Jan Erik Madsen

• 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.

• Sandbæk, Dan Krister Aas; Wünsche, Leonore; Halvorsen, Vera Baasland; Madsen, Jan Erik & Brattgjerd, Jan Egil (2025). The Mini-invasive Medial Approach is Safe for Cross-pinning in Pediatric Supracondylar Humerus Fractures When Performed by Resident Surgeons - A Retrospective Cohort Study. Journal of Pediatric Orthopaedics. ISSN 0271-6798. doi: 10.1097/BPO.0000000000003011. Full text in Research Archive
• Gänsslen, Axel; Pohlemann, Tim; Lindahl, Jan & Madsen, Jan Erik (2025). Pelvic packing – status 2024. Archives of Orthopaedic and Trauma Surgery. ISSN 0936-8051. 145(1). doi: 10.1007/s00402-024-05699-3. Full text in Research Archive
• 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.

• Fraser, Alexander Nilsskog; Wagle, Tone; Karlberg, Anna Cecilia; Madsen, Jan Erik; Mellberg, Megan & Lian, Tom [Show all 12 contributors for this article] (2024). Reverse Shoulder Arthroplasty Is Superior to Plate Fixation for Displaced Proximal Humeral Fractures in the Elderly: Five-Year Follow-up of the DelPhi Randomized Controlled Trial. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 106(21), p. 1945–1956. doi: 10.2106/JBJS.23.01431. Full text in Research Archive Show summary

  The treatment of proximal humeral fractures is controversial, and operative treatment is increasing despite sparse evidence to support any surgical method over another. We present the 5-year results of the DelPhi (Delta-PHILOS) trial, in which the hypothesis was that reverse total shoulder arthroplasty (RTSA) yields better clinical results compared with open reduction and internal fixation (ORIF). The DelPhi trial was a multicenter single-blinded randomized controlled trial comparing RTSA versus ORIF for the treatment of displaced AO/OTA type-B2 and C2 proximal humeral fractures in patients 65 to 85 years of age. One hundred and twenty-four patients were allocated to RTSA (64 patients) or ORIF (60 patients). The primary outcome was the Constant score, and secondary outcomes included the Oxford Shoulder Score, radiographic measurements, and quality of life. The results were reported as the mean difference between the groups, with the 95% confidence interval (CI). The mean age was 75 years, and 90% of the patients were female. Overall, 65 of the 124 patients were available at a minimum of 5 years. The mean Constant score was 71.7 (95% CI, 67.1 to 76.3) for the RTSA group, compared with 58.3 (95% CI, 50.6 to 65.9) for the ORIF group, representing a significant difference of 13.4 (95% CI, 5.2 to 21.7) in favor of RTSA (p = 0.002). Among patients with type-C2 fractures, the mean Constant score was 73.3 (95% CI, 67.5 to 79.2) for the RTSA group and 56.0 (95% CI, 47.4 to 64.7) for the ORIF group, representing a significant difference of 17.3 (95% CI, 7.5 to 27.0) in favor of RTSA (p = 0.001). Patients with type-B2 fractures demonstrated a nonsignificant difference of 8.1 (95% CI, 27.3 to 23.3) in favor of RTSA (p = 0.29). Patients 65 to 74 years of age showed a significant mean difference of 15.7 (95% CI, 4.9 to 26.7) in favor of RTSA (p = 0.006), whereas patients 75 to 85 years of age showed a nonsignificant difference of 10.8 (95% CI, 23.0 to 24.6) in favor of RTSA. In the present study, RTSA was superior to plate fixation for displaced AO/OTA type-B2 and C2 fractures in elderly patients at 5 years. Patients 65 to 74 years of age and patients with type-C2 fractures benefited the most. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

• Eikrem, Morten; Lian, Tom; Madsen, Jan Erik & Figved, Wender (2024). Impact of Pronator Quadratus Muscle Tear in Distal Radius Fractures on Patient Outcomes: Analyses of 55 Patients in a Volar Locking Plate Arm of a Randomized Clinical Trial. Cureus - Journal of Medical Science. 16(4). doi: 10.7759/cureus.58576. Full text in Research Archive Show summary

  Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed in the literature. The aim of this study was to compare grip strength, patient-reported outcomes, and functional results between patients with an intact PQ and those with a ruptured PQ before undergoing surgery with a volar locking plate for dorsally displaced unstable extra-articular DRFs. Methods A total of 120 patients aged 55 years and older were included in a randomized controlled trial comparing a volar locking plate with a dorsal nail plate. Of the 60 patients randomized to the volar plate group, the integrity of the PQ muscle was recorded during surgery for 55 patients, who were included in this study. The outcomes measured were the Quick Disabilities of the Arm, Shoulder, and Hand Outcome Measure (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE) score, the EQ-5D index, the visual analog scale (VAS) score, grip strength, and range of motion (ROM). Results The median age was 67 years (range 55 to 88), and the one-year follow-up rate was 98%. Patients with an identified intact PQ (28/55) before surgical release had better QuickDASH scores after one year (2.5 vs 8.0, mean difference 5.5, 95% CI: 1.3 to 9.8, p=0.028). Patients in the intact group also had better EQ-5D Index scores after one year (0.94 vs 0.85, mean difference 0.089, 95% CI: 0.004 to 0.174, p=0.031), and demonstrated better grip strength throughout the trial; after one year: 24 kg vs 20 kg (mean difference 3.9; 95% CI: 0.3 to 7.6, p=0.016). After one year, the intact group had regained 96% of their grip strength and the nonintact group had regained 93% of their grip strength compared to the uninjured side. The observed differences may be of questionable clinical importance, as they were lower than those of previously proposed minimal clinically important differences (MCIDs). Conclusions Patients with a DRF and a ruptured PQ prior to surgery exhibited higher QuickDASH scores and lower EQ-5D index scores after one year. The integrity of the PQ should be reported in future studies.

• Kirkebø, Ragnhild Loven; Madsen, Jan Erik; Nordsletten, Lars & Clarke-Jenssen, John (2024). Acute treatment of elderly patients with acetabular fractures by open reduction, internal fixation, and total hip arthroplasty: a 1–10-year follow-up of 48 patients. Acta Orthopaedica. ISSN 1745-3674. 95, p. 661–666. doi: 10.2340/17453674.2024.42113. Full text in Research Archive Show summary

  Background and purpose: Acetabular fractures in osteoporotic bone are associated with substantial joint impaction and comminution, previously shown to be prognostic for a poor result. A combined procedure of open reduction, internal fixation (ORIF), and total hip arthroplasty (THA) can be a good option, allowing for immediate weightbearing as tolerated. We report short- to medium-term outcome and complications of the results of patients treated with this combined procedure. Methods: 48 cases treated with ORIF and acute THA from 2000 to 2019 were identified from our local pelvic fracture registry, from which follow-up data was extracted. Descriptive statistics were used and Kaplan–Meier survival curves were calculated. Primary outcome was HHS at 1 year. Secondary outcomes were implant survival, complications requiring surgery, and mortality at 3 months. Results: There were 37 men and 11 women treated in the study period. Mean age was 68 (37–87) years. 6 patients died within 3 months of surgery, leaving 42 cases available for follow-up. Mean follow-up (FU) was 2.8 (1–16) years. The most common mechanism of injury was fall from standing height (n = 36). Medical comorbidities were common. Mean Harris Hip Score (HHS) was 83 (51–100) at 1-year follow-up. There were 7 reoperations: 6 for postoperative infection and 1 closed reduction of implant dislocation. 38 had their implant intact at latest FU. At the latest FU, 28 patients were ambulatory without a walking aid. Conclusion: Our results indicate that ORIF and acute THA can be performed with good functional results in patients with unreconstructable displaced acetabular fractures, but with a significant risk of infection and revision.

• 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.

• Lindahl, Jan; Gänsslen, Axel; Madsen, Jan Erik & Krappinger, Dietmar (2024). Comparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications. Archives of Orthopaedic and Trauma Surgery. ISSN 0936-8051. 144(10), p. 4587–4593. doi: 10.1007/s00402-024-05557-2. Full text in Research Archive Show summary

  Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure. Fracture classifications should be simple and easy to use, comprehensive, and radiographically and anatomically based, resulting in a hierarchical alphanumeric order of types and subtypes and thereby allow adequate treatment decisions based on a high degree of inter- and intraobserver reliability. In 2018 a new AO/OTA pelvic ring fracture and dislocation classification was published that combined the most commonly used “historical” classification schemes, e.g. the Tile/AO classification and the classification according to Young and Burgess. Compared with these older classifications, several relevant changes were integrated in the 2018 edition. The changes between the AO/OTA 1996/2007 and 2018 classifications were analysed in detail. Overall, several problems were identified regarding the type-B pelvic ring injury classification. These changes may result in difficulties in classifying pelvic ring injuries and thereby prevent relevant comparisons between former and future clinical studies on pelvic injuries.

