designed to encourage interdisciplinary collaboration among healthcare professionals. Integrated fall and fracture prevention services should be recognized as a public health priority and incorporated into national strategies for healthy aging, supported by adequate, dedicated, and sustainable resources including evidence-based exercise provision. Finally, future research should focus on evaluating the (cost) effectiveness of integrated care models and examining their practical implementation in real-world settings.

• Nielsen, Mads S.; Jepsen, Ditte B.; Frihagen, Frede; Viberg, Bjarke L. & Jensen, Charlotte M. (2026). Implementing an early supported discharge intervention to nursing homes and respite care centers after hip fracture: A qualitative study of staff experiences and field observations. International Journal of Orthopaedic and Trauma Nursing. ISSN 1878-1241. 62. doi: 10.1016/j.ijotn.2026.101301. Full text in Research Archive
• Laszlo, Sofia; Rosenlund, Anne Mari; Pihl, Elsa; Kristoffersen, Målfrid Holen; Sköldenberg, Olof & Schilcher, Jörg [Show all 10 contributors for this article] (2026). Initial Tendon Retraction is Associated with Muscle Degeneration After Nonoperatively Treated Proximal Hamstring Avulsions. Sports Medicine - Open. 12. doi: 10.1186/s40798-026-01024-x. Full text in Research Archive Show summary

  Background and Purpose Magnetic resonance imaging (MRI) is essential in assessing proximal hamstring avulsions (PHA), where tendon retraction is a key pathological consequence. Beyond its diagnostic role, MRI may also provide prognostic information on subsequent muscle degeneration. This study aimed to determine whether pre-treatment MRI findings, particularly tendon retraction, predict later muscle degeneration and clinical outcomes in nonoperatively treated PHA patients. Methods This study is a post hoc analysis of nonoperatively treated patients (n = 95) with complete proximal hamstring avulsions from the Proximal Hamstring Avulsion Clinical Trial (PHACT). Diagnostic MRIs were reassessed for tendon retraction, Wood classification, number of tendons avulsed, and hematoma size. The primary outcome was muscle degeneration, defined by the loss of lean muscle volume (LMV) and an increase in muscle fat fraction (MFF) quantified by DIXON MRI at 24 months. The secondary outcome was maximum hamstring muscle isometric force at 24 months. Outcome data was expressed as the limb symmetry index (LSI), which was the measurement of the injured hamstring expressed as a percentage of measurement of the uninjured hamstring. Linear regression was used to analyze the association between diagnostic MRI measurements, patient factors, and LSIs for LMV, MFF, and maximum isometric force. Results The median (IQR) LSIs of the LMV, MFF and maximum strength were 78% (67.2, 87.1), 139% (124.5, 166.8), and 84% (75.4, 94.0), respectively, at 24-month follow-up. A multivariate linear regression model including tendon retraction, age, sex, hematoma size and whether the dominant limb was injured explained 48%, 48% and 23% of the variance in the LSIs of LMV, MFF and maximum force, respectively. Tendon retraction was the strongest explanatory factor for the variance of muscle degeneration observed in patients with nonoperatively treated PHA. Interpretation Greater initial tendon retraction is associated with increased muscle atrophy and fat infiltration in the hamstring muscles in patients with nonoperatively treated PHA.

• Rosenlund, Anne-Mari Nissen; Thaulow, Jorunn; Kjellman, Kjell Erling; Jensen, Charlotte Myhre; Nordsletten, Lars & Jonsson, Kenneth [Show all 7 contributors for this article] (2026). Back in stride: patient perspectives on operative and nonoperative treatment and recovery after acute proximal hamstring avulsions – a qualitative study. BMC Musculoskeletal Disorders. 27(1). doi: 10.1186/s12891-026-09632-0. Full text in Research Archive Show summary

  Background Patient-reported outcome measures indicate favorable results after both operative and nonoperative treatment of acute proximal hamstring avulsions. However, little is known about the patients´ experience with treatment and recovery. The aim of this study was to explore the patient perspective on proximal hamstring avulsions, spanning the trajectory from injury through treatment and rehabilitation to the final outcome. Methods Semi-structured interviews were conducted in groups with participants treated either operatively or nonoperatively for a proximal hamstring avulsion. Participants in the “Proximal Hamstring Avulsion Clinical Trial”, a parallel randomized controlled trial and observational cohort, were invited to take part in this focus group study. One focus group included participants who experienced persistent disabling neurological symptoms. Interviews were conducted 22–50 months after injury. The interviews were recorded and transcribed verbatim. The data were analyzed using Systemic Text Condensation. Results Eighteen participants from 30–70 years of age were divided into five focus groups. The inductive analysis led to the following five themes: Concern and uncertainty in the initial phase, Surgical versus nonsurgical treatment, Motivational factors, Physical and psychological sequelae, and “When things do not turn out as expected”. The latter theme was related to participants suffering persistent disabling neurological symptoms. Participants were overall satisfied with their treatment and motivated to return to pre-injury activities and mostly succeeded in doing so. However, most participants experienced lingering discomfort even years after injury. For those who suffered persistent disabling symptoms, quality of life remained significantly reduced. Experiences were similar across treatments, though surgical patients felt reassured everything had been done, while some nonsurgical patients wondered if surgery might have led to better results. Conclusion The findings of this study provide valuable insights for patient education and improving management strategies for proximal hamstring avulsions.

• Mau, Makoa; Leucht, Philipp; Frihagen, Frede; Duque, Gustavo; Yoon, Richard & Schemitsch, Emil [Show all 7 contributors for this article] (2026). Emerging basic science concepts in geriatric fracture fixation and patient recovery. OTA International. ISSN 2574-2167. 8(5S). doi: 10.1097/OI9.0000000000000433. Full text in Research Archive
• Turabi, Ruqayyah; Frihagen, Frede; McGlasson, Rhona; Wyatt, David; Trompeter, Alex & Beaupre, Lauren [Show all 21 contributors for this article] (2025). Fragility Fracture Network Position on Unrestricted Weight-Bearing After Hip Fracture Surgery. Geriatric Orthopaedic Surgery & Rehabilitation (GOS). ISSN 2151-4585. 16. doi: 10.1177/21514593251351136. Full text in Research Archive Show summary

  Objectives This position paper from the Fragility Fracture Network (FFN) responds to the observed global variation in weight-bearing prescriptions after hip fracture surgery in older adults. Methods The paper summarises current guidelines and evidence regarding unrestricted weight-bearing after hip fracture surgery. Results The synthesis of available evidence supports the endorsement of unrestricted weight-bearing after surgery to enhance patient outcomes. Conclusion The FFN endorses unrestricted weight-bearing and recommends healthcare professionals, institutions, and policymakers re-evaluate practices favouring limited or non-weight-bearing prescriptions and establish a standardised system for monitoring and auditing, with clear justification and documentation of any restrictions.

• Bjørnerem, Åshild Marit; Khoshkhabari, Jashar; Hansen, Ann Kristin; Borgen, Tove Tveitan; Frihagen, Frede & Solberg, Lene Bergendal [Show all 8 contributors for this article] (2025). Adherence to secondary fracture prevention is associated with reduced risk of subsequent fractures. Osteoporosis International. ISSN 0937-941X. 36(11), p. 2263–2272. doi: 10.1007/s00198-025-07697-6. Full text in Research Archive
• Bell, Jack J.; Geirsdottir, Olof Gudny; Johansen, Antony; Santy-Tomlinson, Julie; Frihagen, Frede & McGlasson, Rhona [Show all 8 contributors for this article] (2025). The SIMPLER Nutrition Pathway for Fragility Fractures: A Quality Improvement Initiative. Nutrients. 17(12), p. 1987–1987. doi: 10.3390/nu17121987. Full text in Research Archive Show summary

  Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018–2025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the “know-do” gap, and adapted SIMPLER to context through iterative action–reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n = 308, 46 countries), two bi-national audits (n = 965, 63 hospitals), and qualitative interviews (n = 15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action–reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to the local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusions: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support the delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway.

• Midtgaard, Kaare Sourin; Flugsrud, Gunnar Birkeland; Jonsson, Kenneth B.; Snellman, Greta; Coucheron, Marius & Djuv, Ane [Show all 13 contributors for this article] (2025). Tension Band Wiring Versus Precontoured Plate Fixation for 2-Part and Multifragmented Olecranon Fractures: A Prospective Randomized Trial. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 107(17), p. 1907–1917. doi: 10.2106/JBJS.24.01461. Full text in Research Archive Show summary

  Background: We conducted a randomized controlled trial to compare the outcomes of tension band wiring and precontoured plate fixation for the treatment of 2-part and multifragmented isolated, displaced olecranon fractures. Methods: We recruited 200 patients, 18 to 75 years of age, who had isolated, displaced olecranon fractures and randomly allocated them to tension band wiring (n = 100) or plate fixation (n = 100). The patients were followed at 6 weeks, 12 weeks, 12 months, and 24 months. The study was designed as a noninferiority trial. The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 12 months. Results: More patients in the tension band wiring group were classified as ASA (American Society of Anesthesiologists) grade I; otherwise, the randomization groups were similar. Two patients in the tension band wiring group and 3 in the plate fixation group did not receive the allocated treatment. The duration of the surgical procedure was 64 and 88 minutes in the tension band wiring and plate fixation groups, respectively (p < 0.01). After 12 months, the median QuickDASH score was 5 for both groups, and the median of the differences was 0 (95% 1-sided confidence interval [CI], 2.3). There were no clinically relevant differences between the groups at any time point. In addition, there were no differences in outcomes in subgroup analyses of 2-part and multifragmented olecranon fractures. Complications and secondary surgical procedures were analyzed on the basis of the treatment received (tension band wiring = 101 patients, plate fixation = 99 patients). Sixty-four complications were recorded in 52 patients (tension band wiring, 30 patients; plate fixation, 22 patients; relative risk [RR], 1.20 [95% CI, 0.88 to 1.58]; p = 0.23). In the tension band wiring and plate fixation groups, 49 and 34 patients (RR, 1.33 [95% CI, 1.01 to 1.74]; p = 0.04) required at least 1 additional surgical procedure, respectively. Hardware-related irritation was the most reported indication of secondary surgery. Conclusions: When treating isolated, displaced 2-part and multifragmented olecranon fractures, tension band wiring was noninferior compared with plate fixation. The surgical procedure was quicker for tension band wiring, but the frequency of secondary surgical procedures was higher. The majority of secondary surgical procedures were removal of symptomatic hardware. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 21 contributors for this article] (2025). Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative). Osteoporosis International. ISSN 0937-941X. 36(3), p. 501–512. doi: 10.1007/s00198-024-07376-y. Full text in Research Archive Show summary

  Summary Subsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures. Purpose Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality. Methods The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011–2015) or intervention period (2015–2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated. Results A total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83–0.92) and 10% in men (HR 0.90, 95% CI 0.81–0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79–0.86) and 15% in men (HR 0.85, 95% CI 0.81–0.89). Conclusion A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

• Dakhil, Shams; Djuv, Ane; Saltvedt, Ingvild Tina; Wyller, Torgeir Bruun; Frihagen, Frede & Johnsen, Lars Gunnar [Show all 10 contributors for this article] (2025). Postoperative outcomes in patients operated for extra- and intracapsular hip fractures – a secondary analysis of two randomized controlled trials. BMC Musculoskeletal Disorders. 26. doi: 10.1186/s12891-025-08404-6. Full text in Research Archive Show summary

  Background: Hip fractures are among the most common and serious injuries in older adults. There has been a perception that extracapsular hip fractures have worse outcome than intracapsular hip fractures. We aimed to examine postoperative outcomes in patients operated for extra- and intracapsular hip fractures. Methods: This is a secondary analysis of data from two randomized controlled trials evaluating the effect of orthogeriatric care. Bivariate analyses were conducted, comparing patients with extracapsular fracture to patients with intracapsular fracture. Mortality, length of hospital stay (LOS), new nursing home admissions, operative data and measures of functional and cognitive performance were assessed as endpoints. Results: The primary analysis included 711 patients; 283 patients had an extracapsular fracture and 428 an intracapsular fracture. At four months follow-up, the intracapsular fracture group had significantly better Short Physical Performance Battery (SPPB) (5.0 vs. 4.0, p = 0.007), personal Activities of Daily Living (p-ADL) (17.0 vs. 16.0, p = 0.007) and instrumental ADL (i-ADL) (32.5 vs. 28.0, p = 0.049). There were no statistically significant differences between the groups at 12 months. Conclusions: Patients with an extracapsular fracture had worse mobility and ADL levels four months postoperatively, but there were no clinically relevant differences at 12 months postoperatively.

