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Distal biceps tendon rupture is a relatively rare injury usually occurring with excess external extension force applied to a flexed elbow. The aim of this study was to examine the incidence of distal biceps tendon rupture surgery in the Finnish and Swedish adult population between the years 1997 and 2016. A secondary aim was to investigate the distal biceps rupture incidence in the Swedish population in 2001 to 2016. We assessed the number and rate of distal biceps tendon rupture surgery using the Finnish and Swedish Hospital Discharge Register as databases. The study included the entire Finnish and Swedish adult population aged 18 years and older between January 1, 1997 and of December 31, 2016. During the study period, 2,029 patients had a distal biceps tendon rupture in Finland, and the corresponding figure was 2,000 in Sweden. The rate of distal biceps tendon rupture surgery increased steeply, but equally, in both countries, in Finnish men from 1.3 per 100,000 person-years in 1997 to 9.6 in 2016, and in Swedish men from 0.2 in 1997 to 5.6 in 2016. The incidence of distal biceps tendon rupture in Sweden increased in men from 1.6 to 10.0 per 100,000 person-years from 2001 to 2016. There was a 7-fold and a 28-fold increase in the incidence of distal biceps tendon rupture surgery in Finnish and Swedish men during 1997 to 2016. The incidence of distal biceps tendon rupture rose 6-fold in Swedish men in 2001 to 2016. Prognostic IV. [ABSTRACT FROM AUTHOR]

Abstract: Rasch A, Dalén N, Berg HE. Test methods to detect hip and knee muscle weakness and gait disturbance in patients with hip osteoarthritis. Objective: To evaluate test methods for hip and knee muscle weakness and gait disturbance. Design: Test-retest. Setting: Orthopedic university clinic. Participants: Ten young (age, 36±6y) and 13 elderly (age, 69±8y) healthy volunteers and 11 patients (age, 69±8y) with unilateral hip osteoarthritis (OA) were tested for muscular strength. Twenty-five volunteers (age, 42±14y) underwent gait analysis. Interventions: A dynamometer assessing maximal voluntary isometric force of hip and knee muscles and an optosensor walkway detecting limp were developed. Tests evaluated reproducibility and tolerance in patients with OA and elderly subjects. Main Outcome Measures: Relative coefficient of variation (CV%) and force (in newtons). Results: CV% for unilateral strength measurements ranged from 7% to 12% for specific muscle groups. CV% for gait parameters ranged from 4% to 8%, except for the double-support phase. Tests were well tolerated, and no patient had to discontinue because of fatigue. Differences related to sex, age, and disease were detected. Conclusions: Our dynamometer system provides reliable measurements of hip and knee muscle strength in young and old people, and variation is comparable to previous data. Our photocell technique for gait analysis is reliable in people with normal gait. Both methods are attractive because they are affordable, nonstationary, and easy to use. [Copyright &y& Elsevier]

Background: Fractures of the pelvis and acetabulum are major injuries, often associated with hospitalization, reduced function and sometimes life-threatening conditions. Current data on nationwide incidence and treatment is sparse. Existing epidemiological studies are either single-centered or investigating only in-patients. The aim of this study was to investigate the epidemiology and treatment of pelvic and acetabular fractures in a nationwide register study including all adult patients in Sweden during 2001-2016.Methods: We used the Swedish National Patient Register to collect data on the entire Swedish population aged ≥18 years from 2001 to 2016. Variables included age, gender, fracture type and treatment.Results: We found a total of 87,308 pelvic and acetabular fractures (71% females) in Sweden during the 16-year study period and the incidence increased from 64 to 80 per 100,000 person-years from 2001 to 2016. The incidence of pelvic fractures increased from 58 to 73 per 100,000 person-years and the majority of the patients (74%) were female. The incidence of acetabular fracture increased from 8.7 to 11 per 100,000 person years and the majority of the patients (58%) were male. Only 2.0% of all patients with a pelvic fracture were treated surgically, as compared to 15% for acetabular fractures. The rate of surgical treatment was higher for males compared to females for both pelvic (4.4 and 1.2% respectively) and acetabular (19 and 10% respectively) fractures.Conclusion: The incidence of pelvic and acetabular fractures increased markedly in Sweden from 2001-2016. Pelvic fractures were more common among females and acetabular among males. The surgical rate was higher for acetabular compared to pelvic fractures. Major gender differences in treatment choices were found with higherproportion of men treated surgically for both fracture types, and in all age groups. [ABSTRACT FROM AUTHOR]