• Madsen, Jan Erik; Flugsrud, Gunnar Birkeland; Hammer, Niels & Puchwein, Paul (2024). Emergency treatment of pelvic ring injuries: state of the art. Archives of Orthopaedic and Trauma Surgery. ISSN 0936-8051. doi: 10.1007/s00402-024-05447-7. Full text in Research Archive Show summary

  High energy pelvic injuries sustain significant mortality rates, due to acute exsanguination and severe associated injuries. Managing the hemodynamically unstable trauma patient with a bleeding pelvic fracture still forms a major challenge in acute trauma care. Various approaches have been applied through the last decades. At present the concept of Damage Control Resuscitation (DCR) is universally accepted and applied in major trauma centers internationally. DCR combines hemostatic blood transfusions to restore blood volume and physiologic stability, reduced crystalloid fluid administration, permissive hypotension, and immediate hemorrhage control by operative or angiographic means. Different detailed algorithms and orders of hemostatic procedures exist, without clear consensus or guidelines, depending on local traditions and institutional setups. Fracture reduction and immediate stabilization with a binder constitute the basis for angiography and embolization (AE) or pelvic packing (PP) in the hemodynamically unstable patient. AE is time consuming and may not be available 24/7, whereas PP offers a quick and technically easy procedure well suited for the patient in extremis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has also been described as a valuable adjunct in hemostatic non-responders, but merely constitute a bridge to surgical or angiographic hemostasis and its definitive role in DCR is not yet clearly established. A swift algorithmic approach to the hemodynamically unstable pelvic injury patient is required to achieve optimum results. The present paper summarizes the available literature on the acute management of the bleeding pelvic trauma patient, with emphasis on initial assessment and damage control resuscitation including surgical and angiographic hemostatic procedures. Furthermore, initial treatment of open fractures and associated injuries to the nervous and genitourinary system is outlined.

• Kirkebø, Ragnhild Loven; Nordsletten, Lars; Madsen, Jan Erik; Dybvik, Eva Hansen; Lie, Stein Atle & Hallan, Geir [Show all 7 contributors for this article] (2023). Long-term follow-up and survival of delayed total hip arthroplasty following acetabular fracture: a matched cohort study of 552 cases from the Norwegian Arthroplasty Register. HIP International. ISSN 1120-7000. doi: 10.1177/11207000231212884. Full text in Research Archive Show summary

  Background: Operative treatment of acetabular fractures generally yields good results, but several authors report up to 15–20% of patients developing post-traumatic osteoarthritis (OA). Previous studies have shown that total hip arthroplasty (THA) following post-traumatic OA have inferior results compared to THA for primary OA. The aim of this study was to report on long-term outcome of THA following acetabular fracture, compared to primary OA. Materials and methods: We performed a matched cohort study with data from the Norwegian Arthroplasty Register (NAR). All patients receiving THA following an acetabular fracture between 1987 and 2018 were identified. A 3:1 matched cohort consisting of patients treated for primary OA with THA was selected using propensity scores and matched for age, gender and year of surgery. Survival analysis was performed with revision of any cause as endpoint. Cox regression was used to identify factors associated with risk of revision surgery. Results: 552 cases were identified, 397 men and 155 women. Mean age was 58.8 (11–91) years. 224 had previously been operated for the acetabular fracture, 328 had been treated non-operatively. Mean follow up time was 8.7 (1–29) years. Implant survival at 10 years was 79.7% (75.6–83.3) and at 20 years 62.4% (55.5–69.3). The hazard ratio for revision was 1.38 (1.07–1.77, p &lt; 0.001) compared to the OA cohort, regardless of operative or non-operative treatment of the index acetabular fracture. Uncemented acetabular components had an increased risk of revision with hazard ratio for revision 1.61 ( p = 0.012). Conclusions: THA following an acetabular fracture can be performed with acceptable results regarding implant survival, however, we report an increased risk for revision when compared to primary OA. Our results indicate that previous operative fracture treatment does not increase the risk for THA revision compared to cases treated non-operatively.

• Stake, Ingrid Kvello; Bryniarski, Anna R.; Brady, Alex W.; Miles, Jon W.; Dornan, Grant J. & Madsen, Jan Erik [Show all 9 contributors for this article] (2023). Effect of Posterior Malleolar Fixation on Syndesmotic Stability. American Journal of Sports Medicine. ISSN 0363-5465. 51(4), p. 997–1006. doi: 10.1177/03635465231151448. Full text in Research Archive
• 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.

• Stake, Ingrid Kvello; Ræder, Lise Benedikte Wendt; Gregersen, Martin; Molund, Marius; Wang, Johan & Madsen, Jan Erik [Show all 7 contributors for this article] (2023). Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial. The Bone & Joint Journal. ISSN 2049-4394. 105-B(1), p. 72–81. doi: 10.1302/0301-620X.105B1.BJJ-2022-0595.R1. Full text in Research Archive
• Bønes, Ingrid; Karlberg, Anna Cecilia; Liljeholm, Maria Elisabeth; Fraser, Alexander Nilsskog; Madsen, Jan Erik & Fjalestad, Tore (2022). Pegs not superior to screws for fixation of fractures of the proximal humerus. Journal of Orthopaedic Surgery and Research. 17(1). doi: 10.1186/s13018-022-02947-3. Full text in Research Archive Show summary

  Background Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of adverse events and reoperations have been reported. One frequent reason is secondary penetration of screws into the glenohumeral joint, due to sinking of the fracture or avascular head necrosis. To prevent joint penetrations angular stable plates with smooth locking pegs instead of locking screws have been developed. The aim of the present study was to investigate whether blunt pegs instead of pointed screws reduced the risk of secondary penetration into the glenohumeral joint during fracture healing after operatively treated PHFs. Methods From two different patient cohorts with displaced PHFs (60 treated with PHILOS plate with screws and 50 with ALPS-PHP plate with pegs), two groups were matched according to fracture type AO/OTA 11-B2 and 11-C2 and age (55–85 years). They were followed up at 3, 6 and 12 months. Primary outcome was radiographic signs of peg or screw penetrations into the glenohumeral joint at 12 months. Secondary outcomes were Oxford shoulder score (OSS) and Constant Score (CS) and radiographic signs of avascular humeral head necrosis (AVN). Results Eighteen PHILOS patients with B2 and C2 fractures could be matched with a corresponding group of 18 operated with ALPS-PHP with pegs. The number of penetrations of pegs and screws were equal between the two groups and the development of avascular head necrosis did not differ either. The functional outcomes for both OSS and CS at 12 months was clearly in favor of patients without joint penetrations in both groups. Conclusion We found no differences in the number of screw or peg penetrations in the PHILOS and ALPS-PHP group and the occurrence of AVN was equal. Joint penetrations led to inferior functional outcomes at 1 year. The ClinicalTrials.gov identifier 20/11/12 prospectively for the Philos Group is NCT01737060, and for the ALPS group 11/03/20 retrospectively is NCT04622852.