• Ahmad, Zafar; Axelrod, Daniel; Comeau-Gauthier, Marianne; Bzovsky, Sofia; Poolman, Rudolf W. & Frihagen, Frede [Show all 10 contributors for this article] (2025). How does internal fixation compared with arthroplasty affect quality of life for patients who have suffered femoral neck fractures? OTA International. ISSN 2574-2167. 8(2). doi: 10.1097/OI9.0000000000000404. Full text in Research Archive Show summary

  Objectives: To evaluate functional outcomes amongst femoral neck fracture trial participants who did not undergo reoperation. Design: Secondary analysis of 2 randomized controlled trials. Setting: Ninety hospitals in 5 continents. Participants: Patients aged 50 years or older with a femoral neck fracture. Intervention: Arthroplasty, including total hip arthroplasty and hemiarthroplasty, or internal fixation, including sliding hip screw or multiple cancellous screws. Main Outcome Measurement: The Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-item Short Form Health Survey (SF-12) physical component summary (PCS). Results: Data from 716 arthroplasty patients and 549 internal fixation patients were included in our propensity score weighting model. Internal fixation patients had higher WOMAC stiffness scores (leading to poorer function) at 24 months postoperatively compared with total hip arthroplasty patients (adjusted mean difference [AMD] 0.42 points, 99% confidence interval [CI] 0.09–0.75; P < 0.001) and hemiarthroplasty patients (AMD 0.39 points, 99% CI 0.04–0.74; P = 0.004). However, this statistically significant difference did not reach the 7-point threshold for a minimal clinically important difference. No statistically significant differences were found in the other WOMAC scales, nor with the SF-12 PCS. In participants aged 70 years or younger, no difference was found in any of the functional outcomes at 24 months. Conclusion: While stiffness is worse following internal fixation, our results show similar functional outcomes in femoral neck fracture patients undergoing modern methods of internal fixation versus arthroplasty. These results, however, may not be applicable to a younger, more active hip fracture population. Level of Evidence: Prognostic Level II.

• Borgen, Tove Tveitan; Brunborg, Cathrine; Frihagen, Frede; Solberg, Lene Bergendal; Andreasen, Camilla & Figved, Wender [Show all 13 contributors for this article] (2025). External validation of FRISBEE 2-year and 5-year fracture prediction models in a fracture liaison service cohort. Archives of Osteoporosis. ISSN 1862-3522. 20, p. 1–10. doi: 10.1007/s11657-025-01516-5. Full text in Research Archive Show summary

  Summary We externally validated the FRISBEE models of 2-year and 5-year fracture risk prediction in 517 women with index fractures. Both models overestimated the fracture risk. Recalibration of the FRISBEE models are needed before use in Norwegian women with recent fractures. Purpose We externally validated the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) groups’ 2-year and 5-year fracture risk models. Methods We included women above 50 years with a recent fracture from the consent-based part of the Norwegian Capture the Fracture Initiative study (NoFRACT). They had bone mineral density assessed and filled in a questionnaire including risk factors for fracture at baseline between October 2015 and December 2017. We calculated and validated the 2-year and 5-year fracture risk using the FRISBEE equation models. Results Of 517 women aged 65.5 ± 8.6 years with fractures, 94 (18%), 55 (11%), and 31 (6%) sustained a subsequent fracture of any type, major osteoporotic fractures (MOF), or central fracture, during 4.7 ± 1.3 years mean follow-up. The area under the receiver-operating curve (AUC) (95% confidence interval (CI)) for any type of fracture, MOF, and central fracture was 0.57 (0.51–0.63), 0.57 (0.46–0.67), and 0.65 (0.53–0.77), respectively, for the FRISBEE 2-year risk models and 0.57 (0.51–0.64), 0.58 (0.50–0.67), and 0.67 (0.57–0.76) for the FRISBEE 5-year risk models. The calibration slopes (with 95% CI) that compared observed vs. predicted probabilities for fracture across deciles of risk for any type of fracture, MOF, and central fracture were all low: 0.34 (0.02–0.64), 0.33 (− 0.09–0.74), and 0.61 (0.16–1.06), in the FRISBEE 2-year models, and 0.54 (0.13–0.95), 0.43 (0.05–0.80), and 0.69 (0.31–1.08), in the FRISBEE 5-year models. Conclusion Overall, the FRISBEE models overestimated both 2-year and 5-year fracture risk. Recalibration is needed before these models can be used in Norwegian women with recent fractures.

• Høgevold, Magnus; Alm, Carl Erik; Wright, Bryan Joseph; Ragan, Lydia; Frihagen, Frede & Röhrl, Stephan Maximilian [Show all 8 contributors for this article] (2025). The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures a biomechanical study. Bone & Joint Open (BJO). 6(5), p. 582–589. doi: 10.1302/2633-1462.65.BJO-2024-0266.R1. Full text in Research Archive Show summary

  Aims Trochanteric fractures with a reduced lateral wall thickness and a detached lesser trochanter are unstable. These characteristics can lead to failure through a lateral wall fracture after fixation with a sliding hip screw device (SHS). However, the precise mechanism by which these characteristics contribute to lateral wall fractures remains unclear. Accordingly, we examined the impact on failure by incremental decrease of both lateral wall thickness and lesser trochanter attachment in trochanteric fracture fixation using a SHS ex vivo. Methods We tested 14 pairs of embalmed femora, randomly assigned to four osteotomy groups, each representing a specific 31A1 or 31A2 fracture pattern according to the AO/Orthopaedic Trauma Association (OTA) classification. After fixation with a SHS, the specimens underwent quasi-static and dynamic axial compression until failure. Outcome measures included stiffness, deformation, load to failure, and failure pattern following a set protocol. Results We found lateral wall fractures in ten out of 28 specimens. Specimens with a thin lateral wall and a detached lesser trochanter exhibited both a significantly higher rate of lateral wall fractures (5/7 vs 5/21, p = 0.023) and a lower load to failure than specimens with only one or none of these characteristics (1,673 N (SD 810) vs 2,922 N (SD 897), p = 0.003). The specimens with a detached lesser trochanter themselves demonstrated a significantly higher rate of lateral wall fractures than those with an attached lesser trochanter (9/14 vs 1/14, p = 0.004). Conclusion Our findings emphasize the role of a detached lesser trochanter in initiating lateral wall fractures, with a reduction in load to failure when combined with reduced lateral wall thickness. Biomechanically, this suggests a failure mechanism whereby placing a load-sharing implant could overload a fragile lateral wall in unstable trochanteric fractures.

• Lashkari, Reyhaneh; Dahl, Cecilie; Borgen, Tove Tveitan; Bjørnerem, Åshild Marit; Gjertsen, Jan-Erik & Wisløff, Torbjørn [Show all 13 contributors for this article] (2025). Distal forearm fracture risk in a cohort of female and male immigrants and Norwegian-born residents aged 20 to 79 years in Norway. Archives of Osteoporosis. ISSN 1862-3522. 20, p. 1–9. doi: 10.1007/s11657-025-01566-9. Full text in Research Archive Show summary

  Summary The study investigated the risk of distal forearm fractures in adult Norwegian residents according to regions of birth. There were significant differences in fracture risk between the region of birth categories. Although the magnitude of the rates was different between the birth categories, similar sex and seasonal risk patterns were observed. Introduction Worldwide, distal forearm fractures (DFFs) are the most common fractures in adults. This study compared incidence rates of first DFFs in women and men in Norway by region of birth, age, and season. Methods We included Norwegian residents aged 20 to 79 years with a first DFF between 2010 and 2020 using data from the Norwegian Patient Registry and population estimates from Statistics Norway. Three countries of birth groups were compared: Norwegian-born, Global North (most of Europe, North America, Australia, and New Zealand), and Global South (Asia, Africa, Latin America, Oceania). Results Compared to Norwegian-born residents in Norway, immigrants from Global North had 16% and 37% higher age-adjusted DFF incidence rates in women and men, respectively. Compared to Norwegian-born residents, female immigrants from Global South regions had 24% lower rates, whereas male immigrants from Global South regions did not have significantly lower rates. DFF rates were highest in winter for older men and women regardless of birth category, whereas rates in men younger than 50 years were highest during summer months. Conclusion We observed significant differences in DFF rates by sex, region of birth, age, and season. Our findings might have important implications for public health efforts and fracture prevention strategies. Nonetheless, further research is necessary to investigate the underlying risk factors and mechanisms driving these differences.

• Semsarian, Sepideh; Omsland, Tone Kristin; Heen, Espen Kolstad; Madar, Ahmed Ali; Frihagen, Frede & Gjertsen, Jan-Erik [Show all 14 contributors for this article] (2024). Subsequent fracture risk in Norwegians and immigrants with an index forearm fracture: a cohort study. Archives of Osteoporosis. ISSN 1862-3522. 19(1), p. 1–10. doi: 10.1007/s11657-024-01419-x. Full text in Research Archive Show summary

  Summary: The current study investigated subsequent fracture risk following a forearm fracture in three country of birth categories: Norway, Europe and North America, and other countries. Subsequent fracture risk was modestly higher in Norwegian-born individuals compared to the two other groups. Secondary fracture prevention should be recommended regardless of country background. Background: Fracture risk is higher in patients with a previous fracture, but whether subsequent fracture risk differs by origin of birth is unknown. This study explores subsequent fracture risk in patients with an index forearm fracture according to region of birth. Methods: Nationwide data on forearm fractures in patients ≥ 18 years in 2008–2019 were obtained from the Norwegian Patient Registry and Statistics Norway. Index fractures were identified by ICD-10 code S52, whereas subsequent fractures included any ICD-10 fracture code. Data on country of birth were from Statistics Norway and included three regional categories: (1) Norway, (2) other Europe and North America and (3) other countries. Direct age standardization and Cox proportional hazard regression were used to analyse the data. Results: Among 143,476 individuals with an index forearm fracture, 35,361 sustained a subsequent fracture. Norwegian-born forearm fracture patients had the highest subsequent fracture rates (516/10,000 person-years in women and 380 in men). People born outside Europe and North America had the lowest rates (278/10,000 person-years in women and 286 in men). Compared to Norwegian-born individuals, the hazard ratios (HRs) of subsequent fracture in individuals from Europe and North American were 0.93 (95% CI 0.88–0.98) in women and 0.85 (95% CI 0.79–0.92) in men. The corresponding HRs in individuals from other countries were 0.76 (95% CI 0.70–0.84) in women and 0.82 (95% CI 0.74–0.92) in men. Conclusion: Individuals born outside Norway had a lower subsequent fracture risk than Norwegian-born individuals; however, subsequent fracture risk increased with age in all groups. Our results indicate that secondary fracture prevention should be recommended regardless of region of origin.

• Geweiss, Jan; Albers, Christoph Emanuel; Keel, Marius Johann Baptist; Frihagen, Frede; Rommens, Pol Maria & Bastian, Johannes Dominik (2024). Chronic pelvic insufficiency fractures and their treatment. Archives of Orthopaedic and Trauma Surgery. ISSN 0936-8051. 145(1). doi: 10.1007/s00402-024-05717-4. Full text in Research Archive Show summary

  Fragility and insufficiency fractures of the pelvis (FFP) and sacrum (SIF) are increasingly prevalent, particularly among the elderly, due to weakened bone structure and low-energy trauma. Chronic instability from these fractures causes persistent pain, limited mobility, and significant reductions in quality of life. Hospitalization is often required, with substantial risks of loss of independence (64–89%) and high mortality rates (13–27%). While conservative treatment is possible, surgical intervention is preferred for unstable or progressive fractures. FFP and SIF are primarily associated with osteoporosis, with 71% of patients not receiving adequate secondary fracture prevention. Imaging modalities play a crucial role in diagnosis. Conventional radiography often misses sacral fractures, while computed tomography (CT) is the gold standard for evaluating fracture morphology. Magnetic resonance imaging (MRI) offers the highest sensitivity (99%), essential for detecting complex fractures and assessing bone edema. Advanced techniques like dual-energy CT and SPECT/CT provide further diagnostic value. Rommens and Hofmann’s classification system categorizes FFP based on anterior and posterior pelvic ring involvement, guiding treatment strategies. Progression from stable fractures (FFP I–II) to highly unstable patterns (FFP IV) is common and influenced by factors like pelvic morphology, bone density, and sarcopenia. Treatment varies based on fracture type and stability. Non-displaced posterior fractures can be managed with sacroplasty or screw fixation, while displaced or unstable patterns often require more invasive methods, such as triangular lumbopelvic fixation or transsacral bar osteosynthesis. Sacroplasty provides significant pain relief but has limited stabilizing capacity, while screw augmentation with polymethylmethacrylate improves fixation in osteoporotic bones. Anterior ring fractures may be treated with retrograde transpubic screws or symphyseal plating, with biomechanical stability and long-term outcomes depending on fixation techniques. FFP and SIF management requires a multidisciplinary approach to ensure stability, pain relief, and functional recovery, emphasizing early diagnosis, tailored surgical strategies, and secondary prevention of osteoporotic fractures.