• All the developed machine learning models outperformed TRISS in predicting 30-day mortality among severely injured trauma patients. • The eXtreme Gradient Boosting model was the most successful predictive model. • Head injuries were a risk factor for mortality. • The average Respiratory rate did not differ much between the surviving and mortality groups. Given the huge impact of trauma on hospital systems around the world, several attempts have been made to develop predictive models for the outcomes of trauma victims. The most used, and in many studies most accurate predictive model, is the "Trauma Score and Injury Severity Score" (TRISS). Although it has proven to be fairly accurate and is widely used, it has faced criticism for its inability to classify more complex cases. In this study, we aimed to develop machine learning models that better than TRISS could predict mortality among severely injured trauma patients, something that has not been studied using data from a nationwide register before. Patient data was collected from the national trauma register in Sweden, SweTrau. The studied period was from the 1st of January 2015 to 31st of December 2019. After feature selection and multiple imputation of missing data three machine learning (ML) methods (Random Forest, eXtreme Gradient Boosting, and a Generalized Linear Model) were used to create predictive models. The ML models and TRISS were then tested on predictive ability for 30-day mortality. The ML models were well-calibrated and outperformed TRISS in all the tested measurements. Among the ML models, the eXtreme Gradient Boosting model performed best with an AUC of 0.91 (0.88–0.93). This study showed that all the developed ML-based prediction models were superior to TRISS for the prediction of trauma mortality. [ABSTRACT FROM AUTHOR]

Abstract: The flywheel exercise device (FWED) is planned for use as an in-flight exercise system, to demonstrate its efficacy as a countermeasure device to prevent muscle atrophy, bone loss and impairment of muscle function in human beings in response to long duration spaceflight. It is intended to be used on the International Space Station (ISS) and will be launched by the European cargo carrier, the automated transfer vehicle (ATV) in late 2005. The FWED is a non-gravity-dependent mechanical device based on the Yo–Yo principle, which provides resistance during coupled concentric and eccentric muscle actions, through the inertia of a spinning flywheel. Currently, the development of a FWED Flight and Ground Model is in progress and is due to be completed in May 2004. An earlier developed prototype is available that has been used for various ground studies. Our FWED design provides a maximum of built-in safety and support to the operation by one astronaut. This is achieved in particular by innovative mechanical design features and an easy, safe to use man–machine interface. The modular design is optimized for efficient set-up and maintenance operations to be performed in orbit by the crew. The mechanical subsystem of the FWED includes a disturbance suspension, which minimizes the mechanical disturbances of the exercising subject at the mechanical interface to the ISS. During the FWED operation the astronaut is guided through the exercises by the data management subsystem, which acquires sensor data from the FWED, calculates and displays real-time feedback to the subject, and stores all data on hard disk and personalized storage media for later scientific analysis. [Copyright &y& Elsevier]

Abstract The study compared the centre of pressure measurements (COP) and vertical ground reaction forces (vGRF) from a pressure insole system to that from force plates (FP) during two flywheel quadriceps resistance exercises: leg press and squat. The comparison was performed using a motion capture system and simultaneous measurements of COP and vGRF from FP and insoles. At lower insole-vGRF (<250 N/insole) COP accuracy deteriorated and those data were excluded from further analysis. The insoles systematically displaced the COP slightly posteriorly and medially compared to the FP measurements. Pearson's coefficient of correlation (r) between insole- and FP-COP showed good agreement in both the anteroposterior (squat: r = 0.96, leg press: r = 0.97) and mediolateral direction (squat: r = 0.84, leg press: r = 0.90), whereas the root-mean-square errors (RMSE) were lower in the mediolateral (squat: 3.9 mm, leg press: 4.5 mm) than the anteroposterior (squat and leg press: 11.8 mm) direction. Vertical GRF was slightly overestimated by the insoles in leg press and RMSE were greater in leg press (8% of peak force) than in squat (6%). Overall, results were within the range of previous studies performed on gait. The strong agreement between insole and FP measurements indicates that insoles may replace FPs in field applications and biomechanical computations during resistance exercise, provided that the applied force is sufficient. [ABSTRACT FROM AUTHOR]