• Bjørdal, Jonas; Fraser, Alexander Nilsskog; Wagle, Tone; Kleven, Linn; Lien, Odd Arve & Eilertsen, Lars [Show all 11 contributors for this article] (2022). A cost-effectiveness analysis of reverse total shoulder arthroplasty compared with locking plates in the management of displaced proximal humerus fractures in the elderly: the DelPhi trial. Journal of shoulder and elbow surgery. ISSN 1058-2746. 31(10), p. 2187–2195. doi: 10.1016/j.jse.2022.05.022. Full text in Research Archive Show summary

  Aim: To evaluate the cost-effectiveness of surgical treatment with reversed total shoulder arthroplasty (RTSA) compared to open reduction and internal fixation (ORIF) with a locking plate for patients 65-85 years old with a displaced proximal humerus fracture. Methods: A cost-utility analysis (CUA) was conducted alongside a multicenter randomized controlled trial, taking a health care perspective. A total of 124 patients with displaced proximal humerus fractures were randomized to treatment with RTSA (n=64) or ORIF (n=60) during a two-year period. The outcome measure was quality-adjusted life years (QALYs) derived from the generic questionnaire 15D in an intention to treat population. The results were expressed as incremental cost-effectiveness ratios (ICERs), and a probabilistic sensitivity analysis was done to account for uncertainty in the analysis. Results: At 2 years, 104 patients were eligible for analyses. The mean QALY in the RTSA group was 1.24 (95% CI 1.21-1.28) and 1.26 (95% CI 1.22-1.30) in the ORIF group. The mean cost was higher in the RTSA group with mean cost of 36.755 € (€ 17 654 - € 55 855) compared to 31.953 € (€ 16 226 - € 47 279) in the ORIF group. Using ICER, ORIF was the dominant treatment. When using a probabilistic sensitivity analysis with 1000 replications, the plots were centered around origo. This indicates that there is no significant difference in cost or effect. Conclusion: In the cost-utility analysis of treatment of displaced proximal humeral fractures, there were no difference between RTSA and ORIF.

• Rosenlund, Anne-Mari; Søreide, Endre; Madsen, Jan Erik; Flugsrud, Gunnar B; Douglass, Brenton W. & Midtgaard, Kaare Sourin (2022). and internal fixation of distal humeral fractures with precontoured locking plates. OTA International. ISSN 2574-2167. p. 1–7. doi: 10.1097/OI9.0000000000000220. Full text in Research Archive
• Grün, Wolfram; Hansen, Emilie Johannah Jellum; Andreassen, Geir; Clarke-Jenssen, John & Madsen, Jan Erik (2022). Functional outcomes and health-related quality of life after reconstruction of segmental bone loss in femur and tibia using the induced membrane technique. Archives of Orthopaedic and Trauma Surgery. ISSN 0936-8051. p. 1–10. doi: 10.1007/s00402-022-04714-9. Full text in Research Archive Show summary

  Abstract Introduction The induced membrane technique (IMT), frequently called Masquelet technique, is an operative, two-staged technique for treatment of segmental bone loss. Previous studies mainly focused on radiological outcome parameters and complication rates, while functional outcomes and health-related quality of life after the IMT were sparsely reported. Materials and methods Retrospective study containing of a chart review as well as a clinical and radiological follow-up examination of all patients treated with the IMT at a single institution. The clinical outcomes were evaluated using the Lower Extremity Functional Scale (LEFS), the Short-Form-36 (SF-36) and the visual analog scale (VAS) for pain. The radiographic evaluation contained of standard anteroposterior and lateral, as well as hip-knee-ankle (HKA) radiographs. Results Seventeen patients were included in the study. All had suffered high-energy trauma and sustained additional injuries. Ten bone defects were localized in the femur and seven in the tibia. Ten patients underwent additional operative procedures after IMT stage 2, among them three patients who contracted a postoperative deep infection. The median LEFS was 59 (15–80), and the SF-36 physical component summary (PCS) and mental component summary (MCS) were 41.3 (24.0–56.1) and 56.3 (13.5–66.2), respectively. The median length of the bone defect was 9 (3–15) cm. In 11 patients, union was obtained directly after IMT stage 2. Bone resorption was observed in two patients. At follow-up, 16 of the 17 bone defects had healed. The median follow-up was 59 months (13–177). Conclusion Our results show a high occurrence of complications after IMT stage 2 in segmental bone defects of femur and tibia requiring additional operative procedures. However, fair functional outcomes as well as a good union rate were observed at follow-up.

• 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.

• Stødle, Are H.; Hvaal, Kjetil H.; Brøgger, Helga Maria; Madsen, Jan Erik & Husebye, Elisabeth Ellingsen (2021). Outcome after nonoperative treatment of stable Lisfranc injuries. A prospective cohort study. Foot and Ankle Surgery. ISSN 1268-7731. p. 1–6. doi: 10.1016/j.fas.2021.03.017. Full text in Research Archive Show summary

  Background The aim of this study was to evaluate the outcome after nondisplaced and stable Lisfranc injuries. Methods 26 patients with injuries to the Lisfranc joint complex detected on CT scans, but without displacement were tested to be stable using a fluoroscopic stress test. The patients were immobilized in a non-weightbearing short leg cast for 6 weeks. The final follow-up was 55 (IQR 53–60) months after injury. Results All the Lisfranc injuries were confirmed to be stable on follow-up weightbearing radiographs at a minimum of 3 months after injury. Median American Foot and Ankle Society (AOFAS) midfoot score at 1-year follow-up was 89 (IQR 84–97) and at final follow-up 100 (IQR 90–100); The AOFAS score continued to improve after 1-year (P=.005). The median visual analog scale (VAS) for pain was 0 (IQR 0–0) at the final follow-up. One patient had radiological signs of osteoarthritis at 1-year follow-up. Conclusion Stable Lisfranc injuries treated nonoperatively had an excellent outcome in this study with a median follow-up of 55 months. The AOFAS score continued to improve after 1 year.

• Stake, Ingrid Kvello; Brady, Alex; Bryniarski, Anna; Dornan, Grant; Madsen, Jan Erik & Engebretsen, Lars [Show all 8 contributors for this article] (2021). The impact of posterior malleolar fixation on syndesmotic stability. In Hansen, Ann Kristin (Eds.), Høstmøteboka 2021. Norsk Ortopedisk Forening. ISSN 9788299427531. p. 106–106. Full text in Research Archive
• 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.

• Tallay, Elias; Lindberg, Sondre K.; Lee-Ødegård, Sindre; Bjordal, Jonas; Fraser, Alexander Nilsskog & Madsen, Jan Erik [Show all 7 contributors for this article] (2021). External validity in a multicenter randomized clinical trial of proximal humeral fractures: the DelPhi trial. European Journal of Orthopaedic Surgery & Traumatology (EJOST). ISSN 1633-8065. doi: 10.1007/s00590-021-02982-6. Full text in Research Archive
• 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
• Eikrem, Morten; Brannsten, Hege; Bjørkøy, Dagfinn; Lian, Tom; Madsen, Jan Erik & Figved, Wender (2021). Volar Locking Plate Versus Dorsal Locking Nail-Plate Fixation for Dorsally Displaced Unstable Extra-Articular Distal Radial Fractures: Functional and Radiographic Results from a Randomized Controlled Trial. JBJS Open Access. 6(4), p. 1–11. doi: 10.2106/JBJS.OA.21.00068. Full text in Research Archive Show summary

  Background: The use of low-profile dorsal and volar locking plates for distal radial fracture surgery has improved results and lowered the complication rate compared with older plate designs. The purpose of the present randomized controlled trial was to compare patient-reported outcomes as well as radiographic and functional results between patients who underwent stabilization with a volar locking plate or a dorsal locking nail-plate for the treatment of dorsally displaced unstable extra-articular distal radial fractures. Methods: One hundred and twenty patients ≥55 years of age were randomized to surgery with either a volar locking plate or a dorsal locking nail-plate and were assessed at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. The primary outcome was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes were the Patient-Rated Wrist Evaluation (PRWE), EuroQol 5 Dimensions (EQ-5D) index and visual analog scale (VAS), range of motion, grip strength, radiographic measurements, and complication rate. Results: The median age was 66 years (range, 55 to 88 years). The rate of follow-up was 97%. There was no clinically important difference between the groups at any point during follow-up. Patients in the volar locking plate group had better mean QuickDASH scores at 6 weeks, 6 months, and 1 year. However, the differences were small (5.8 vs. 11.3 points at 1 year; mean difference, −5.5 points [95% confidence interval (CI), −9.9 to 1.2]; p = 0.014), which is lower than any proposed minimum clinically important difference (MCID). The difference in PRWE scores was also lower than the MCID (1.0 vs. 3.5 at 1 year; mean difference, −2.5 [95% CI, −4.4 to 0.6]; p = 0.012). The dorsal locking nail-plate group had slightly better restoration of volar tilt (p = 0.011). EQ-5D index, EQ-5D VAS, range of motion, grip strength, and complication rates were similar. Conclusions: We found no clinically relevant difference between the volar locking plate and dorsal locking nail-plate groups after 1 year or in the time period up to 1 year. A dorsal locking nail-plate can therefore be an alternative method for the treatment of these unstable fractures or in cases in which a dorsal approach is preferable over a volar approach.

• 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.