• Pihl, Elsa; Laszlo, Sofia; Rosenlund, Anne-Mari Nissen; Kristoffersen, Målfrid Holen; Schilcher, Jörg & Hedbeck, Carl Johan [Show all 12 contributors for this article] (2024). Operative versus Nonoperative Treatment of Proximal Hamstring Avulsions. NEJM Evidence. 3(8). doi: 10.1056/EVIDoa2400056. Full text in Research Archive Show summary

  Background: Operative treatment is widely used for acute proximal hamstring avulsions, but its effectiveness compared with that of nonoperative treatment has not been shown in randomized trials. Methods: In this noninferiority trial at 10 centers in Sweden and Norway, we enrolled patients 30 to 70 years of age with a proximal hamstring avulsion in a randomized trial and a parallel observational cohort. Treatments were operative reinsertion of the tendons or nonoperative management. The primary end point was the Perth Hamstring Assessment Tool (PHAT) at 2 years of follow-up. Secondary outcomes included scores on the Lower Extremity Functional Scale (LEFS). Results: A total of 119 patients were enrolled in the randomized trial and 97 patients in the observational cohort. In the per-protocol analysis of the randomized trial, the mean (±standard deviation) PHAT scores were 79.9±19.5 and 78.5±19.4 in the operative and nonoperative groups, respectively (PHAT scores range from 0 to 100, with higher scores indicati

• Alm, Carl Erik; Karlsten, Anders; Madsen, Jan Erik; Nordsletten, Lars; Brattgjerd, Jan Egil & Pripp, Are Hugo [Show all 8 contributors for this article] (2024). No benefit of the trochanteric stabilizing plate on loss of fracture reduction in AO/OTA 31-A2 trochanteric fractures a randomized controlled trial using radiostereometric analysis. Bone & Joint Open (BJO). 5(1), p. 37–45. doi: 10.1302/2633-1462.51.BJO-2023-0082.R1. Full text in Research Archive Show summary

  Aims Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Methods Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the “after weightbearing” images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Results Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in clinical outcomes were found. Conclusion The TSP did not influence the course of healing or postoperative fracture motion compared to SHS alone. Based on our results, routine use of the TSP in AO/OTA 31-A2 trochanteric fractures cannot be recommended. The TSP has been shown, in biomechanical studies, to increase stability in sliding hip screw constructs in both unstable and intermediate stable trochanteric fractures, but the clinical evidence is limited. This study showed no advantage of the TSP in unstable (AO 31-A2) fractures in elderly patients when fracture movement was evaluated with radiostereometric analysis.

• Coeckelberghs, E.; Vanhaecht, Kris; Akiki, A.; Castillón, P.; Cox, B. & Attal, R El [Show all 17 contributors for this article] (2024). Variation in care and outcome for fragile hip fracture patients: a European multicentre study benchmarking fulfilment of established quality indicators. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. doi: 10.1007/s00068-024-02549-0. Full text in Research Archive Show summary

  Purpose Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries. Methods This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients. Results A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6 h (range 15.7–42.5 h). The median LOS was 9.0 days (range 5.0–19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%). Conclusion The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.

• Oftebro, Ingrid; Skjaker, Stein Arve; Fridheim, Henrik; Frihagen, Frede; Meyer, Haakon Eduard & Nordsletten, Lars [Show all 7 contributors for this article] (2024). Decrease in incidence of distal radius fractures in Oslo, Norway. Archives of Osteoporosis. ISSN 1862-3522. 19. doi: 10.1007/s11657-024-01383-6. Full text in Research Archive Show summary

  This study reported the incidence of validated adult distal radius fractures in Oslo, Norway, in 2019. The incidence has been reduced over the last 20 years. However, it is still high compared to other regions in Norway and some of the other Nordic countries. Purpose We aimed to report the incidence of distal radius fractures in Oslo in 2019 and compare it to the incidence rates in 1998/1999. Methods Patients aged ≥ 20 years resident in Oslo sustaining a distal radius fracture in 2019 were identified by electronic diagnosis registers, patient protocols, and/or radiology registers. The diagnosis was verified using medical records and/or radiology descriptions. We used the same method as the previous study from Oslo, making the comparison over time more accurate. The age-adjusted incidence rates and the age-standardized incidence rate ratio (IRR) were calculated. Results The absolute number of fractures decreased from 1490 in 1998/1999 to 1395 in 2019. The IRR for women and men in the age group ≥ 20 years in 2019 compared to 1998/1999 was 0.77 (95% CI 0.71–0.84) and 0.77 (95% CI 0.66–0.90), respectively. The IRR for women and men in the age group ≥ 50 years in 2019 compared to 1998/1999 was 0.78 (95% CI 0.71–0.86) and 0.78 (95% CI 0.63–0.97), respectively. For the population in Oslo with Asian background compared to Norwegian background in the age group ≥ 50 years, the IRR in 2019 was 0.57 (95% CI 0.40–0.80) for women and 0.77 (95% CI 0.44–1.37) for men. Conclusions The incidence of distal radius fractures in Oslo has decreased over the last 20 years. It is still, however, higher than in other areas of Norway and in some of the other Nordic countries.

• Comeau-Gauthier, Marianne; Bzovsky, S.; Axelrod, D.; Poolman, R.W.; Frihagen, Frede & Bhandari, M. [Show all 8 contributors for this article] (2023). Is the use of bipolar hemiarthroplasty over monopolar hemiarthroplasty justified? A propensity score-weighted analysis of a multicentre randomized controlled trial. Bone & Joint Open (BJO). 4(5), p. 370–377. doi: 10.1302/2633-1462.45.BJO-2023-0026.R1. Full text in Research Archive Show summary

  Aims Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA). Methods This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and (MCS) were compared between the two HA groups using a propensity score-weighted analysis. Results Of 746 HAs performed in the HEALTH trial, 404 were bipolar prostheses and 342 were unipolar. After propensity score weighting, adequate balance between the bipolar and unipolar groups was obtained as shown by standardized mean differences less than 0.1 for each covariable. A total of 24 months after HA, the total WOMAC score and its subcomponents showed no statistically significant difference between the unipolar and bipolar groups. Similarly, no statistically significant difference was found in the PCS and MCS scores of the SF-12 questionnaire. In participants aged 70 years and younger, no difference was found in any of the functional outcomes. Conclusion From the results of this study, the use of bipolar HA over unipolar design does not provide superior functional outcomes at 24 months postoperatively. The theoretical advantage of reduced acetabular wear with bipolar designs does not appear to influence functional outcomes in the first two years postoperatively. Cite this article: Bone Jt Open  2023;4(5):370–377.

• Dahl, Cecilie; Ohm, Eyvind; Solbakken, Siri Marie; Anwar, Nudrat; Holvik, Kristin & Madsen, Christian [Show all 11 contributors for this article] (2023). Forearm fractures–are we counting them all? An attempt to identify and include the missing fractures treated in primary care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(3), p. 247–256. doi: 10.1080/02813432.2023.2231028. Full text in Research Archive Show summary

  Objective: Norway has a high incidence of forearm fractures, however, the incidence rates based on secondary care registers can be underestimated, as some fractures are treated exclusively in primary care. We estimated the proportion of forearm fracture diagnoses registered exclusively in primary care and assessed the agreement between diagnosis for forearm fractures in primary and secondary care. <p> <p>Design: Quality assurance study combining nationwide data from 2008 to 2019 on forearm fractures registered in primary care (Norwegian Control and Payment of Health Reimbursement) and secondary care (the Norwegian Patient Registry).<p> <p>Setting and patients: Forearm fracture diagnoses in patients aged ≥20 treated in primary care (n = 83,357) were combined with injury diagnoses for in- and outpatients in secondary care (n = 3,294,336).<p> <p>Main outcome measures: Proportion of forearm fractures registered exclusively in primary care, and corresponding injury diagnoses for those registered in both primary and secondary care.<p> <p>Results: Of 189,105 forearm fracture registrations in primary and secondary care, 13,948 (7.4%) were registered exclusively in primary care. The proportion ranged from 4.9% to 13.5% on average between counties, but was higher in some municipalities (>30%). Of 66,747 primary care forearm fractures registered with a diagnosis in secondary care, 62% were incident forearm fractures, 28% follow-up controls, and 10% other fractures or non-fracture injuries.<p> <p>Conclusion: An overall small proportion of forearm fractures were registered only in primary care, but it was larger in some areas of Norway. Failing to include fractures exclusively treated in primary care could underestimate the incidence rates in these areas.

• Andreasen, Camilla; Dahl, Cecilie; Solberg, Lene Bergendal; Borgen, Tove Tveitan; Wisløff, Torbjørn & Gjertsen, Jan-Erik [Show all 13 contributors for this article] (2023). Epidemiology of forearm fractures in women and men in Norway 2008–2019. Osteoporosis International. ISSN 0937-941X. doi: 10.1007/s00198-023-06990-6. Full text in Research Archive Show summary

  Summary The purpose of this paper is to describe rates of forearm fractures in adults in Norway 2008–2019. Incidence rate of distal forearm fractures declined over time in both sexes. Forearm fracture constitute a significant health burden and prevention strategies are needed. Purpose To assess age- and sex-specific incidence rates, and time trends for forearm fractures in Norway, and compare these with incidence rates in other Nordic countries. Methods Data on all patients aged 20–107 years with forearm fractures treated in Norwegian hospitals from 2008 to 2019 was retrieved from the Norwegian Patient Registry. Fractures were identified based on International Classification of Disease 10th revision code S52. Age- and sex-specific incidence rates and changes in incidence rates were calculated. Results We identified 181,784 forearm fractures in 45,628,418 person-years. Mean annual forearm fracture incidence rates per 100,000 person-years were 398 (95% CI 390–407) for all, 565 (95% CI 550–580) for women, and 231 (95% CI 228–234) for men above 20 years. Mean annual number of forearm fractures was 15,148 (95% CI 14,575–15,722). From 2008 to 2019, age-adjusted total incidence rates of forearm fractures S52 diagnoses declined by 3.5% (incidence rate ratio (IRR) of 0.997 (95% CI 0.994–0.999)) in men. The corresponding decline in women was not significant (IRR: 0.999 (95% CI 0.997–1.002)). In the same period, the age-adjusted incidence rates of distal forearm fractures declined by 7.0% in men (IRR = 0.930; 95% CI 0.886–0.965) and 4.7% in women (IRR = 0.953; 95% CI 0.919–0.976). The incidence rates of distal forearm fractures were similar to rates in Sweden and Finland. Conclusion Age-adjusted incidence rates of distal forearm fractures in both sexes declined over time.

• Solberg, Lene Bergendal; Vesterhus, Elise Berg; Hestnes, Ingvild; Ahmed, Marc; Ommundsen, Nina & WESTBERG, MARIANNE [Show all 7 contributors for this article] (2023). Comparing two different orthogeriatric models of care for hip fracture patients: An observational prospective cross-sectional study. BMJ Open Quality. 12. doi: 10.1136/bmjoq-2023-002302. Full text in Research Archive Show summary

  Introduction Patients with hip fractures are almost always operated with quite extensive surgery and are often frail with a high risk of complications, increased dependency, and death. Orthogeriatric interdisciplinary care has shown better results compared with orthopaedic care alone. The best way of delivering orthogeriatric care, however, is still largely unknown. It is believed that a high degree of integration and shared care is better than on-demand consultative services. We aimed to evaluate two different orthogeriatric models for patients with hip fracture. Methods A prospective hip fracture quality database was used to evaluate two coexisting models of care from 2019 to 2021 in our hospital. An ‘integrated care model’ (ICM) was compared with a ‘geriatric consult service’ (GCS). Results 516 patients were available for analysis, 360 from ICM and 156 from GCS. Mean age was 84 years. There were 370 (72%) women. American Society of Anesthesiologists class and prefracture cognitive impairment was similar between the groups. There were more patients with femoral neck fractures in the ICM group, and more patients were living independently prefracture. A logistic regression adjusting for the variables above showed that more patients in the ICM group were given a nerve block preoperatively (OR 2.0 (95% CI 1.31 to 2.97); p&lt;0.01), had their urinary catheter removed the first day after surgery (OR 1.9 (95% CI 1.27 to 2.89); p&lt;0.01), were mobilised to standing or seated in a chair beside the bed the first day after surgery (OR 1.5 (95% CI 1.03 to 2.30); p=0.033) and more ICM patients were considered for treatment against osteoporosis (OR 8.58 (95% CI 4.03 to 18.28); p&lt;0.001). There were no significant differences in time to surgery, length of stay, discharge destination or mortality. Conclusion The ICM group performed equally good or better on all quality indicators than the GCS.

• Dakhil, Shams; Saltvedt, Ingvild Tina; Benth, Jurate Saltyte; Thingstad, Anne Pernille Mæhle; Watne, Leiv & Wyller, Torgeir Bruun [Show all 10 contributors for this article] (2023). Longitudinal trajectories of functional recovery after hip fracture. PLOS ONE. 18(3). doi: 10.1371/journal.pone.0283551. Full text in Research Archive Show summary

  Background There is limited evidence regarding predictors of functional trajectories after hip fracture. We aimed to identify groups with different trajectories of functional recovery the first year after hip fracture, and to determine predictors for belonging to such groups. Methods This longitudinal study combined data from two large randomized controlled trials including patients with hip fracture. Participants were assessed at baseline, four and 12 months. We used the Nottingham Extended Activities of Daily Living (NEADL) as a measure of instrumental ADL (iADL) and Barthel Index for personal ADL (pADL). A growth mixture model was estimated to identify groups of patients following distinct trajectories of functioning. Baseline characteristics potentially predicting group-belonging were assessed by multiple nominal regression. Results Among 726 participants (mean age 83.0; 74.7% women), we identified four groups of patients following distinct ADL trajectories. None of the groups regained their pre-fracture ADL. For one of the groups identified in both ADL outcomes, a steep decline in function was shown the first four months after surgery, and none of the groups showed functional recovery between four and 12 months after surgery. Conclusions No groups regained their pre-fracture ADL. Some of the patients with relatively high pre-fracture function, had a steep ADL decline. For this group there is a potential for recovery, but more knowledge and research is needed in this group. These findings could be useful in uncovering groups of patients with different functioning after a hip fracture, and aid in discharge planning.