Although distal radius fracture (DRF) is the most common fracture type in children, research on its seasonality across different age groups is limited. We investigated secular trends in incidence and seasonal variation of pediatric DRF based on Swedish nationwide population database. In this observational study, data for all children aged <18 years in Sweden with DRF defined by ICD-codes were analyzed for each month and each year during 2002–2016 using the Swedish National Patient Register. The general population counts for each age and sex-category were acquired to evaluate population at risk for each period. We calculated the age standardized and sex specific annual incidence rates, seasonal incidence rates, and monthly incidence rates and analyzed the seasonal variation in the mechanisms of injury. A total of 155,891 DRF cases were identified. The age standardized and sex specific incidence rate was 531 (95%CI 528–533) per 100,000 patient years at risk. Fracture risk was highest during summer and lowest in the winter. The highest seasonal variation was observed among boys 2- < 5 years. The crude incidence rate and the age-standardized incidence rates in winter significantly decreased between 2002 and 2016 (annual percentage change, −2 %). We found significant seasonal variation in DRF among all age groups in Swedish children. The findings can help in developing strategies to prevent fractures as well as in allocating medical and social resources. • The incidence of distal radius fractures in children showed a seasonal variation. • The incidence in Swedish children was higher in summer and lower in winter. • Annual changes showed a downward trend from 2002 to the early 2010s. • Only in the winter season did it decline significantly from 2002 to 2016. [ABSTRACT FROM AUTHOR]

Older adults are encouraged to engage in multicomponent physical activity, which includes aerobic and muscle-strengthening activities. The current work is an extension of the Vitality, Independence, and Vigor in the Elderly 2 (VIVE2) study – a 6-month multicenter, randomized, placebo-controlled trial of physical activity and nutritional supplementation in community dwelling 70-year-old seniors. Here, we examined whether the magnitude of changes in muscle size and quality differed between major lower-extremity muscle groups and related these changes to functional outcomes. We also examined whether daily vitamin-D-enriched protein supplementation could augment the response to structured physical activity. Forty-nine men and women (77 ± 5 yrs) performed brisk walking, muscle-strengthening exercises for the lower limbs, and balance training 3 times weekly for 6 months. Participants were randomized to daily intake of a nutritional supplement (20 g whey protein + 800 IU vitamin D), or a placebo. Muscle cross-sectional area (CSA) and radiological attenuation (RA) were assessed in 8 different muscle groups using single-slice CT scans of the hip, thigh, and calf at baseline and after the intervention. Walking speed and performance in the Short Physical Performance Battery (SPPB) were also measured. For both CSA and RA, there were muscle group × time interactions (P < 0.01). Significant increases in CSA were observed in 2 of the 8 muscles studied, namely the knee extensors (1.9%) and the hip adductors (2.8%). For RA, increases were observed in 4 of 8 muscle groups, namely the hip flexors (1.1 HU), hip adductors (0.9 HU), knee extensors (1.2 HU), and ankle dorsiflexors (0.8 HU). No additive effect of nutritional supplementation was observed. While walking speed (13%) and SPPB performance (38%) improved markedly, multivariate analysis showed that these changes were not associated with the changes in muscle CSA and RA after the intervention. We conclude that this type of multicomponent physical activity program results in significant improvements in physical function despite relatively small changes in muscle size and quality of some, but not all, of the measured lower extremity muscles involved in locomotion. • The effects of physical activity on muscle size (CSA) and density (RA) of multiple lower extremity muscles were studied • Structured physical activity resulted in small changes in CSA and RA of several, but not all, lower extremity muscles • Marked improvements in physical function were noted that could not be explained by changes in CSA or RA • A protein- and vitamin D-enriched nutritional supplement did not enhance muscle-specific adaptations to this program [ABSTRACT FROM AUTHOR]