• 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
• Sundet, Mads; Mulima, Gift; Kajombo, Chifundo; Gjerde, Hallvard; Christophersen, Asbjørg S. & Madsen, Jan Erik [Show all 7 contributors for this article] (2021). Geographical mapping of road traffic injuries in Lilongwe, Malawi. Injury. ISSN 0020-1383. 52(4), p. 806–813. doi: 10.1016/j.injury.2021.02.028. Full text in Research Archive Show summary

  Background Road traffic injuries are a leading cause of death and disability, especially in low- and middle-income countries. Identifying injury hotspots are valuable for introducing preventive measures. This is usually accomplished by using police data, but these are often unreliable in low-income countries. This study aimed to identify hotspots for injuries by collecting geographical data in the emergency room. Methods This was a cross-sectional study of adult road traffic injury patients presenting to the Casualty Department in the central hospital in Lilongwe, the capital of Malawi. An electronic tablet with downloaded maps and satellite photos was used to establish the exact location of the injuries. The geographical data were analyzed with geographic information software. Results We included 1244 road traffic injured patients, of which 23.9% were car passengers or drivers, 18.6% were motorcyclists, 17.8% were pedestrians and 18.0% were cyclists or bicycle passengers. Heatmaps of the injuries identified 5 locations where the incidence of injuries was especially high, and 148 patients were injured in these hotspots during the 90 days of inclusion. Four of these hotspots were along the main road through the capital. Age over 55, rural setting, alcohol use before the injury, high speed limit at the site of injury and being a pedestrian or motorcyclist were significantly associated with a higher degree of injury severity. Around half of the patients that were injured in a four-wheeled vehicle did not use a seat belt, and these patients had a much higher risk of getting a more severe injury. Conclusion We have identified specific locations with a high incidence of road traffic injuries in Lilongwe, Malawi, with a simple methodology and within a short time frame. The study demonstrates the feasibility of collecting geographical data at admission to hospital.

• 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
• Fraser, Alexander Nilsskog; Bøe, Berte Marie Grimsmo; Fjalestad, Tore; Madsen, Jan Erik & Röhrl, Stephan Maximillian (2021). Stable glenoid component of reverse total shoulder arthroplasty at 2 years as measured with model-based radiostereometric analysis (RSA). Acta Orthopaedica. ISSN 1745-3674. 92(6), p. 644–650. doi: 10.1080/17453674.2021.1943932. Full text in Research Archive Show summary

  Background and purpose — Reverse total shoulder arthroplasty (TSA) is used for treating cuff arthropathy, displaced proximal humeral fractures (PHF), and in revision shoulder surgery, despite sparse evidence on long-term results. We assessed stability of the glenoid component in reverse TSA, using model-based RSA. Patients and methods — 20 patients (mean age 76 years, 17 female), operated on with reverse TSA at Oslo University Hospital, in 2015–2017 were included. Indications for surgeries were PHFs, malunion, cuff arthropathy, and chronic shoulder dislocation. RSA markers were placed in the scapular neck, the coracoid, and the acromion. RSA radiographs were conducted postoperatively, at 3 months, 1 year, and 2 years. RSA analysis was performed using RSAcore with Reversed Engineering (RE) modality, with clinical precision < 0.25 mm for all translations (x, y, z) and < 0.7° for rotations (x, z). Scapular “notching” was assessed in conventional radiographs. Results — 1 patient was excluded due to revision surgery. More than half of the patients displayed measurable migration at 2 years: 6 patients with linear translations below 1 mm and 8 patients who showed rotational migration. Except for one outlier, the measured rotations were below 2°. The migration pattern suggested implant stability at 2 years. 10 patients showed radiolographic signs of “notching”, and the mean Oxford Shoulder Score (OSS) at 2 years was 29 points (15–36 points). Interpretation — Stability analysis of the glenoid component of reversed total shoulder arthroplasty using reversed engineering (RE) model-based RSA indicated component stability at 2 years.

• Midtgaard, Kaare Sourin; Søreide, Endre; Brattgjerd, Jan Egil; Moatshe, Gilbert; Madsen, Jan Erik & Flugsrud, Gunnar B (2020). Biomechanical comparison of tension band wiring and plate fixation with locking screws in transverse olecranon fractures. Journal of shoulder and elbow surgery. ISSN 1058-2746. 29(6), p. 1242–1248. doi: 10.1016/j.jse.2020.01.079. Full text in Research Archive Show summary

  Background: Tension band wiring (TBW) is the standard method for treating transverse olecranon fractures, but high rates of complications and reoperations have been reported. Plate fixation (PF) with locking screws has been introduced as an alternative method that may retain the fracture reduction better with a higher load to failure. Methods: Twenty paired cadaveric elbows were used. All soft tissues except for the triceps tendon were removed. A standardized transverse fracture was created, and each pair was allocated randomly to TBW or PF with locking screws. The triceps tendon was mounted to the materials testing machine with the elbow in 90° of flexion. Construct stiffness was compared 3 times. Then, the elbows underwent a chair lift-off test by loading the triceps tendon to 300 N for 500 cycles. Finally, a load-to-failure test was performed, and failure mechanism was recorded. Results: The construct stiffness of PF was higher in the first of 3 measurements. No difference was observed in the cyclic test or in load to failure. Hardware failure was the failure mechanism in 8 of 10 TBW constructs, and all failures occurred directly under the twists of the metal wire. Hardware failure was the cause of failure in only 1 elbow in the PF group (P < .01). Conclusion: There was no difference in fracture displacement following fixation with TBW and PF with locking screws in transverse olecranon fractures. However, assessment of the mode of hardware failure identified the metal cerclage twist as the weakest link in the TBW construct.

• Stødle, Are Haukåen; Hvaal, Kjetil; Brøgger, Helga Maria; Madsen, Jan Erik & Husebye, Elisabeth Ellingsen (2020). Temporary Bridge Plating vs Primary Arthrodesis of the First Tarsometatarsal Joint in Lisfranc Injuries: Randomized Controlled Trial. Foot & ankle international. ISSN 1071-1007. 41(8), p. 901–910. doi: 10.1177/1071100720925815. Full text in Research Archive Show summary

  Background: Unstable Lisfranc injuries are best treated with anatomic reduction and stable fixation. There are controversies regarding which type of stabilization is best. In the present study, we compared primary arthrodesis of the first tarsometatarsal (TMT) joint to temporary bridge plating in unstable Lisfranc injuries. Methods: Forty-eight patients with Lisfranc injuries were included and followed for 2 years. Twenty-four patients were randomized to primary arthrodesis (PA) of the medial 3 TMT joints, whereas 24 patients were randomized to temporary bridge plate (BP) over the first TMT joint and primary arthrodesis of the second and third TMT joints. The main outcome parameter was the American Orthopaedic Foot &amp; Ankle Society (AOFAS) midfoot scale and the secondary outcome parameters were the 36-Item Short Form Health Survey (SF-36) and visual analog scale for pain (VAS pain). Computed tomography (CT) scans pre- and postoperatively were obtained. Radiographs were obtained at follow-ups. Pedobarographic examination was performed at the 2-year follow-up. Twenty-two of 24 patients in the PA and 23/24 in the BP group completed the 2-year follow-up. Results: The mean AOFAS midfoot score 2 years postoperatively was 89 (SD 9) in the PA group and 85 (SD 15) in the BP group ( P = .32). There were no significant differences between the groups with regard to SF-36 or VAS pain scores. The alignment of the first metatarsal was better in the BP group than in the PA group measured by the anteroposterior Meary angle ( P = .04). The PA group had a reduced peak pressure under the fifth metatarsal ( P = .047). In the BP group, 11/24 patients had radiologic signs of osteoarthritis in the first TMT joint. Conclusion: Both treatment groups had good outcome scores. The first metatarsal was better aligned in the BP group; however, there was a high incidence of radiographic osteoarthritis in this group. Level of Evidence: Therapeutic level I, prospective randomized controlled study.