• Omsland, Tone Kristin; Solberg, Lene Bergendal; Bjørnerem, Åshild Marit; Borgen, Tove Tveitan; Andreasen, Camilla & Wisløff, Torbjørn [Show all 23 contributors for this article] (2023). Validation of forearm fracture diagnoses in administrative patient registers. Archives of Osteoporosis. ISSN 1862-3522. 18(1), p. 1–9. doi: 10.1007/s11657-023-01322-x. Full text in Research Archive Show summary

  Summary The validity of forearm fracture diagnoses recorded in fve Norwegian hospitals was investigated using image reports and medical records as gold standard. A relatively high completeness and correctness of the diagnoses was found. Algorithms used to defne forearm fractures in administrative data should depend on study purpose. Purpose In Norway, forearm fractures are routinely recorded in the Norwegian Patient Registry (NPR). However, these data have not been validated. Data from patient administrative systems (PAS) at hospitals are sent unabridged to NPR. By using data from PAS, we aimed to examine (1) the validity of the forearm fracture diagnoses and (2) the usefulness of washout periods, follow-up codes, and procedure codes to defne incident forearm fracture cases. Methods This hospital-based validation study included women and men aged≥19 years referred to fve hospitals for treatment of a forearm fracture during selected periods in 2015. Administrative data for the ICD-10 forearm fracture code S52 (with all subgroups) in PAS and the medical records were reviewed. X-ray and computed tomography (CT) reports from examinations of forearms were reviewed independently and linked to the data from PAS. Sensitivity and positive predictive values (PPVs) were calculated using image reports and/or review of medical records as gold standard. Results Among the 8482 reviewed image reports and medical records, 624 patients were identifed with an incident forearm fracture during the study period. The sensitivity of PAS registrations was 90.4% (95% CI: 87.8–92.6). The PPV increased from 73.9% (95% CI: 70.6–77.0) in crude data to 90.5% (95% CI: 88.0–92.7) when using a washout period of 6 months. Using procedure codes and follow-up codes in addition to 6-months washout increased the PPV to 94.0%, but the sensitivity fell to 69.0%. Conclusion A relatively high sensitivity of forearm fracture diagnoses was found in PAS. PPV varied depending on the algorithms used to defne cases. Choice of algorithm should therefore depend on study purposes. The results give useful measures of forearm fracture diagnoses from administrative patient registers. Depending on local coding practices and treatment pathways, we infer that the fndings are relevant to other fracture diagnoses and registers.

• Hassellund, Sondre Stafsnes; Oftebro, Ingrid; Williksen, John Håkon; Søreide, Endre; Madsen, Jan Erik & Frihagen, Frede (2023). Closed reduction of dorsally displaced distal radius fractures in the elderly provided improved final radiographic results. Journal of Orthopaedic Surgery and Research. 18(1). doi: 10.1186/s13018-023-03733-5. Full text in Research Archive Show summary

  Background Recent guidelines recommend non-operative treatment as primary treatment in elderly patients with displaced distal radius fractures. Most of these fractures are closely reduced. We aimed to evaluate the radiological results of closed reduction and casting of dorsally displaced distal radius fractures in patients 65 years or older. Methods A total of 290 patients treated during the years 2015, 2018 and 2019 in an urban outpatient fracture clinic with complete follow-up at least 5 weeks post-reduction were available for analysis. Closed fracture reduction was performed by manual traction under hematoma block. A circular plaster of Paris cast was used. Radiographs pre- and post-reduction and at final follow-up were analyzed. Results Mean age was 77 years (SD 8) and 258 (89%) were women. Dorsal tilt improved from mean 111° (range 83–139) to 89° (71–116) post-reduction and fell back to mean 98° (range 64–131) at final follow-up. Ulnar variance was 2 mm ((-1)-12) pre-reduction, 0 mm ((-3)-5) post-reduction and ended at mean 2 mm (0–8). Radial inclination went from 17° ((-6)-30) to 23° (SD 7–33), and then back to 18° (0–32) at final follow-up. 41 (14%) patients had worse alignment at final follow-up compared to pre-reduction. 48 (17%) obtained a position similar to the starting point, while 201 (69%) improved. Fractures with the volar cortex aligned after reduction retained 0.4 mm (95% Confidence Interval (CI) 0.1 to 0.7; p = 0,022) more radius length during immobilization. In a regression analysis, less ulnar variance in initial radiographs (OR 1.8 (95% CI 1.4 to 2.3) per mm, p < 0.001) and lower age (OR 1.06 (95% CI 1.02 to 1.09) per year, p < 0.003) protected against loss of reduction. Conclusion Subsequent loss of reduction after initial closed reduction was seen in most distal radius fractures. Reduction improved overall alignment in 2/3 of the patients at final follow-up. An aligned volar cortex seemed to protect partially against loss of radial length.

• Laszlo, Sofia; Nilsson, Martin; Pihl, Elsa; Mattila, Ville M.; Schilcher, Jörg & Sköldenberg, Olof [Show all 8 contributors for this article] (2022). Proximal Hamstring Tendon Avulsions: A Survey of Orthopaedic Surgeons’ Current Practices in the Nordic Countries. Sports Medicine - Open. 8(49), p. 1–10. doi: 10.1186/s40798-022-00439-6. Full text in Research Archive Show summary

  Background and purpose Evidence guiding the decision on whether to treat proximal hamstring tendon avulsions (PHA) operatively or non-operatively is very limited. The aim of this study was to identify the current practices and the rationale behind PHA treatment decisions in the Nordic countries. Methods A survey was sent to orthopaedic surgeons in Sweden, Norway, Finland and Denmark. The study population consisted of responding surgeons with exposure to surgical treatment of PHA (n = 125). The questions covered surgeon and unit characteristics, and surgeons’ understanding of the evidence for treatment, and they explored which patient and injury factors influence treatment allocation. Results Although some surgeons indicated a preference for one of the treatments, 84% stated that the treatment decision was based on patient and injury-related factors. Severe obesity, drug abuse, a sedentary lifestyle, age > 60 years and delayed diagnosis (> 6 weeks) were considered contraindications to surgical treatment. Also, there was agreement that patients expressing a preference for non-operative treatment should not be operated. Complete avulsions with tendon dislocation ≥ 2–3 cm on MRI were relative indications for surgical treatment. The majority of surgeons did not believe that operatively treated patients did better than non-operatively treated patients and experienced that patients, generally, were satisfied with the treatment result, regardless of the type of treatment. Most surgeons had experienced significant complications to operative treatment. Conclusion Current practices varied among different units, and despite the lack of evidence for their prognostic value, several factors were inconsistently being used as decision modifiers when selecting patients for surgical treatment.

• Amundsen, Asgeir; Rizzo, Marco; Berger, Richard A.; Houdek, Matthew T.; Frihagen, Frede & Moran, Steven L. (2022). Twenty-Year Experience With Primary Distal Radioulnar Joint Arthroplasty From a Single Institution. Journal of Hand Surgery-American Volume. ISSN 0363-5023. doi: 10.1016/j.jhsa.2022.02.014. Full text in Research Archive Show summary

  Purpose The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcomes of distal radioulnar joint arthroplasty. Methods Patient data were collected in a patient registry from 2000 to 2019. The follow-up included radiographic examination, physical examination, Mayo Wrist Scores, pain level, range of motion, and grip strength. Reoperations were recorded. The implants were a semi-constrained prosthesis and a metallic UHP. The mean age at surgery was 50 years. Patient demographics were similar, but the semi-constrained group had a higher preoperative percentage of instability (85 vs 52 percent). The median follow-up time was 30 months for the semi-constrained implants group and 102 months for the UHP group. Results A total of 53 primary semi-constrained total joint arthroplasties and 102 UHPs were included. The grip strength and Mayo Wrist Score improved for both the implant groups. Pain reduced in 76% of the patients. Supination improved for the semi-constrained total joint arthroplasty group. Lifting capacity was better in the semi-constrained total joint arthroplasty patients. The unadjusted reoperation rate was 23% for the semi-constrained implants group and 34% for the UHP group. Twenty-two implants were bilateral; these had comparable results to unilateral implants. Kaplan–Meier survival curves demonstrated 94% survival rate for the semi-constrained implants group and 87% survival for the UHP group after 5 years. The risk factors associated with reoperation for the combined implant group included younger age at surgery, previous wrist surgery, ulnar shortening, and wrist fusion. Conclusions Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. The semi-constrained implants group had better lifting capacity. The bilateral implants had comparable outcomes to the unilateral implants. Type of study/level of evidence Therapeutic IV.

• Watne, Leiv Otto; Pollmann, Christian Thomas; Neerland, Bjørn Erik; Paulsen, Else Quist; Halaas, Nathalie Bodd & Idland, Ane-Victoria [Show all 20 contributors for this article] (2022). Cerebrospinal fluid quinolinic acid is strongly associated with delirium and mortality in hip-fracture patients. Journal of Clinical Investigation. ISSN 0021-9738. 133(2). doi: 10.1172/JCI163472. Full text in Research Archive Show summary

  Background: The kynurenine pathway (KP) has been identified as a potential mediator linking acute illness to cognitive dysfunction by generating neuroactive metabolites in response to inflammation. Delirium (acute confusion) is a common complication of acute illness and is associated with increased risk of dementia and mortality. However, the molecular mechanism underlying delirium, particularly in relation to the KP, remain elusive. Methods: We undertook a multi-center observational study with 586 hospitalized patients (248 with delirium) and investigated associations between delirium and KP metabolites measured in cerebrospinal fluid (CSF) and serum by targeted metabolomics. We also explored associations between KP metabolites and markers of neuronal damage and one-year mortality. Results: In delirium, we found concentrations of the neurotoxic metabolite quinolinic acid in CSF (CSF-QA, OR 2.26 [1.78, 2.87], p

• Amundsen, Asgeir; Rizzo, Marco; Berger, Richard; Frihagen, Frede Jon & Moran, Steven L. (2022). Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion. Journal of Wrist Surgery (JWS). ISSN 2163-3916. doi: 10.1055/s-0042-1743119. Full text in Research Archive
• Frihagen, Frede (2022). How to navigate the landscape of trochanteric hip fracture implants. Acta Orthopaedica. ISSN 1745-3674. 93, p. 358–359. doi: 10.2340/17453674.2022.2255. Full text in Research Archive
• Bartels, Stefan; Kristensen, Torbjørn; Gjertsen, Jan-Erik; Frihagen, Frede; Rogmark, Cecilia & Dolatowski, Filip Celestyn [Show all 9 contributors for this article] (2022). Total Hip Arthroplasty Leads to Better Results After Low-Energy Displaced Femoral Neck Fracture in Patients Aged 55 to 70 Years: A Randomized Controlled Multicenter Trial Comparing Internal Fixation and Total Hip Arthroplasty. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 104(15), p. 1341–1351. doi: 10.2106/JBJS.21.01411. Full text in Research Archive Show summary

  Background:  The optimal treatment of displaced femoral neck fractures in patients 55 to 70 years old remains controversial. The aim of the present study was to assess the effect of closed reduction and internal fixation with cannulated screws (IF) compared with total hip arthroplasty (THA) on hip pain and function, with use of data for outcome measures, complications, and reoperations. Methods:  This multicenter randomized controlled trial included all patients 55 to 70 years old who presented with a low-energy displaced femoral neck fracture between December 2013 and December 2018. Patients were randomly allocated to undergo either IF or THA. The primary outcome was the Harris Hip Score (HHS) at 12 months postoperatively. Secondary outcomes were the HHS at 4 and 24 months postoperatively, Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), health-related quality of life (EQ-5D-3L [EuroQol 5 Dimensions 3 Levels] index score and EQ-VAS [visual analogue scale]), VAS for pain, and VAS for patient satisfaction at 4, 12, and 24 months postoperatively. Complications and reoperations were continuously monitored. The primary analyses were performed according to the intention-to-treat principle. Results:  A total of 102 patients with a mean (± standard deviation) age of 63.7 ± 4.2 years were allocated to IF (n = 51) or THA (n = 51). The mean difference in the primary outcome, the HHS at 12 months postoperatively (5.3; 95% confidence interval, 0.9 to 9.7; p = 0.017), was below the predefined minimal clinically important difference of 10 points. However, patients who underwent THA had a significantly higher HHS at 4 and 12 months, better OHS at 4 and 12 months, and better HOOS at 4, 12, and 24 months postoperatively. Patients who underwent THA also reported better health-related quality of life at 4 months postoperatively and reported greater satisfaction and less pain at 4 and 12 months postoperatively. A total of 26 patients in the IF group (51%; 95% confidence interval, 37% to 65%) and 2 patients in the THA group (4%; 95% confidence interval, 0.5% to 13%) underwent a major reoperation. Conclusions:  In this randomized controlled trial, we showed that patients between 55 and 70 years old who underwent THA for a low-energy displaced femoral neck fracture experienced better outcomes than those who underwent closed reduction and internal fixation. Level of Evidence:  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

• Frihagen, Frede; Comeau-Gauthier, Marianne; Axelrod, Daniel; Bzovsky, Sofia; Poolman, Rudolf W & Heels-Ansdell, Diane [Show all 9 contributors for this article] (2022). Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture?: a post hoc subgroup analysis of the HEALTH trial. Bone & Joint Open (BJO). 3(8), p. 611–617. doi: 10.1302/2633-1462.38.Bjo-2022-0074.R1. Full text in Research Archive Show summary

  Aims The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. Methods We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed. Results There were 143 patients included in the fittest cohort. Mean age was 66 years (SD 4.5) and 103 were female (72%). No clinically relevant differences were found between the treatment groups in the primary and sensitivity analyses. Conclusion This analysis found no differences in functional outcomes between HA and THA within two years of displaced low-energy FNF in a subgroup analysis of the fittest HEALTH patients. These findings suggest that very few patients above 50 years of age benefit in a clinically meaningful way from a THA versus a HA early after injury. Cite this article: Bone Jt Open 2022;3(8):611–617.