Declining trends of hip fracture incidence in dialysis patients were reported from USA and Japan while studies from Europe are lacking. We investigated trends in hip fracture incidence and subsequent mortality in Swedish dialysis patients, comparing with the Swedish general population. We used the population-based Swedish national database of fractures and the Swedish National Renal Registry to retrieve data on hip fractures incidence and subsequent mortality for years 2007–2016. Trends for age-standardized hip fracture incidence rate (ASR hip fracture) and age-standardized 30-day (ASMR 30day) and 180-day (ASMR 180day) post-hip fracture mortality rate in Swedish general population were evaluated by joinpoint regression analysis. Standardized incidence ratios of hip fracture (SIR) and standardized mortality ratios (SMR) were calculated for Swedish dialysis patients. In the general population, ASR hip fracture declined significantly: in women from 2007 and in men from 2009. In dialysis patients, SIR was 3–5 times higher compared to the general population and declined over time in women but not in men. In general population, mortality (ASMR 30day and ASMR 180day) declined significantly in women and men. In dialysis patients, post-fracture mortality (SMR, mainly for 180-day mortality) remained two-fold higher than in general population with no consistent trend towards improvement. Hip fracture incidence and subsequent mortality fell among women and men in the Swedish general population. In dialysis patients, hip fracture incidence declined in women but not in men while post-fracture mortality did not improve, and the incidence and subsequent mortality remained 3 to 5-fold and 2-fold higher than in the general population. • This is the first study from Europe describing trends in hip fracture incidence and subsequent mortality in dialysis patients. • Hip fracture incidence and subsequent mortality fell in the Swedish general population. • In dialysis patients, the incidence declined in women but not in men. • Post-fracture mortality did not improve, and the incidence and subsequent mortality remained higher than in the general population. [ABSTRACT FROM AUTHOR]

Major fractures (MF) are associated with increased mortality in the general population and represent an even higher risk in patients with chronic kidney disease. We investigated incidence, predictors and clinical outcomes associated with first MF (MF first) following kidney transplantation (KT). We used the Swedish National Renal Registry of 3992 first KT recipients (2005–2016) (median age 53 years, 65% men) and identified all MF first in hip, spine, humerus and forearm following KT. We estimated incidence rates and predictors of MF first using flexible parametric hazard models and Fine-Gray analysis accounting for competing risk of death, and risk of all-cause mortality following MF first using Cox proportional hazards models with fracture as time-varying exposure. During median follow-up of 4.8 years (IQR 2.2–7.9 years), there were 279 fractures of which 139 were forearm fractures. The crude incidence rate of MF first (n = 279) was 13.5/1000 patient-years and that of hip fractures (n = 69) 3.4/1000 patient-years. The multivariate-adjusted fracture incidence rates were highest during the first 6 months following KT, and 86% higher in women than in men. High age, female sex, previous history of MF, diabetes nephropathy, pretransplant dialysis therapy and acute rejection were associated with increased risk for MF first , whereas pre-emptive KT was associated with lower risk of MF first. Spline curves showed markedly higher impact of higher age on risk of MF first in women than in men. MF first (n = 279) independently predicted increased all-cause mortality risk (hazard ratio, HR, 1.78(95%CI 1.35–2.36)). Among MF first , with humerus fracture as reference, hip fracture (HR, 4.68(95%CI 1.56–14.06)) and spine fracture (HR, 4.02(95%CI 1.19–13.54)), but not forearm fracture (HR, 1.17 (95%CI 0.38–3.53)), were associated with increased all-cause mortality risk. The initial 6 months following kidney transplantation is a high-risk period for MF. Among MF, hip fracture and spine fracture associate with substantially increased all-cause mortality risk. • The initial 6 months following kidney transplantation is a high-risk period for major fractures. • Fractures occurring after kidney transplantation associate with substantially increased all-cause mortality risk. • Compared to humerus fracture, hip fracture and spine fracture associated with markedly increased mortality risk. • But, forearm fracture – the most common type of fracture in our study - had no such association. [ABSTRACT FROM AUTHOR]