• 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
• 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
• Fraser, Alexander Nilsskog; Bjørdal, Jonas; Wagle, Tone; Karlberg, Anna Cecilia; Lien, Odd Arve & Eilertsen, Lars [Show all 11 contributors for this article] (2020). Reverse shoulder arthroplasty is superior to plate fixation at 2 years for displaced proximal humeral fractures in the elderly: a multicenter randomized controlled trial. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 102(6), p. 477–485. doi: 10.2106/JBJS.19.01071. Full text in Research Archive Show summary

  Almost one-third of patients with proximal humeral fractures are treated surgically, and the number is increasing. When surgical treatment is chosen, there is sparse evidence on the optimum method. The DelPhi (Delta prosthesis-PHILOS plate) trial is a clinical trial comparing 2 surgical treatments. Our hypothesis was that reverse total shoulder arthroplasty (TSA) yields better clinical results compared with open reduction and internal fixation (ORIF) using an angular stable plate. The DelPhi trial is a randomized controlled trial comparing reverse TSA with ORIF for displaced proximal humeral fractures (OTA/AO types 11-B2 and 11-C2) in elderly patients (65 to 85 years of age). The primary outcome measure was the Constant score at a 2-year follow-up. The secondary outcome measures included the Oxford Shoulder Score and radiographic evaluation. Results were reported as the mean difference with 95% confidence interval (CI). The intention-to-treat principle was applied for crossover patients. There were 124 patients included in the study. At 2 years, the mean Constant score was 68.0 points (95% CI, 63.7 to 72.4 points) for the reverse TSA group compared with 54.6 points (95% CI, 48.5 to 60.7 points) for the ORIF group, resulting in a significant mean difference of 13.4 points (95% CI, 6.2 to 20.6 points; p < 0.001) in favor of reverse TSA. When stratified for fracture classification, the mean score was 69.3 points (95% CI, 63.9 to 74.7 points) for the reverse TSA group and 50.6 points (95% CI, 41.9 to 59.2 points) for the ORIF group for type-C2 fractures, which yielded a significant mean difference of 18.7 points (95% CI, 9.3 to 28.2 points; p < 0.001). In the type-B2 fracture group, the mean score was 66.2 points (95% CI, 58.6 to 73.8 points) for the reverse TSA group and 58.5 points (95% CI, 49.6 to 67.4 points) for the ORIF group, resulting in a nonsignificant mean difference of 7.6 points (95% CI, -3.8 to 19.1 points; p = 0.19). At a 2-year follow-up, the data suggested an advantage of reverse TSA over ORIF in the treatment of displaced OTA/AO type-B2 and C2 proximal humeral fractures in elderly patients.

• 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
• Stødle, Are Haukåen; Hvaal, Kjetil; Enger, Martine Merete; Brøgger, Helga Maria; Madsen, Jan Erik & Husebye, Inger Elisabeth Ellingsen (2019). Lisfranc injuries: Incidence, mechanisms of injury and predictors of instability. Foot and Ankle Surgery. ISSN 1268-7731. doi: 10.1016/j.fas.2019.06.002. Full text in Research Archive Show summary

  Background In Lisfranc injuries the stability of the tarsometatarsal joints guides the treatment of the injury. Determining the stability, especially in the subtle Lisfranc injuries, can be challenging. The purpose of this study was to identify incidence, mechanisms of injury and predictors for instability in Lisfranc injuries. Methods Eighty-four Lisfranc injuries presenting at Oslo University Hospital between September 2014 and August 2015 were included. The diagnosis was based on radiologically verified injuries to the tarsometatarsal joints. Associations between radiographic findings and stability were examined. Results The incidence of Lisfranc injuries was 14/100,000 person-years, and only 31% were high-energy injuries. The incidence of unstable injuries was 6/100,000 person–years, and these were more common in women than men (P = 0.016). Intraarticular fractures in the two lateral tarsometatarsal joints increased the risk of instability (P = 0.007). The height of the second tarsometatarsal joint was less in the unstable injuries than in the stable injuries (P = 0.036). Conclusion The incidence of Lisfranc injuries in the present study is higher than previously published. The most common mechanism of injury is low-energy trauma. Intraarticular fractures in the two lateral tarsometatarsal joints, female gender and shorter second tarsometatarsal joint height increase the risk of an unstable injury.

• 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
• Hjorthaug, Geir Aasmund; Søreide, Endre; Nordsletten, Lars; Madsen, Jan Erik; Reinholt, Finn P. & Niratisairak, Sanyalak [Show all 7 contributors for this article] (2019). Short-term perioperative parecoxib is not detrimental to shaft fracture healing in a rat model. Bone and Joint Research. ISSN 2046-3758. 8(10), p. 472–480. doi: 10.1302/2046-3758.810.BJR-2018-0341.R1. Full text in Research Archive
• Reimer, Lisa Cecilie; Jakobsen, Stig; Mortensen, Louise; Dalgas, Ulrik; Jacobsen, Julie Sandell & Søballe, Kjeld [Show all 11 contributors for this article] (2019). Efficacy of periacetabular osteotomy followed by progressive resistance training compared to progressive resistance training as non-surgical treatment in patients with hip dysplasia (PreserveHip) - a protocol for a randomised controlled trial. BMJ Open. 9(12), p. 1–8. doi: 10.1136/bmjopen-2019-032782. Full text in Research Archive Show summary

  Introduction Periacetabular osteotomy (PAO) is an established treatment for adolescent and adult patients with hip dysplasia. However, the efficacy of PAO has not been tested against another surgical intervention or conservative treatment in a randomised controlled trial before. We suggest that progressive resistance training (PRT) could be an alternative to PAO. The primary aim of this trial is therefore to examine the efficacy of PAO followed by 4 months of usual care followed by 8 months of PRT compared to 12 months of solely PRT in patients with hip dysplasia eligible for PAO in terms of patient-reported pain measured by The Copenhagen Hip and Groin Outcome Score (HAGOS). Methods and analysis This trial is a single-blinded multicentre randomised controlled clinical trial, where patients with hip dysplasia, who are eligible for PAO, will be randomised to either PAO followed by usual care and PRT or PRT only. Primary outcome is patient-reported pain, measured on the subscale pain on the HAGOS questionnaire 12 months after initiation of PAO or PRT. The key secondary outcomes are the other subscales of the HAGOS, adverse and serious adverse events, usage of painkillers (yes/no) and type of analgesics. Based on the sample size calculation, the trial needs to include 96 patients. Ethics and dissemination The trial is approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-234-18) and by the Danish Data Protection Agency (Journal No 1-16-02-120-19). The trial is also approved by The Regional Committee for Medical and Health Research Ethics, Region South-East Norway (Ref. 2018/1603). All results from this trial will be published in international peer-reviewed scientific journals regardless of whether the results are positive, negative or inconclusive.

• 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
• Hammer, Ola-Lars; Clementsen, Ståle; Hast, Joakim Aasli; Benth, Jurate Saltyte; Madsen, Jan Erik & Randsborg, Per-Henrik (2019). Volar Locking Plates Versus Augmented External Fixation of Intra-Articular Distal Radial Fractures - Functional Results from a Randomized Controlled Trial. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 101(4), p. 311–321. doi: 10.2106/JBJS.18.00014. Full text in Research Archive
• Lundgreen, Kirsten; Madsen, Jan Erik; KVAKESTAD, RUNE; Dimmen, Sigbjørn & Jenssen, Kjersti Kaul (2018). Prognostic Factors for Functional Outcome After Rotator Cuff Repair: A Prospective Cohort Study With 2-Year Follow-up. American Journal of Sports Medicine. ISSN 0363-5465. 46(14), p. 3463–3470. doi: 10.1177/0363546518803331. Full text in Research Archive
• Jenssen, Kjersti Kaul; Lundgreen, Kirsten; Madsen, Jan Erik; Kvakestad, Rune; Pripp, Are Hugo & Dimmen, Sigbjørn (2018). No functional difference between three and six weeks of immobilization after arthroscopic rotator cuff repair: A Prospective randomized controlled non-inferiority trial. Arthroscopy: The Journal of Arthroscopy And Related. ISSN 0749-8063. 34(10), p. 2765–2774. doi: 10.1016/j.arthro.2018.05.036. Full text in Research Archive
• Isaksen, Kjetil; Roscher, Elin K.; Iversen, Kjetil S.; Eitzen, Ingrid; Clarke-Jenssen, John & Nordsletten, Lars [Show all 7 contributors for this article] (2018). Preoperative incipient osteoarthritis predicts failure after periacetabular osteotomy: 69 hips operated through the anterior intrapelvic approach. HIP International. ISSN 1120-7000. doi: 10.1177/1120700018804786. Full text in Research Archive
• Fraser, Alexander Nilsskog; Tsukanaka, Masako; Fjalestad, Tore; Madsen, Jan Erik & Röhrl, Stephan Maximillian (2018). Model-based RSA is suitable for clinical trials on the glenoid component of reverse total shoulder arthroplasty. Journal of Orthopaedic Research. ISSN 0736-0266. 36(12), p. 3299–3307. doi: 10.1002/jor.24111. Full text in Research Archive
• Hjorthaug, Geir Aasmund; Søreide, Endre; Nordsletten, Lars; Madsen, Jan Erik; Reinholt, Finn P. & Niratisairak, Sanyalak [Show all 7 contributors for this article] (2018). Negative effect of zoledronic acid on tendon-to-bone healing: In vivo study of biomechanics and bone remodeling in a rat model. Acta Orthopaedica. ISSN 1745-3674. 89(3), p. 360–366. doi: 10.1080/17453674.2018.1440189. Full text in Research Archive Show summary