• Alm, Carl Erik; Gjertsen, Jan-Erik; Basso, Trude; Matre, Kjell; Röhrl, Stephan Maximillian & Madsen, Jan Erik [Show all 7 contributors for this article] (2021). Trochanteric stabilizing plate in the treatment of trochanteric fractures: a scoping review. Acta Orthopaedica. ISSN 1745-3674. 92, p. 1–6. doi: 10.1080/17453674.2021.1954305. Full text in Research Archive Show summary

  Background and purpose — The trochanteric stabilizing plate (TSP) may be used as an adjunct to a sliding hip screw (SHS) in the treatment of trochanteric fractures to increase construct stability. We performed a scoping review of the literature to clarify when and how the TSP may be useful. Methods — A systematic search was performed in 5 databases and followed by a backwards-and-forwards citation search of the identified papers. 24 studies were included. Results — 6 biomechanical studies and 18 clinical studies were included in the review. The studies presented mainly low-level evidence. All studies were on unstable trochanteric fractures or fracture models. Due to the heterogeneity of methods and reporting, we were not able to perform a meta-analysis. In the biomechanical trials, the TSP appeared to increase stability compared with SHS alone, up to a level comparable with intramedullary nails (IMNs). We identified 1,091 clinical cases in the literature where a TSP had been used. There were 82 (8%) reoperations. The rate of complications and reoperations for SHS plus TSP was similar to previous reports on SHS alone and IMN. It was not possible to conclude whether the TSP gave better clinical results, when compared with either SHS alone or with IMN. Interpretation — The heterogeneity of methods and reporting precluded any clear recommendations on when to use the TSP, or if it should be used at all.

• Midtgaard, Kaare Sourin; Frihagen, Frede; Dornan, Grant J.; Coucheron, Marius; Fossåen, Carina Lavransdatter & Grundel, Dag [Show all 12 contributors for this article] (2021). Predicting secondary surgery after operative fixation of olecranon fractures: a model using data from 800 patients. JSES International. 5(5), p. 948–953. doi: 10.1016/j.jseint.2021.04.014. Full text in Research Archive Show summary

  Background: High rates of secondary surgery after fixation of olecranon fractures have been reported. Identification of risk factors can aid surgeons to reduce complications leading to additional surgical procedures. Methods: Olecranon fractures treated at seven hospitals from 2007 to 2017 were identified, and the radiographs were classified. Isolated, displaced olecranon fractures treated operatively with tension band wiring (TBW) or precontoured plate fixation (PF) were reviewed. Adjusted risk factors for secondary surgery were analyzed, and a multivariable predictive model for secondary surgery was built. Results: After the initial review of 1259 olecranon fractures, 800 isolated, displaced olecranon fractures met the inclusion and exclusion criteria. The distribution of two-part and multifragmented fractures was equal. TBW was used in 636 patients and PF in 164 patients. Multifragmentation was a significant variable influencing preference for PF. Secondary surgery was performed in 41% patients and symptomatic hardware removal was the most frequent primary indication. In both the TBW and PF group, the rates of major complications leading to secondary surgery were 13% (P = .96). The adjusted risk of secondary surgery was lower with increasing age (odds ratio by 10 years increments, 0.74; 95% confidence interval, 0.68-0.80, P < .01). Compared with PF, TBW with transcortical K-wires (odds ratio, 2.06; 95% confidence interval, 1.36-3.14; P < .01) and TBW with intramedullary K-wires (odds ratio, 4.32; 95% confidence interval, 2.16-8.86, P < .01) had significantly higher adjusted risk of secondary surgery. Conclusion Surgeons preferred to use PF in younger patients and multifragmented fractures. Patients should be counseled that secondary surgery is common after surgical fixation of olecranon fractures. Symptomatic hardware removal was the most frequently reported reason for secondary surgery and more frequent after TBW. When using TBW, intramedullary K-wire positioning should be avoided. The rate of major complications leading to secondary surgery was similar in the TBW and PF groups. Overall, the risk of subsequent secondary surgery was higher in younger patients and patients treated with TBW.

• Hassellund, Sondre Stafsnes; Williksen, John Håkon; Laane, Marit Mjelde; Pripp, Are Hugo; Rosales, Carina & Karlsen, Øyvind [Show all 8 contributors for this article] (2021). Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. The Bone & Joint Journal. ISSN 2049-4394. 103-B(2), p. 247–255. doi: 10.1302/0301-620X.103B2.BJJ-2020-0192.R2. Full text in Research Archive
• Alm, Carl Erik; Frihagen, Frede; Dybvik, Eva Hansen; Matre, Kjell; Madsen, Jan Erik & Gjertsen, Jan-Erik (2021). Implants for trochanteric fractures in Norway: the role of the trochanteric stabilizing plate—a study on 20,902 fractures from the Norwegian hip fracture register 2011–2017. Journal of Orthopaedic Surgery and Research. 16, p. 1–8. doi: 10.1186/s13018-020-02163-x. Full text in Research Archive Show summary

  Background The trochanteric stabilizing plate (TSP) is used as an adjunct to the sliding hip screw (SHS) in unstable trochanteric and subtrochanteric fractures. We wanted to describe the choice of implant for trochanteric fractures with a focus on the TSP in Norway. Methods A total of 20,902 fractures from the Norwegian Hip Fracture Register treated surgically in 43 hospitals from 2011 to 2017 were included. Logistic regression analyses were performed to detect factors potentially influencing implant choice. Results The mean age was 83 years, and 15,137 (72%) were women. An SHS was used in 13,273 (63%) fractures, of them 4407 (33%) with a TSP. Fracture classification was the most important determinant of TSP. In cases where an SHS was used, the odds ratio (OR) for using a TSP was 14 for AO/OTA 31A2 fractures and 71 for AO/OTA 31A3 and subtrochanteric fractures, compared to AO/OTA 31A1 fractures. The probability of receiving a TSP was higher in urban, academic, and high-volume hospitals (OR 1.2 to 1.3) and lower in Central and Northern Norway (OR 0.3 to 0.7). The use of an intramedullary nail (IMN) (n = 7629 (36%)) was also to a degree decided by fracture classification (OR 1.8 to 5.3). However, hospital factors, with OR 0.1 to 0.4 for IMN in academic, urban, and high-volume hospitals and OR 1.5 to 2.6 outside South-Eastern Norway (all p < 0.001), were also important. Conclusions Fracture classification was the main determinant for TSP use. Any additional benefit from a TSP on postoperative fracture stability or clinical outcome needs to be clarified.

• Dakhil, Shams; Thingstad, Pernille; Frihagen, Frede; Johnsen, Lars Gunnar; Lydersen, Stian & Skovlund, Eva [Show all 10 contributors for this article] (2021). Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials. BMC Geriatrics. 21(208). doi: 10.1186/s12877-021-02152-7. Full text in Research Archive Show summary

  Background The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL). Methods This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery. Results Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points. Conclusions Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.

• Hassellund, Sondre Stafsnes; Zolic-Karlsson, Zinajda; Williksen, John Håkon; Husby, Torstein; Madsen, Jan Erik & Frihagen, Frede (2021). Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over. Bone & Joint Open (BJO). 2(12), p. 1027–1034. doi: 10.1302/2633-1462.212.BJO-2021-0108.R1. Full text in Research Archive Show summary

  Aims The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034.

• Hassellund, Sondre Stafsnes; Williksen, John Håkon; Mjelde, Marit; Pripp, Are Hugo; Rosales, Carina & Karlsen, Øystein Espeland [Show all 8 contributors for this article] (2021). Infographic: Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. The Bone & Joint Journal. ISSN 2049-4394. 103-B(2), p. 245–246. doi: 10.1302/0301-620X.103B2.BJJ-2020-2562. Full text in Research Archive
• Comeau-Gauthier, Marianne; Zura, Robert D.; Bzovsky, Sofia; Schemitsch, Emil H.; Axelrod, Daniel & Avram, Victoria [Show all 12 contributors for this article] (2021). Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 103(14), p. 1328–1334. doi: 10.2106/JBJS.20.01586. Full text in Research Archive Show summary

  Background: Heterotopic ossification (HO) is a frequent complication following hip surgery. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we aimed to (1) determine the prevalence of HO following total hip arthroplasty (THA) for femoral neck fracture in patients ≥50 years of age, (2) identify whether HO is associated with an increased risk of revision surgery within 24 months after the fracture, and (3) determine the impact of HO on functional outcomes. Methods: We performed a multivariable Cox regression analysis using revision surgery as the dependent variable and HO as the independent variable. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between participants with and those without HO at 24 months. Results: Of 1,441 participants in the study, 287 (19.9%) developed HO within 24 months. HO was not associated with subsequent revision surgery. Grade-III HO was associated with statistically significant and clinically relevant deterioration in the total WOMAC score, which was mainly related to the function component of the score, compared with grade I or II. Conclusions: The impact of grade-III HO on the functional outcomes and quality of life after THA for hip fracture is clinically important, and HO prophylaxis for selected high-risk patients may be appropriate. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

• Henjum, Kristi; Godang, Kristin; Quist-Paulsen, Else; Idland, Ane-Victoria; Neerland, Bjørn Erik & Sandvig, Heidi Vihovde [Show all 13 contributors for this article] (2021). Cerebrospinal fluid catecholamines in delirium and dementia. Brain Communications. 3(3), p. 1–11. doi: 10.1093/braincomms/fcab121. Full text in Research Archive Show summary

  Dopamine and noradrenaline are functionally connected to delirium and have been targets for pharmacological interventions but the biochemical evidence to support this notion is limited. To study the CSF levels of dopamine, noradrenaline and the third catecholamine adrenaline in delirium and dementia, these were quantified in three patient cohorts: (i) cognitively normal elderly patients (n¼122); (ii) hip fracture patients with or without delirium and dementia (n¼118); and (iii) patients with delirium precipitated by another medical condition (medical delirium, n¼26). Delirium was assessed by the Confusion Assessment Method. The hip fracture cohort had higher CSF levels of noradrenaline and adrenaline than the two other cohorts (both P<0.001). Within the hip fracture cohort those with delirium (n¼65) had lower CSF adrenaline and dopamine levels than those without delirium (n¼52, P¼0.03, P¼0.002). Similarly, the medical delirium patients had lower CSF dopamine levels than the cognitively normal elderly (P<0.001). Age did not correlate with the CSF catecholamine levels. These findings with lower CSF dopamine levels in hip fracture- and medical delirium patients challenge the theory of dopamine excess in delirium and question use of antipsychotics in delirium. The use of alpha-2 agonists with the potential to reduce noradrenaline release needs further examination.

• Ernst, Gernot Walter; Watne, Leiv Otto; Frihagen, Frede; Wyller, Torgeir Bruun; Dominik, Andreas & Rostrup, Morten (2021). Low Heart Rate Variability Predicts Stroke and Other Complications in the First Six Postoperative Months After a Hip Fracture Operation. Frontiers in Cardiovascular Medicine. 8, p. 1–8. doi: 10.3389/fcvm.2021.640970. Full text in Research Archive
• Ræder, Lise Benedikte Wendt; Andersen, Mette Renate; Madsen, Jan Erik; Jacobsen, Silje Berild; Frihagen, Frede & Figved, Wender (2021). Prognostic value of the Haraguchi classification in posterior malleolar fractures in A0 44-C type ankle fractures. Injury. ISSN 0020-1383. 52(10), p. 3150–3155. doi: 10.1016/j.injury.2021.07.038. Full text in Research Archive
• Ingstad, Frida; Solberg, Lene Bergendal; Nordsletten, Lars; Thorsby, Per Medbøe; Hestnes, Ingvild & Frihagen, Frede Jon (2020). Vitamin D status and complications, readmissions, and mortality after hip fracture. Osteoporosis International. ISSN 0937-941X. doi: 10.1007/s00198-020-05739-9. Full text in Research Archive Show summary

  Summary Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year. Introduction We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU. Methods Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions. Results A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12; p = 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61); p = 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12); p = 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03) p = 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin D-deficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97) p = 0.044) the first 30 days after surgery. Conclusion Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study.