  Background and purpose: Outcome after ligament reconstruction or tendon repair depends on secure tendon-to-bone healing. Increased osteoclastic activity resulting in local bone loss may contribute to delayed healing of the tendon–bone interface. The objective of this study was to evaluate the effect of the bisphosphonate zoledronic acid (ZA) on tendon-to-bone healing. Methods: Wistar rats (n = 92) had their right Achilles tendon cut proximally, pulled through a bone tunnel in the distal tibia and sutured anteriorly. After 1 week animals were randomized to receive a single dose of ZA (0.1 mg/kg IV) or control. Healing was evaluated at 3 and 6 weeks by mechanical testing, dual-energy X-ray absorptiometry and histology including immunohistochemical staining of osteoclasts. Results: ZA treatment resulted in 19% (95% CI 5–33%) lower pullout strength and 43% (95% CI 14–72%) lower stiffness of the tendon–bone interface, compared with control (2-way ANOVA; p = 0.009, p = 0.007). Administration of ZA did not affect bone mineral density (BMD) or bone mineral content (BMC). Histological analyses did not reveal differences in callus formation or osteoclasts between the study groups. Interpretation: ZA reduced pullout strength and stiffness of the tendon–bone interface. The study does not provide support for ZA as adjuvant treatment in tendon-to-bone healing.

• 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
• Clarke-Jenssen, John; Røise, Olav; Øvre, Stein A. & Madsen, Jan Erik (2017). Long-term survival and risk factors for failure of the native hip joint after operatively treated displaced acetabular fractures. The Bone & Joint Journal. ISSN 2049-4394. 99B(6), p. 834–840. doi: 10.1302/0301-620X.99B6.BJJ-2016-1013.R1. Full text in Research Archive Show summary

  Aims Our aim in this study was to describe the long-term survival of the native hip joint after open reduction and internal fixation of a displaced fracture of the acetabulum. We also present long-term clinical outcomes and risk factors associated with a poor outcome. Patients and Methods A total of 285 patients underwent surgery for a displaced acetabular fracture between 1993 and 2005. For the survival analysis 253 were included, there were 197 men and 56 women with a mean age of 42 years (12 to 78). The mean follow-up of 11 years (1 to 20) was identified from our pelvic fracture registry. There were 99 elementary and 154 associated fracture types. For the long-term clinical follow-up, 192 patients with complete data were included. Their mean age was 40 years (13 to 78) with a mean follow-up of 12 years (5 to 20). Injury to the femoral head and acetabular impaction were assessed with CT scans and patients with an ipsilateral fracture of the femoral head were excluded. Results A total of 36 patients underwent total hip arthroplasty (THA). The overall ten-year survival of the hip joint was 86% (95% confidence interval (CI) 81% to 90%) and the 20-year survival was 82% (95% CI 76% to 87%). Injury to the femoral head and acetabular impaction were the strongest predictors of failure, with the long-term survival rate falling towards 50% in these patients. The survival fell to 0% at three years when both these risk factors were present in patients aged > 60 years. Conclusion The long-term survival of the native hip joint after acetabular fractures was good, but the presence of injury to the femoral head and acetabular impaction proved to be strong predictors of failure, especially in patients aged > 60 years. These patients may be better treated with a combination of open reduction and internal fixation and primary arthroplasty.

• Svenøy, Stian; WESTBERG, MARIANNE; Figved, Wender; Valland, Haldor; Brun, Ole-Christian Laahne & Wangen, Helge [Show all 8 contributors for this article] (2017). Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: Early complications in a prospective cohort of 583 patients. Injury. ISSN 0020-1383. 48(7), p. 1565–1569. doi: 10.1016/j.injury.2017.03.024. Full text in Research Archive
• Clarke-Jenssen, John; Westberg, Marianne; Røise, Olav; Storeggen, Stein Arne Øvre; Bere, Tone Tufte & Silberg, Inger Elisabeth [Show all 7 contributors for this article] (2017). Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures. Injury. ISSN 0020-1383. 48(11), p. 2534–2539. doi: 10.1016/j.injury.2017.08.071. Full text in Research Archive Show summary

  Background Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures. Methods We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1–14.1) years after an operatively treated acetabular fracture. The median age was 54 (11–82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years. Results Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre. Conclusion Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present. Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures. Clarke-Jenssen J, Westberg M, Røise O, Storeggen SAØ, Bere T, Silberg I, Madsen JE. Injury. 2017 Nov;48(11):2534-2539. © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license.

• Jenssen, Kjersti Kaul; Lundgreen, Kirsten; Madsen, Jan Erik & Dimmen, Sigbjørn (2017). Targeted intervention of acute postoperative infection after rotator cuff repair results in good functional outcomes. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 26(1), p. 285–291. doi: 10.1007/s00167-017-4743-z. Full text in Research Archive
• Nerhus, Tor Kjetil; Ekeland, Arne Erling; Solberg, Geir; Olsen, Birgitte Holt; Madsen, Jan Erik & Heir, Stig (2017). No difference in time-dependent improvement in functional outcome following closing wedge versus opening wedge high tibial osteotomy. The Bone & Joint Journal. ISSN 2049-4394. 99B(9), p. 1157–1166. doi: 10.1302/0301-620X.99B9.BJJ-2017-0062.R1. Full text in Research Archive
• Adelved, Aron; Töttermann, Anna; Glott, Thomas; Hellund, Johan Castberg; Madsen, Jan Erik & Røise, Olav (2016). Long-term functional outcome after traumatic lumbosacral dissociation. A retrospective case series of 13 patients. Injury. ISSN 0020-1383. 47(7), p. 1562–1568. doi: 10.1016/j.injury.2016.04.006. Full text in Research Archive
• Clarke-Jenssen, John; Wikerøy, Annette Konstanse Bordewich; Røise, Olav; Øvre, Stein A. & Madsen, Jan Erik (2016). Long-term survival of the native hip after a minimally displaced, nonoperatively treated acetabular fracture. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 98(16), p. 1392–1399. doi: 10.2106/JBJS.15.01154. Full text in Research Archive
• Gaski, Iver Anders; Barckman, Jeppe; Næss, Pål Aksel; Skaga, Nils Oddvar; Madsen, Jan Erik & Kløw, Nils-Einar [Show all 8 contributors for this article] (2016). Reduced need for extraperitoneal pelvic packing for severe pelvic fractures is associated with improved resuscitation strategies. Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 81(4), p. 644–651. doi: 10.1097/TA.0000000000001139. Full text in Research Archive
• Stake, Ingrid Kvello; Madsen, Jan Erik; Hvaal, Kjetil; Johnsen, Elena & Husebye, Elisabeth Ellingsen (2016). Surgically treated talar fractures. A retrospective study of 50 patients. Foot and Ankle Surgery. ISSN 1268-7731. 22(2), p. 85–90. doi: 10.1016/j.fas.2015.05.005. Full text in Research Archive
• ANDERSEN, METTE RENATE; Frihagen, Frede Jon; Madsen, Jan Erik & Figved, Wender (2015). High complication rate after syndesmotic screw removal. Injury. ISSN 0020-1383. 46(11), p. 2283–2287. doi: 10.1016/j.injury.2015.08.021. Full text in Research Archive
• Nerhus, Tor Kjetil; Ekeland, Arne Erling; Solberg, Geir; Sivertsen, Einar Andreas; Madsen, Jan Erik & Heir, Stig (2015). Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. p. 1–8. doi: 10.1007/s00167-015-3817-z. Full text in Research Archive
• Clarke-Jenssen, John; Øvre, Stein A.; Røise, Olav & Madsen, Jan Erik (2015). Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous? Archives of Orthopaedic and Trauma Surgery. ISSN 0936-8051. 135(7), p. 913–918. doi: 10.1007/s00402-015-2223-9. Full text in Research Archive
• Hjorthaug, Geir Aasmund; Madsen, Jan Erik; Nordsletten, Lars; Reinholt, Finn P.; Steen, Harald & Dimmen, Sigbjørn (2015). Tendon to bone tunnel healing - A study on the time-dependent changes in biomechanics, bone remodeling, and histology in a rat model. Journal of Orthopaedic Research. ISSN 0736-0266. 33(2), p. 216–223. doi: 10.1002/jor.22756. Full text in Research Archive
• Audigè, Laurent; Kellam, Jim; Lambert, Simon; Madsen, Jan Erik; Babst, Reto & Andermahr, Jonas [Show all 8 contributors for this article] (2014). The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement. Journal of shoulder and elbow surgery. ISSN 1058-2746. 23(2), p. 189–196. doi: 10.1016/j.jse.2013.07.040. Full text in Research Archive
• Langslet, Ellen; Frihagen, Frede Jon; Opland, Vidar; Madsen, Jan Erik; Nordsletten, Lars & Figved, Wender (2014). Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures: 5-year Followup of a Randomized Trial. Clinical Orthopaedics and Related Research. ISSN 0009-921X. 472(4), p. 1291–1299. doi: 10.1007/s11999-013-3308-9. Full text in Research Archive
• Støen, Ragnhild Øydna; Lofthus, Cathrine Marie; Nordsletten, Lars; Madsen, Jan Erik & Frihagen, Frede Jon (2014). Randomized trial of hemiarthroplasty versus internal fixation for femoral neck fractures: no differences at 6 years. Clinical Orthopaedics and Related Research. ISSN 0009-921X. 472(1), p. 360–367. doi: 10.1007/s11999-013-3245-7. Full text in Research Archive
• Adelved, Aron; Tötterman, Anna; Glott, Thomas; Søberg, Helene L.; Madsen, Jan Erik & Røise, Olav (2014). Patient-reported health minimum 8 years after operatively treated displaced sacral fractures: A prospective cohort study. Journal of Orthopaedic Trauma. ISSN 0890-5339. 28(12), p. 686–693. doi: 10.1097/BOT.0000000000000242. Full text in Research Archive
• Adelved, Aron; Tötterman, Anna; Hellund, Johan Castberg; Glott, Thomas; Madsen, Jan Erik & Røise, Olav (2014). Radiological findings correlate with neurological deficits but not with pain after operatively treated sacral fractures. An 11-year follow-up study of 28 patients. Acta Orthopaedica. ISSN 1745-3674. 85(4), p. 408–414. doi: 10.3109/17453674.2014.908344. Full text in Research Archive
• Fjalestad, Tore; Iversen, Petter; Hole, Margrethe Øye; SMEDSRUD, MORTEN & Madsen, Jan Erik (2014). Clinical investigation for displaced proximal humeral fractures in the elderly: a randomized study of two surgical treatments: reverse total prosthetic replacement versus angular stable plate Philos (The DELPHI-trial). BMC Musculoskeletal Disorders. 15(1), p. 323–323. doi: 10.1186/1471-2474-15-323. Full text in Research Archive Show summary

  Background Treatment for displaced proximal humeral fractures is still under debate. Few studies exist at the highest level of evidence. Although reversed total shoulder prosthesis has gained popularity and showed promising results in the treatment for proximal humeral fractures in the elderly patients, no randomized controlled trials exist to the authors’ knowledge. Methods/Design This study is a randomized semi-blinded controlled multicenter trial designed according to the Consort statement and the recommendations given by the Cochrane reviewers for proximal humeral fractures. The study will investigate whether a reversed total shoulder prosthetic replacement gain better functional outcome compared to open reduction and internal fixation using an angular stable plate in displaced three- and four parts proximal humeral fractures after two and five years follow-up. Participants are aged 65–85 admitted in seven different hospitals with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2. The intervention group is surgical treatment using a reversed total shoulder prosthesis (Delta X-tend) compared to open reduction and internal fixation with an angular stable plate (Philos) and thread cerclage in the control group. 60 patients will be randomized to each group. The primary outcome is shoulder function (Constant score). Secondary outcomes will be patient self-assessment form (Oxford shoulder score), a quality of life questionnaire (15D score) and resource implications (cost-effectiveness). Follow-ups take place at 3, 6, 12 and 24 months, and five years. The trial design is semi-blinded with blinded physiotherapists performing the functional testing of patients at all follow-ups. Randomization to treatment groups is electronic online, by independent supervisor (web-CRF). The recruitment of patients started at January 1.st 2013. Inclusion of 120 patients during three years is expected. Discussion This semiblinded trial include a high number of patients compared to existing randomized trials in this field. To our knowledge and according to ClinicalTrials.gov, this is the first study that compare these two treatments for a displaced proximal humeral fracture in elderly patients. This may provide important information to help the surgeon to decide the best treatment in the future. Trial registration number ClinicalTrials.gov Identifier: NCT01737060

• Jaeger, Martin; Lambert, Simon; Südkamp, Norbert P.; Kellam, James F.; Madsen, Jan Erik & Babst, Reto [Show all 9 contributors for this article] (2013). The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on glenoid fossa involvement. Journal of shoulder and elbow surgery. ISSN 1058-2746. 22(4), p. 512–520. doi: 10.1016/j.jse.2012.08.003. Full text in Research Archive
• Lambert, S.; Kellam, James F.; Jaeger, M.; Madsen, Jan Erik; Babst, Reto & Andermahr, Jonas [Show all 8 contributors for this article] (2013). Focussed classification of scapula fractures: Failure of the lateral scapula suspension system. Injury. ISSN 0020-1383. 44(11), p. 1507–1513. doi: 10.1016/j.injury.2013.03.001. Full text in Research Archive
• Nerhus, Tor Kjetil; Heir, Stig; Svege, Ida Charlott; Skråmm, Inge; Jervidalo, Tore & Madsen, Jan Erik [Show all 7 contributors for this article] (2012). Time-dependent improvement in functional outcome following Oxford medial unicompartmental knee arthroplasty A prospective longitudinal multicenter study involving 96 patients. Acta Orthopaedica. ISSN 1745-3674. 83(1), p. 46–52. doi: 10.3109/17453674.2011.652890. Full text in Research Archive
• Husebye, Inger Elisabeth Ellingsen; Lyberg, Torstein; Opdahl, Helge; Aspelin, Trude; Støen, Ragnhild Øydna & Madsen, Jan Erik [Show all 7 contributors for this article] (2012). Intramedullary nailing of femoral shaft fractures in polytraumatized patients. A longitudinal, prospective and observational study of the procedure-related impact on cardiopulmonary- and inflammatory responses. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 20. doi: 10.1186/1757-7241-20-2. Full text in Research Archive Show summary

  Background Early intramedullary nailing (IMN) of long bone fractures in severely injured patients has been evaluated as beneficial, but has also been associated with increased inflammation, multi organ failure (MOF) and morbidity. This study was initiated to evaluate the impact of primary femoral IMN on coagulation-, fibrinolysis-, inflammatory- and cardiopulmonary responses in polytraumatized patients. Methods Twelve adult polytraumatized patients with femoral shaft fractures were included. Serial blood samples were collected to evaluate coagulation-, fibrinolytic-, and cytokine activation in arterial blood. A flow-directed pulmonary artery (PA) catheter was inserted prior to IMN. Cardiopulmonary function parameters were recorded peri- and postoperatively. The clinical course of the patients and complications were monitored and recorded daily. Results Mean Injury Severity Score (ISS) was 31 ± 2.6. No procedure-related effect of the primary IMN on coagulation- and fibrinolysis activation was evident. Tumor necrosis factor alpha (TNF-α) increased significantly from 6 hours post procedure to peak levels on the third postoperative day. Interleukin-6 (IL-6) increased from the first to the third postoperative day. Interleukin-10 (IL-10) peaked on the first postoperative day. A procedure-related transient hemodynamic response was observed on indexed pulmonary vascular resistance (PVRI) two hours post procedure. 11/12 patients developed systemic inflammatory response syndrome (SIRS), 7/12 pneumonia, 3/12 acute lung injury (ALI), 3/12 adult respiratory distress syndrome (ARDS), 3/12 sepsis, 0/12 wound infection. Conclusion In the polytraumatized patients with femoral shaft fractures operated with primary IMN we observed a substantial response related to the initial trauma. We could not demonstrate any major additional IMN-related impact on the inflammatory responses or on the cardiopulmonary function parameters. These results have to be interpreted carefully due to the relatively few patients included. Trial Registration ClinicalTrials.gov: NCT00981877