• Blankstein, Michael; Schemitsch, Emil H.; Bzovsky, Sofia; Axelrod, Daniel; Poolman, Rudolf W. & Frihagen, Frede [Show all 10 contributors for this article] (2020). The FAITH and HEALTH Trials: Are We Studying Different Hip Fracture Patient Populations? Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S1–S8. doi: 10.1097/BOT.0000000000001930. Full text in Research Archive
• Noori, Atefeh; Sprague, Sheila; Bzovsky, Sofia; Schemitsch, Emil H.; Poolman, Rudolf W. & Frihagen, Frede [Show all 10 contributors for this article] (2020). Predictors of Long-Term Pain After Hip Arthroplasty in Patients With Femoral Neck Fractures: A Cohort Study. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S55–S63. doi: 10.1097/BOT.0000000000001929. Full text in Research Archive
• Bzovsky, Sofia; Comeau-Gauthier, Marianne; Schemitsch, Emil H.; Swiontkowski, Marc; Heels-Ansdell, Diane & Frihagen, Frede [Show all 8 contributors for this article] (2020). Factors associated with mortality after surgical management of femoral neck fractures. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S15–S21. doi: 10.1097/BOT.0000000000001937. Full text in Research Archive
• MacDonald, David R W; Neilly, David; Schneider, Prism S.; Bzovsky, Sofia; Sprague, Sheila & Axelrod, Daniel [Show all 12 contributors for this article] (2020). Venous thromboembolism in hip fracture patients: A subanalysis of the FAITH and HEALTH Trials. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S70–S75. doi: 10.1097/BOT.0000000000001939. Full text in Research Archive
• Sivaratnam, Surabhi; Comeau-Gauthier, Marianne; Sprague, Sheila; Schemitsch, Emil H.; Poolman, Rudolf W. & Frihagen, Frede [Show all 9 contributors for this article] (2020). Predictors of loss to follow-up in hip fracture trials: A secondary analysis of the FAITH and HEALTH Trials. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S22–S28. doi: 10.1097/BOT.0000000000001928. Full text in Research Archive
• Axelrod, Daniel; Comeau-Gauthier, Marianne; Bzovsky, Sofia; Schemitsch, Emil H.; Poolman, Rudolf W. & Frihagen, Frede [Show all 10 contributors for this article] (2020). What predicts health-related quality of life for patients with displaced femoral neck fractures managed with arthroplasty? A secondary analysis of the HEALTH Trial. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S29–S36. doi: 10.1097/BOT.0000000000001933. Full text in Research Archive
• Afaq, Shaikh; OʼHara, Nathan N.; Schemitsch, Emil H.; Bzovsky, Sofia; Sprague, Sheila & Poolman, Rudolf W. [Show all 11 contributors for this article] (2020). Arthroplasty versus internal fixation for the treatment of undisplaced femoral neck fractures: A retrospective cohort study. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S9–S14. doi: 10.1097/BOT.0000000000001940. Full text in Research Archive
• Neilly, David; MacDonald, David R W; Sprague, Sheila; Bzovsky, Sofia; Axelrod, Daniel & Poolman, Rudolf W. [Show all 11 contributors for this article] (2020). Predictors of medical serious adverse events in hip fracture patients treated with arthroplasty. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S42–S48. doi: 10.1097/BOT.0000000000001935. Full text in Research Archive
• Ræder, Lise Benedikte Wendt; Stake, Ingrid Kvello; Madsen, Jan Erik; Frihagen, Frede Jon; Jacobsen, Silje Berild & Andersen, Mette Renate [Show all 7 contributors for this article] (2020). Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years. Acta Orthopaedica. ISSN 1745-3674. 91. doi: 10.1080/17453674.2020.1818175. Full text in Research Archive Show summary

  Background and purpose — Better outcomes are reported for suture button (SB) compared with syndesmotic screws (SS) in patients treated for an acute ankle syndesmotic injury. One reason could be that screws are more rigid than an SB. A single tricortical 3.5 mm syndesmotic screw (TS) is the most dynamic screw option. Our hypothesis is that 1 SB and 1 TS provide similar results. Therefore, in randomized controlled trial, we compared the results between SB and TS for syndesmotic stabilization in patients with acute syndesmosis injury. Patients and methods — 113 patients with acute syndesmotic injury were randomized to SB (n = 55) or TS (n = 58). The American Orthopedic Foot & Ankle Society (AOFAS) Ankle–Hindfoot Score was the primary outcome measure. Secondary outcome measures included Manchester Oxford Foot Questionnaire (MOXFQ), Olerud–Molander Ankle score (OMA), visual analogue scale (VAS), EuroQol- 5D (EQ-5D), radiologic results, range of motion, complications, and reoperations (no implants were routinely removed). CT scans of both ankles were obtained after surgery, and after 1 and 2 years. Results — The 2-year follow-up rate was 84%. At 2 years, median AOFAS score was 97 in both groups (IQR SB 87–100, IQR TS 90–100, p = 0.7), median MOXFQ index was 5 in the SB group and 3 in the TS group (IQR 0–18 vs. 0–8, p = 0.2), and median OMA score was 90 in the SB group and 100 in the TS group (IQR 75–100 vs. 83–100, p = 0.2). The syndesmotic reduction was similar 2 years after surgery; 19/55 patients in the SB group and 13/58 in the TS group had a difference in anterior syndesmotic width ≥ 2 mm (p = 0.3). 0 patients in the SB group and 5 patients in the TS group had complete tibiofibular synostosis (p = 0.03). At 2 years, 10 TS were broken. Complications and reoperations were similar between the groups. Interpretation — We found no clinically relevant differences regarding outcome scores between the groups. TS is an inexpensive alternative to SB.

• Ræder, Lise Benedikte Wendt; Figved, Wender; Madsen, Jan Erik; Frihagen, Frede Jon; Jacobsen, Silje Berild & Andersen, Mette Renate (2020). Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: Five-year results of a randomized controlled trial. The Bone & Joint Journal. ISSN 2049-4394. 102-B(2), p. 212–219. doi: 10.1302/0301-620X.102B2.BJJ-2019-0692.R2. Full text in Research Archive
• Tornetta, Paul; Rocca, Gregory J. Della; Morshed, Saam; Jones, Clifford; Heels-Ansdell, Diane & Sprague, Sheila [Show all 437 contributors for this article] (2020). Risk Factors Associated With Infection in Open Fractures of the Upper and Lower Extremities. JAAOS: Global Research & Reviews. ISSN 2474-7661. 4(12). doi: 10.5435/JAAOSGlobal-D-20-00188. Full text in Research Archive
• Frihagen, Frede Jon; Madsen, Jan Erik; Sundfeldt, Mikael; Flugsrud, Gunnar B; Andreassen, Joakim S. & Andersen, Mette Renate [Show all 7 contributors for this article] (2020). Taylor spatial frame or reamed intramedullary nailing for closed fractures of the tibial shaft: A randomized controlled trial. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34(11), p. 612–619. doi: 10.1097/BOT.0000000000001802. Full text in Research Archive
• Blankstein, Michael; Schemitsch, Emil H.; Bzovsky, Sofia; Poolman, Rudolf W.; Frihagen, Frede & Axelrod, Daniel [Show all 10 contributors for this article] (2020). What factors increase revision surgery risk when treating displaced femoral neck fractures with arthroplasty: A secondary analysis of the HEALTH Trial. Journal of Orthopaedic Trauma. ISSN 0890-5339. 34, p. S49–S54. doi: 10.1097/BOT.0000000000001936. Full text in Research Archive
• Svenøy, Stian; Watne, Leiv; Hestnes, Ingvild; WESTBERG, MARIANNE; Madsen, Jan Erik & Frihagen, Frede Jon (2020). Results after introduction of a hip fracture care pathway: comparison with usual care. Acta Orthopaedica. ISSN 1745-3674. 91(2), p. 139–145. doi: 10.1080/17453674.2019.1710804. Full text in Research Archive
• Frihagen, Frede; Madsen, Jan Erik; Sundfeldt, Mikael; Flugsrud, Gunnar Birkeland; Andersen, Mette & Andreassen, Geir Stray (2020). Taylor Spatial Frame or Reamed Intramedullary Nailing for Closed Fractures of the Tibial Shaft: A Randomized Controlled Trial. Journal of Orthopaedic Trauma. ISSN 0890-5339. doi: 10.1097/BOT.0000000000001802. Full text in Research Archive
• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Stenbro, May-Britt [Show all 19 contributors for this article] (2019). Post-Fracture Risk Assessment: Target The Centrally Sited Fractures First! A Substudy of NoFRACT. Journal of Bone and Mineral Research. ISSN 0884-0431. 34(11), p. 2036–2044. doi: 10.1002/jbmr.3827. Full text in Research Archive Show summary

  The location of osteoporotic fragility fractures adds crucial information to post-fracture risk estimation. Triaging patients according tofracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracturerisk. The objectives of this cross-sectional study were therefore to explore potential differences between central (vertebral, hip, proximalhumerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoralneck, total hip, and lumbar spine assessed using dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS) calculated, con-comitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire con-cerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1-SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (allp< 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1–SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with centralfragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patientswith peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure,translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fractureprevention, although attention to peripheral fractures should still not be diminished.

• Andersen, Mette Renate; Diep, Lien My; Frihagen, Jon Frede; Hellund, Johan Castberg; Madsen, Jan Erik & Figved, Paul Wender (2019). Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries. Journal of Orthopaedic Trauma. ISSN 0890-5339. 33(8), p. 397–403. doi: 10.1097/BOT.0000000000001485. Full text in Research Archive
• Bartels, Stefan; Gjertsen, Jan-Erik; Frihagen, Frede Jon; Rogmark, Cecilia & Utvåg, Stein-Erik (2019). Low bone density and high morbidity in patients between 55 and 70 years with displaced femoral neck fractures: A case-control study of 50 patients vs 150 normal controls. BMC Musculoskeletal Disorders. 20, p. 1–8. doi: 10.1186/s12891-019-2732-8. Full text in Research Archive Show summary

  Background A displaced femoral neck fracture (FNF) in patients 55-70 years is a serious injury with a high risk of treatment failure and the optimal surgical treatment remains unclear. We aimed to describe characteristics of fracture patients compared to a sample from the normal population. Methods Fifty patients aged 55-70 years with a displaced FNF were gender- and age- matched with a control group of 150 persons without a hip fracture using computergenerated randomization and the Norwegian National Population Register. To reduce the risk of spurious selection bias, the sample size of the control group was trebled compared to the fracture group. Dual-energy x-ray absorptiometry (DXA) was performed. Demographics and hip function (Harris Hip Score, Oxford Hip Score, and Hip Dysfunction and Osteoarthritis Outcome Score) were collected. Results There were more than 75% women in both groups. The mean age was 64.5 years in the fracture group and 65.1 in the control group. Results for DXA measured for lumbar spine, total hip and the femoral neck showed that patients with displaced FNF were significantly more osteoporotic. Fracture patients had significantly lower body mass index, higher Charlson comorbidity index (CCI), and higher ASA (American Society of Anesthesiologists) score than the control group. No clinically relevant differences in hip function were found. There were 48% smokers in the fracture group compared to 10% in the control group. The odds ratio for obtaining a displaced FNF was high if the patients suffered from osteoporosis, smoked or had several comorbidities. Conclusions This study showed that patients aged 55-70 years with a displaced femoral neck fracture had lower bone density and higher comorbidity compared with a gender- and age-matched population without femoral neck fractures. This suggests that this patient group is epidemiologically similar to older patients with femoral neck fractures.

• Bhandari, Mohit; Einhorn, Thomas A.; Guy-Att, Gordon; Schemitsch, Emil H.; Zura, Robert D. & Sprague, Sheila [Show all 16 contributors for this article] (2019). Total hip arthroplasty or hemiarthroplasty for hip fracture. New England Journal of Medicine. ISSN 0028-4793. 381(23), p. 2199–2208. doi: 10.1056/NEJMoa1906190. Full text in Research Archive
• Frisvoll, Cassandra; Clarke-Jenssen, John; Madsen, Jan Erik; Flugsrud, Gunnar B; Frihagen, Frede Jon & Andreassen, Geir [Show all 7 contributors for this article] (2019). Long-term outcomes after high-energy open tibial fractures: Is a salvaged limb superior to prosthesis in terms of physical function and quality of life? European Journal of Orthopaedic Surgery & Traumatology (EJOST). ISSN 1633-8065. 29(4), p. 899–906. doi: 10.1007/s00590-019-02382-x. Full text in Research Archive
• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Stenbro, May-Britt [Show all 18 contributors for this article] (2019). Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT. Osteoporosis International. ISSN 0937-941X. 31, p. 505–514. doi: 10.1007/s00198-019-05215-z. Full text in Research Archive Show summary

  Summary - Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1–SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1–SQ3 fractures. SQ1–SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS. Introduction - Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1–SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1–SQ3 fractures. Methods - This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1–SQ3 fracture assessed. Results - Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1–SQ3 fractures. In multiple variable analysis, higher age (βper SD = − 0.26, 95% CI: − 0.36,− 0.15), parental hip fracture (β = − 0.29, 95% CI: − 0.54,− 0.05), and daily alcohol intake (β = − 0.43, 95% CI − 0.79, − 0.08) were associated with lower TBS. Higher BMD of femoral neck (βper SD = 0.34, 95% CI 0.25–0.43) and lumbar spine (βper SD = 0.40, 95% CI 0.31–0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (ORper SD = 1.94, 95% CI 1.51–2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09–2.71) were positively associated with SQ1–SQ3 fractures, while lumbar spine BMD (ORper SD = 0.75 95% CI 0.60–0.95) was negatively associated with SQ1–SQ3 fractures. No association between TBS and SQ1–SQ3 fractures was found. Conclusion - Since TBS and SQ1–SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.