• Adelved, Aron; Tötterman, Anna; Glott, Thomas; Madsen, Jan Erik & Røise, Olav (2012). Functional outcome 10 years after surgical treatment of displaced sacral fractures. Spine. ISSN 0362-2436. 37(16), p. E1009–E1016. doi: 10.1097/BRS.0b013e31823a0d83. Full text in Research Archive
• Figved, Wender; Dahl, Jon; Snorrason, Finnur; Frihagen, Frede Jon; Röhrl, Stephan Maximillian & Madsen, Jan Erik [Show all 7 contributors for this article] (2012). Radiostereometric analysis of hemiarthroplasties of the hip - a highly precise method for measurements of cartilage wear. Osteoarthritis and Cartilage. ISSN 1063-4584. 20(1), p. 36–42. doi: 10.1016/j.joca.2011.11.006. Full text in Research Archive
• Harvey, Edward; Audige, Laurent; Herscovici, Dolfi Jr; Agel, Julie; Madsen, Jan Erik & Babst, Reto [Show all 8 contributors for this article] (2012). Development and Validation of the New International Classification for Scapula Fractures. Journal of Orthopaedic Trauma. ISSN 0890-5339. 26(6), p. 364–369. doi: 10.1097/BOT.0b013e3182382625. Full text in Research Archive
• Wikerøy, Annette Konstanse Bordewich; Clarke-Jenssen, John; Øvre, Stein A.; Nordsletten, Lars; Madsen, Jan Erik & Hellund, Johan Castberg [Show all 7 contributors for this article] (2012). The natural history of bone bruise and bone remodelling in the traumatised hip A prospective 2-year follow-up study of bone bruise changes and DEXA measurements in 13 patients with conservatively treated traumatic hip dislocations and/or fractures. Injury. ISSN 0020-1383. 43(10), p. 1672–1677. doi: 10.1016/j.injury.2012.05.025. Full text in Research Archive
• Bjørnelv, Gudrun Maria Waaler; Frihagen, Frede Jon; Madsen, Jan Erik; Nordsletten, Lars & Aas, Eline (2012). Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial. Osteoporosis International. ISSN 0937-941X. 23(6), p. 1711–1719. doi: 10.1007/s00198-011-1772-1. Full text in Research Archive
• Madsen, Jan Erik; Frihagen, Frede Jon & Flugsrud, Gunnar B (2010). Optimal ortopedisk behandling av den hardt skadde pasienten. Kirurgen. ISSN 1504-8888. p. 146–149. Full text in Research Archive
• Nerhus, Tor Kjetil; Heir, Stig; Thornes, Elisabeth; Madsen, Jan Erik & Ekeland, Arne Erling (2010). Time-dependent improvement in functional outcome following LCS rotating platform knee replacement. Acta Orthopaedica. ISSN 1745-3674. 81(6), p. 727–732. doi: 10.3109/17453674.2010.533929. Full text in Research Archive
• Frihagen, Frede Jon; Figved, Wender; Madsen, Jan Erik; Lofthus, Cathrine Marie; Støen, Ragnhild Øydna & Nordsletten, Lars (2010). Behandling av lårhalsbrudd :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(16), p. 1614–1617. doi: 10.4045/tidsskr.09.1264. Full text in Research Archive

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• Midtgaard, Kaare Sourin; Madsen, Jan Erik & Alm, Carl Erik (2019). 2019: Høstmøteboken - vitenskapelig program og abstrakter. Norsk Ortopedisk Forening. ISBN 9788299427517. 236 p. Full text in Research Archive

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• 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.

• Wünsche, Leonore; Brattgjerd, Jan Egil; Halvorsen, Vera Baasland & Madsen, Jan Erik (2021). Nerveskader ved krysspinning av suprakondylære humerusfrakturer hos barn - en retrospektiv studie. Full text in Research Archive
• Stake, Ingrid Kvello; Brady, Alex; Bryniarski, Anna; Dornan, Grant; Madsen, Jan Erik & Engebretsen, Lars [Show all 8 contributors for this article] (2021). The impact of posterior malleolar fixation on syndesmotic stability. Full text in Research Archive
• Midtgaard, Kaare Sourin; Søreide, Endre; Moatshe, Gilbert; Brattgjerd, Jan Egil; Steen, Harald & Madsen, Jan Erik [Show all 7 contributors for this article] (2018). Biomekanisk studie av pinner og tensjonsbånd vs. moderne plateosteosyntese ved to-parts olecranonfraktur. Full text in Research Archive
• Paulsrud, Øyvind & Madsen, Jan Erik (2015). Reponering og implantatvalg. In Matre, Kjell & Hole, Randi Margrete (Ed.), Bruddbehandling. Legeforlaget AS. ISSN 9788292934111. p. 66–77. Full text in Research Archive
• Hole, Randi Margrete & Madsen, Jan Erik (2015). Humerus skaftfrakturer. In Matre, Kjell & Hole, Randi Margrete (Ed.), Bruddbehandling. Legeforlaget AS. ISSN 9788292934111. p. 146–151. Full text in Research Archive
• Madsen, Jan Erik (2015). Bekkenfrakturer. In Matre, Kjell & Hole, Randi Margrete (Ed.), Bruddbehandling. Legeforlaget AS. ISSN 9788292934111. p. 206–214. Full text in Research Archive
• Svenøy, Stian; Brattgjerd, Jan Egil; WESTBERG, MARIANNE; Madsen, Jan Erik; Nordsletten, Lars & Frihagen, Frede (2014). Preoperativ liggetid for hofebrudd operert ved Oslo universitetssykehus. Full text in Research Archive
• Adelved, Aron; Tötterman, Anna; Glott, Thomas; Søberg, Helene L.; Madsen, Jan Erik & Røise, Olav (2013). Patient-reported health 10 years after operatively treated displaced sacral fractures. Full text in Research Archive
• Adelved, Aron; Tötterman, Anna; Glott, Thomas; Søberg, Helene L.; Madsen, Jan Erik & Røise, Olav (2013). Patient-Reported Health After Operatively Treated Displaced Sacral Fractures: A 10-Year Follow-Up. Full text in Research Archive
• Adelved, Aron; Tötterman, Anna; Glott, Thomas; Søberg, Helene L.; Madsen, Jan Erik & Røise, Olav (2013). Patient-reported health 10 years after displaced sacral fractures treated with internal fixation. Full text in Research Archive
• Adelved, Aron; Tötterman, Anna; Glott, Thomas; Søberg, Helene L.; Madsen, Jan Erik & Røise, Olav (2013). Patient-reported health after operatively treated displaced sacral fractures: a 10-year follow-up. Full text in Research Archive
• Frihagen, Frede Jon; Madsen, Jan Erik; Nordsletten, Lars; Lofthus, Cathrine Marie & Støen, Ragnhild Øydna (2013). HEMIARTHROPLASTY OR INTERNAL FIXATION FOR DISPLACED FEMORAL NECK FRACTURES IN THE ELDERLY: 6 YEAR FOLLOW UP OF AN RCT. Osteoporosis International. ISSN 0937-941X. 24, p. S135–S135. Full text in Research Archive
• Brattgjerd, Jan Egil; Frihagen, Frede & Madsen, Jan Erik (2013). Preoperativ liggetid ved hoftebrudd operert ved Oslo universitetssykehus i 2012. Full text in Research Archive
• Adelved, Aron; Tötterman, Anna; Glott, Thomas; Madsen, Jan Erik & Røise, Olav (2011). Long-Term Outcome After Displaced Sacral Fractures Treated With Internal Fixation. Full text in Research Archive
• Madsen, Jan Erik (2010). Treatment of displaced intracapsular hip fractures in older patients. BMJ. British Medical Journal. ISSN 0959-8146. 340. doi: 10.1136/bmj.c2810. Full text in Research Archive
• Frihagen, Frede Jon; Figved, Wender; Madsen, Jan Erik; Lofthus, Cathrine Marie; Støen, Ragnhild Øydna & Nordsletten, Lars (2010). F. Frihagen og medarbeidere svarer: :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(20), p. 2011–2011. Full text in Research Archive

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