• Ranhoff, Anette Hylen; Saltvedt, Ingvild; Frihagen, Frede Jon; Ræder, Johan; Maini, Sameer & Sletvold, Olav (2019). Interdisciplinary care of hip fractures: Orthogeriatric models, alternative models, interdisciplinary teamwork. Baillière's Best Practice & Research : Clinical Rheumatology. ISSN 1521-6942. 33(2), p. 205–226. doi: 10.1016/j.berh.2019.03.015. Full text in Research Archive Show summary

  Hip fractures are common among older people, and the prognosis is serious in terms of mobility, independence in daily life activities, and cognition, with 42% of patients never achieving the same function as before the fracture. Norway has the highest incidence of hip fractures, and the important tasks are to improve patient care and prevent new fractures. The aim was to develop Norwegian Guidelines for Interdisciplinary Care for Hip Fractures, which included models of care, organization, and clinical issues. These guidelines were based on review of the literature, including existing guidelines such as the NICE guidelines, as well as clinical experience of the members of the group, where consensus was reached after discussions. The guidelines focus on interdisciplinary patient management through a clinical pathway from admission to discharge. Here, we will present a shortened and internationally adapted version of these guidelines, which has newly been released.

• Figved, Wender; Myrstad, Marius; Saltvedt, Ingvild; Finjarn, Merete; Odland, Liv Marie Flaten & Frihagen, Frede Jon (2019). Team approach: Multidisciplinary treatment of hip fractures in elderly patients: Orthogeriatric care. Journal of bone and joint surgery reviews (JBJS Reviews). 7(6), p. 1–9. doi: 10.2106/JBJS.RVW.18.00136. Full text in Research Archive Show summary

  Patients with hip fractures are best managed by a multidisciplinary team. The multidisciplinary team consists of an orthogeriatrician, orthopaedic surgeon, aanesthesiologist, orthopaedic and/or geriatric nurse, occupational therapist, physical therapist, and clinical pharmacologist and may also include other professions, such as endocrinologist, nutritional therapist, and social worker. Key factors include perioperative assessment and minimal delay to surgery; comprehensive geriatric assessment; multidisciplinary in-ward assessment including discharge planning, treatment, and rehabilitation; and secondary fracture prevention. Current evidence shows that older people receiving multidisciplinary treatment for a hip fracture, comprehensive geriatric assessment, and systematic secondary fracture prevention have reduced morbidity and mortality and a lower risk of subsequent fractures and are more likely to return to the same location in which they lived before hospital admission.

• Pihl, Elsa; Kristoffersen, Målfrid Holen; Rosenlund, Anne-Mari; Laszlo, Sofia; Berglöf, Mida & Ribom, Eva [Show all 16 contributors for this article] (2019). The proximal hamstring avulsion clinical trial (PHACT) - a randomised controlled non-inferiority trial of operative versus non-operative treatment of proximal hamstrings avulsions: Study protocol. BMJ Open. 9:e031607(9), p. 1–5. doi: 10.1136/bmjopen-2019-031607. Full text in Research Archive
• Dolatowski, Filip Celestyn; Frihagen, Frede Jon; Bartels, Stefan; Opland, Vidar; Benth, Jurate Saltyte & Talsnes, Ove [Show all 8 contributors for this article] (2019). Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients - A Multicenter Randomized Controlled Trial. Journal of bone and joint surgery reviews (JBJS Reviews). 101(2), p. 136–144. doi: 10.2106/JBJS.18.00316. Full text in Research Archive
• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Stenbro, May-Britt [Show all 20 contributors for this article] (2019). High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: A cross-sectional sub-study of NoFRACT. Bone. ISSN 8756-3282. 122, p. 14–21. doi: 10.1016/j.bone.2019.02.008. Full text in Research Archive Show summary

  Purpose - Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures. Methods - This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire. Results - Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-score ≤ −2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all p < 0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0 years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all p < 0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%. Conclusions - More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.

• Figved, Wender; Svenøy, Stian; Röhrl, Stephan Maximillian; Dahl, Jon; Nordsletten, Lars & Frihagen, Frede Jon (2018). Higher cartilage wear in unipolar than bipolar hemiarthroplasties of the hip at 2 years: A randomized controlled radiostereometric study in 19 fit elderly patients with femoral neck fractures. Acta Orthopaedica. ISSN 1745-3674. 89(5), p. 503–508. doi: 10.1080/17453674.2018.1475899. Full text in Research Archive Show summary

  Background and purpose: The use of unipolar hemi­arthroplasties for femoral neck fractures is increasing in some countries due to reports of higher reoperation rates in bipolar prostheses. On the other hand, it has been proposed that bipolar hemiarthroplasties have clinical advantages and less cartilage wear than unipolar hemiarthroplasties. We compared cartilage wear between bipolar and unipolar hemiarthroplasties using radiostereometric analyses (RSA), in patients aged 70 years or older. Patients and methods: 28 ambulatory, lucid patients were randomized to treatment with a unipolar or a bipolar hemiarthroplasty for an acute femoral neck fracture. Migration of the prosthetic head into the acetabulum was measured using RSA. Secondary outcomes were Harris Hip Score (HHS), and EQ-5D scores. Patients were assessed at 3, 12. and 24 months. Results: 19 patients were available for follow-up at 2 years: mean proximal penetration was 0.83 mm in the unipolar group and 0.24 mm in the bipolar group (p = 0.01). Mean total point movement was 1.3 mm in the unipolar group and 0.95 mm in the bipolar group (p = 0.3). Median HHS was 78 (62–96) in the unipolar group and 100 (70–100) in the bipolar group (p = 0.004). Median EQ-5D Index Score was 0.73 (0.52–1.00) in the unipolar group and 1.00 (0.74–1.00) in the bipolar group (p = 0.01). Median EQ-5D VAS was 70 (50–90) in the unipolar group and 89 (70–95) in the bipolar group (p = 0.03) Interpretation: Patients with unipolar hemiarthroplasties had higher proximal cartilage wear and lower functional outcomes. Unipolar hemiarthroplasties should be used with caution in ambulatory, lucid patients.

• Halaas, Nathalie Bodd; Blennow, Kaj; Idland, Ane-Victoria; Wyller, Torgeir Bruun; Ræder, Johan & Frihagen, Frede Jon [Show all 9 contributors for this article] (2018). Neurofilament light in serum and cerebrospinal fluid of hip fracture patients with delirium. Dementia and Geriatric Cognitive Disorders. ISSN 1420-8008. 46(5-6), p. 346–357. doi: 10.1159/000494754. Full text in Research Archive Show summary

  Background: Delirium is associated with new-onset dementia, suggesting that delirium pathophysiology involves neuronal injury. Neurofilament light (NFL) is a sensitive biomarker for neuroaxonal injury. Methods: NFL was measured in cerebrospinal fluid (CSF) (n = 130), preoperative serum (n = 192), and postoperative serum (n = 280) in hip fracture patients, and in CSF (n = 123) and preoperative serum (n = 134) in cognitively normal older adults under-going elective surgery. Delirium was diagnosed with the Confusion Assessment Method. Re-sults: Median serum NFL (pg/mL) was elevated in delirium in hip fracture patients (94 vs. 54 pre- and 135 vs. 92 postoperatively, both p < 0.001). Median CSF NFL tended to be higher in hip fracture patients with delirium (1,804 vs. 1,636, p = 0.074). Serum and CSF NFL were posi-tively correlated (ρ = 0.56, p < 0.001). Conclusion: Our findings support an association be-tween neuroaxonal injury and delirium. The correlation between serum and CSF NFL supports the use of NFL as a blood biomarker in future delirium studies.

• Hassel, Bjørnar; Mariussen, Espen; Idland, Ane-Victoria; Dahl, Gry Torsæter; Ræder, Johan & Frihagen, Frede Jon [Show all 10 contributors for this article] (2018). CSF sodium at toxic levels precedes delirium in hip fracture patients. Neurotoxicology. ISSN 0161-813X. 69(December), p. 11–16. doi: 10.1016/j.neuro.2018.08.010. Full text in Research Archive
• Torbergsen, Anne Cathrine; Watne, Leiv; Frihagen, Frede Jon; Wyller, Torgeir Bruun & Mowe, Morten (2018). Effects of nutritional intervention upon bone turnover in elderly hip fracture patients. Randomized controlled trial. Clinical Nutrition ESPEN. ISSN 2405-4577. doi: 10.1016/j.clnesp.2017.11.012. Full text in Research Archive
• Andreasen, Camilla; Solberg, Lene Bergendal; Basso, Trude; Borgen, Tove Tveitan; Dahl, Cecilie & Wisløff, Torbjørn [Show all 20 contributors for this article] (2018). Effect of a Fracture Liaison Service on the Rate of Subsequent Fracture Among Patients With a Fragility Fracture in the Norwegian Capture the Fracture Initiative (NoFRACT): A Trial Protocol. JAMA Network Open. 1(8). doi: 10.1001/jamanetworkopen.2018.5701. Full text in Research Archive Show summary

  Importance Fragility fracture is a major health issue because of the accompanying morbidity, mortality, and financial cost. Despite the high cost to society and personal cost to affected individuals, secondary fracture prevention is suboptimal in Norway, mainly because most patients with osteoporotic fractures do not receive treatment with antiosteoporotic drugs after fracture repair. Objectives To improve secondary fracture prevention by introducing a standardized intervention program and to investigate the effect of the program on the rate of subsequent fractures. Design, Setting, and Participants Trial protocol of the Norwegian Capture the Fracture Initiative (NoFRACT), an ongoing, stepped wedge cluster randomized clinical trial in 7 hospitals in Norway. The participating hospitals were cluster randomized to an intervention starting date: May 1, 2015; September 1, 2015; and January 1, 2016. Follow-up is through December 31, 2019. The outcome data were merged from national registries of women and men 50 years and older with a recent fragility fracture treated at 1 of the 7 hospitals. Discussion The NoFRACT trial is intended to enroll 82 000 patients (intervention period, 26 000 patients; control period, 56 000 patients), of whom 23 578 are currently enrolled by January 2018. Interventions include a standardized program for identification, assessment, and treatment of osteoporosis in patients with a fragility fracture that is led by a trained coordinating nurse. The primary outcome is rate of subsequent fracture (per 10 000 person-years) based on national registry data. Outcomes before (2008-2015; control period) and after (2015-2019; intervention period) the intervention will be compared, and each hospital will act as its own control. Use of outcomes from national registry data means that all patients are included in the analysis regardless of whether they are exposed to the intervention (intention to treat). A sensitivity analysis with a transition window will be performed to mitigate possible within-cluster contamination. Results Results are planned to be disseminated through publications in peer-reviewed journals and presented at local, national, and international conferences. Conclusions By introducing a standardized intervention program for assessment and treatment of osteoporosis in patients with fragility fractures, we expect to document reduced rates of subsequent fractures and fracture-related mortality.

• ANDERSEN, METTE RENATE; Frihagen, Frede Jon; Hellund, Johan Castberg; Madsen, Jan Erik & Figved, Wender (2018). Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 100(1), p. 2–12. doi: 10.2106/JBJS.16.01011. Full text in Research Archive
• Guren, Ellen; Figved, Wender; Frihagen, Frede Jon; Watne, Leiv Otto & WESTBERG, MARIANNE (2017). Prosthetic joint infection?a devastating complication of hemiarthroplasty for hip fracture. Acta Orthopaedica. ISSN 1745-3674. 88(4), p. 383–389. doi: 10.1080/17453674.2017.1301009. Full text in Research Archive
• Ernst, Gernot Walter; Watne, Leiv Otto; Frihagen, Frede Jon; Wyller, Torgeir Bruun; Dominik, Andreas & Rostrup, Morten (2017). Decreases in heart rate variability are associated with postoperative complications in hip fracture patients. PLOS ONE. 12:e0180423(7), p. 1–14. doi: 10.1371/journal.pone.0180423. Full text in Research Archive
• Torbergsen, Anne Cathrine; Watne, Leiv Otto; Wyller, Torgeir Bruun; Frihagen, Frede Jon; Strømsøe, Knut & Bøhmer, Thomas [Show all 7 contributors for this article] (2017). Micronutrients and the risk of hip fracture: Case–control study. Clinical Nutrition. ISSN 0261-5614. 36(2), p. 438–443. doi: 10.1016/j.clnu.2015.12.014. Full text in Research Archive Show summary

  Background: Vitamin D, and possibly vitamin K, has an established association to fracture risk. Other vitamins are, however, less studied. Aim: To determine whether specific micronutrients other than 25(OH)D and vitamin K play a role in risk of hip fracture and bone turnover. Methods: In this caseecontrol study, blood was drawn for measurements of vitamins A, B6, B12, C, E, and folic acid as well as the bone turnover markers osteocalcin and bone-specific alkaline phosphatase upon admission for hip fracture in 116 patients and in 73 home-dwelling non fractured controls. Results for vitamin K1 and 25(OH)D from the same populations have been reported previously. Results: Low vitamin A, C, and E concentrations were independently associated with a risk of hip fracture. The adjusted odds ratio (95% confidence interval) per 10 mmol/L increase in vitamin A concentration was 0.74 (0.65e0.84); for 1 mmol/L vitamin C and E: 0.94 (0.92e0.97) and 0.81 (0.74e0.89) respectively. The results were principally unchanged when 25(OH)D, vitamin K1, Body Mass Index, and other potential confounders were adjusted for. All vitamins except B12 and folic acid correlated positively with total osteocalcin and negatively with bone-specific alkaline phosphatase. Conclusions: Low vitamin A, C, and E concentrations are associated with an increased risk of hip fracture, possibly mediated through bone turnover mechanisms. This caseecontrol study is registered at: ClinicalTrials.gov. NCT01738776. The patient related outcome is also registered at: ClinicalTrials.gov. NCT01009268.

• Hov, Karen Roksund; Bolstad, Nils; Idland, Ane-Victoria; Zetterberg, Henrik; Blennow, Kaj & Chaudhry, Farrukh Abbas [Show all 10 contributors for this article] (2017). Cerebrospinal Fluid S100B and Alzheimer's Disease Biomarkers in Hip Fracture Patients with Delirium. Dementia and Geriatric Cognitive Disorders Extra. 7(3), p. 374–385. doi: 10.1159/000481853. Full text in Research Archive Show summary

  Objectives: This study aimed to investigate the relationship between cerebrospinal fluid (CSF) S100B astrocyte-derived protein and delirium and to perform stratified analyses according to clinical and CSF markers of dementia. Methods: We performed a prospective cohort study in a university hospital setting. The participants were patients admitted for hip fracture (n = 98) or for elective surgery (n = 50). Delirium was assessed daily perioperatively in hip fracture patients using the Confusion Assessment Method. A consensus-based diagnosis of prefracture dementia was made using all available information. CSF was drawn at the onset of spinal anesthesia. S100B and phosphorylated tau (P-tau) concentrations were measured using electrochemiluminescence immunoassay and enzyme-linked immunosorbent assays, respectively. Results: In the hip fracture population (n = 98) there was no significant difference in CSF S100B concentrations between patients with ongoing preoperative (i.e., prevalent) delirium (n = 36, median [interquartile range] 1.11 μg/L [0.91–1.29]) and patients who never developed delirium (n = 46, 1.08 μg/L [0.92–1.28], p = 0.92). In patients without preoperative delirium, those who developed delirium postoperatively (i.e., incident delirium) (n = 16, 1.38 μg/L [1.08–1.62]) had higher concentrations of S100B than the 46 who never did (p = 0.013). This difference was confined to patients with pathological concentrations of P-tau (≥60 ng/L, n = 38). We also found that P-tau and S100B were correlated in CSF in the elective surgery patients. Conclusions: CSF S100B was elevated in patients with incident delirium who also had pathological levels of the Alzheimer disease biomarker P-tau, suggesting vulnerability caused by a preexisting process of astrocytic activation and tau pathology.

• Bartels, Stefan; Gjertsen, Jan-Erik; Frihagen, Frede Jon; Rogmark, Cecilia & Utvåg, Stein-Erik (2017). High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years. An observational study of 2,713 patients reported to the Norwegian Hip Fracture Register. Acta Orthopaedica. ISSN 1745-3674. 89(1), p. 53–58. doi: 10.1080/17453674.2017.1376514. Full text in Research Archive Show summary

  Background and purpose — The treatment of patients between 55 and 70 years with displaced intracapsular femoral neck fracture remains controversial. We compared internal fixation (IF), bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) in terms of mortality, reoperations and patient-reported outcome by using data from the Norwegian Hip Fracture Register. Patients and methods — We included 2,713 patients treated between 2005 and 2012. 1,111 patients were treated with IF, 1,030 with HA and 572 patients with THA. Major reoperations (defined as re-osteosynthesis, secondary arthroplasty, exchange, or removal of prosthesis components and Girdlestone procedure), patient-reported outcome measures (satisfaction, pain, and health-related quality of life (EQ5D) after 4 and 12 months), 1-year mortality, and change in treatment methods over the study period were investigated. Results — Major reoperations occurred in 27% after IF, 3.8% after HA and 2.8% after THA. 549 patients (20% of total study population) answered both questionnaires. Compared with IF, patients treated with THA were more satisfied after 4 and 12 months, reported less pain after 4 months and 12 months, had a higher EQ5D-index score after 4 months and 12 months, and EQ-VAS score after 4 months. Compared with IF, patients treated with HA were more satisfied and reported less pain after 4 months. EQ5D-index and EQ-VAS were similar. Patients treated with HA had higher 1-year mortality and had more comorbidities than both the THA and IF group. All these differences were statistically and clinically significant. Interpretation — This study showed high reoperation rate after IF and better patient-reported outcome after both THA and HA with medium follow-up. Patients selected for HA represented a frailer group than patients treated with THA or IF.

• Neerland, Bjørn Erik; Krogseth, Maria; Juliebø, Vibeke; Ranhoff, Anette Hylen; Engedal, Knut & Frihagen, Frede Jon [Show all 9 contributors for this article] (2017). Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study. PLOS ONE. 12(7:e0180641), p. 1–18. doi: 10.1371/journal.pone.0180641. Full text in Research Archive Show summary

  Background Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. Methods: Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method. Pre-fracture cognitive function was assessed using the Informant Questionnaire of Cognitive Decline in the Elderly and by consensus diagnosis. The presence of new-onset dementia was determined at follow-up evaluation at six or twelve months after surgery. Blood pressure was recorded at admission, perioperatively and postoperatively. Results: Preoperative delirium was present in 149 of 536 (28%) assessable patients, and 124 of 387 (32%) developed delirium postoperatively (incident delirium). The following risk factors for incident delirium in patients without pre-fracture cognitive impairment were identified: low body mass index, low level of functioning, severity of physical illness, and receipt of ≥ 2 blood transfusions. New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively. Conclusion: Risk factors for incident delirium seem to differ according to pre-fracture cognitive status. The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture.

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• Haanæs, Esten Konstad Øiaas; Frihagen, Frede; Lønne, Greger; Paulsen, Aksel; Nilsen, Jostein Skorpa & Gregersen, Martin [Show all 7 contributors for this article] (2025). The Benefit of Repairing the Deltoid Ligament in Unstable Ankle Fractures: Patient-Reported Functional Outcome and Radiological Stability Measurements; a Clinical Trial Protocol. doi: 10.1177/24730114251386735. Full text in Research Archive Show summary

  Background: Suturing the deep posterior deltoid ligament in unstable ankle fractures is novel to established treatment. Some cadaveric and clinical trials support that adding deltoid ligament repair to plating of the lateral fracture will improve stability restoration. Objectives: We will investigate the effects of deep deltoid ligament repair on patient-reported function, radiologic stability parameters, and the incidence of ankle osteoarthritis and the possible side effects from this additional procedure. The medial ankle injury patterns found will be described. Study design: A randomised controlled nonblinded multicentre trial. Methods: A total of 120 patients with Lauge Hansen SER 4B ankle fractures will be randomised (1:1 ratio) to conventional plating of the lateral malleolus only or additional suture of the deep deltoid ligament. The primary end point was patient-reported function measured in Olerud-Molander Ankle Score (OMAS) at 1 and 2 years. The secondary end points included Self-Reported Foot and Ankle Score (SEFAS), Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), VAS pain, and EuroQol-5D-5L scores; rates of treatment-related adverse events, reoperations, and incidence of posttraumatic arthritis; and comparison of side-to-side differences in tibiotalar medial clear space from bilateral weightbearing ankle radiographs and gravity stress on group level.

• Saatvedt, Ola; Riiser, Martin Økelsrud; Frihagen, Frede; Figved, Wender; Madsen, Jan Erik & Molund, Marius [Show all 7 contributors for this article] (2024). Non-operative versus operative treatment of suprasyndesmotic ankle fractures: Protocol for a prospective, multicentre, randomised controlled trial. BMJ Open. 14(1). doi: 10.1136/bmjopen-2023-075122. Full text in Research Archive Show summary

  Introduction: Surgery is widely recognised as the treatment of choice for suprasyndesmotic ankle fractures, because of the assumption that these injuries yield instability of the ankle joint. Stability assessment of ankle fractures using weightbearing radiographs is now used regularly to guide the treatment of transsyndesmotic and infrasyndesmotic ankle fractures. Patients with a congruent ankle joint on weightbearing radiographs can be treated non-operatively with excellent results. Weightbearing radiographs are, however, rarely performed on suprasyndesmotic fractures due to the assumed unstable nature of these fractures. If weightbearing radiographs can be used to identify suprasyndesmotic fractures suitable for non-operative treatment, we may save patients from the potential burdens of surgery. Our aim is to compare the efficacy of operative and non-operative treatment of patients with suprasyndesmotic ankle fractures that reduce on weightbearing radiographs. Methods and analysis: A non-inferiority randomised controlled trial involving 120 patients will be conducted. A total of 120 patients with suprasyndesmotic ankle fractures with an initial radiographic medial clear space of <7 mm will be subjected to weightbearing radiographs. If the tibio-talar joint is completely reduced, we will randomise in a 1:1 ratio to either operative treatment including reduction and fixation of the syndesmosis or non-operative treatment with an orthosis. The primary study outcome is patient-reported ankle function and symptoms as measured by the Olerud-Molander Ankle Score at 2-year follow-up. Secondary outcomes include the Manchester-Oxford Foot Questionnaire, range of motion, radiographic results and rates of adverse events. Ethics and dissemination: The Regional Committee for Medical and Health Research South East, group A (permission number: 169307), has granted ethics approval. The results of this study will provide valuable insights for developing future diagnostic and treatment strategies for a common fracture type. The findings will be shared through publication in peer-reviewed journals and presentations at conferences. Trial registration number: NCT04615650.

• Frihagen, Frede & Ranhoff, Anette Hylen (2023). Gamle som brekker. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(13). doi: 10.4045/tidsskr.23.0566. Full text in Research Archive
• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 20 contributors for this article] (2023). Fracture Liaison Services and Subsequent Fracture Risk: a multicenter, pragmatic, Stepped-Wedge Cluster-Randomized controlled trial. Full text in Research Archive
• Paulsen, Aksel; Silberg, Ingunn; Aas, Emilie Jul-Larsen; Tangerud, Audun Høegh & Frihagen, Frede (2023). Oxford Elbow Score: Norsk oversettelse og krysskulturell adaptasjon. Full text in Research Archive
• Sermon, An; Slock, Cedric; Coeckelberghs, Ellen; Seys, Deborah; Panella, Massimiliano & Bruyneel, Luk [Show all 21 contributors for this article] (2022). Correction to: Quality indicators in the treatment of geriatric hip fractures: literature review and expert consensus (Archives of Osteoporosis, (2021), 16, 1, (152), 10.1007/s11657-021-00995-6). Archives of Osteoporosis. ISSN 1862-3522. 17(1). doi: 10.1007/s11657-022-01091-z. Full text in Research Archive
• Nordbø, Jakob Vangen; Frihagen, Frede Jon & Solberg, Lene Bergendal (2020). Fastlegens rolle ved osteoporosebehandling etter brudd. 17, p. 1738–1739. doi: 10.4045/tidsskr.20.0822. Full text in Research Archive
• Hedström, Margareta; Ekström, Wilhelmina; Al-Ani, Amer; Campenfeldt, Pierre; Bartels, Stefan & Gjertsen, Jan-Erik [Show all 9 contributors for this article] (2019). High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years. Acta Orthopaedica. ISSN 1745-3674. 90(1), p. 94–95. doi: 10.1080/17453674.2018.1556875. Full text in Research Archive
• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Brunborg, Cathrine; Andreasen, Camilla & Hübschle, Lars Michael [Show all 18 contributors for this article] (2019). Individuals with Central Fractures have More Prevalent Vertebral Fractures, Lower Trabecular Bone Score and Lower BMD than Individuals with Peripheral Fractures: a Sub-study of NoFRACT. Full text in Research Archive
• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Hübschle, Lars Michael [Show all 17 contributors for this article] (2019). Determinants of Trabecular Bone Score and Vertebral Fracture Status in Women With Fragility Fractures: A Cross-sectional Sub-study of NoFRACT. Full text in Research Archive
• Pettersen, Petter Morten; Frihagen, Frede Jon; Saltvedt, Ingvild & Figved, Wender (2018). På tide å innføre ortogeriatri i Norge? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(14), p. 1320–1321. doi: 10.4045/tidsskr.18.0485. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in high adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in improved adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in high adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive

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