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Two long-lasting high-pressure systems in summer 2018 led to persisting heatwaves over Scandinavia and other parts of Europe and an extended summer period with devastating impacts on agriculture, infrastructure, and human life. We use five climate model ensembles and the unique 263-year-long Stockholm temperature time series along with a composite 150-year-long time series for the whole of Sweden to set the latest heatwave in the summer of 2018 into historical perspective. With 263 years of data, we are able to grasp the pre-industrial period well and see a clear upward trend in temperature as well as upward trends in five heatwave indicators. With five climate model ensembles providing 20 580 simulated summers representing the latest 70 years, we analyse the likelihood of such a heat event and how unusual the 2018 Swedish summer actually was. We find that conditions such as those observed in summer 2018 are present in all climate model ensembles. An exception is the monthly mean temperature for May for which 2018 was warmer than any member in one of the five climate model ensembles. However, even if the ensembles generally contain individual years like 2018, the comparison shows that such conditions are rare. For the indices assessed here, anomalies such as those observed in 2018 occur in a maximum of 5 % of the ensemble members, sometimes even in less than 1 %. For all of the indices evaluated, we find that the probability of a summer such as that in 2018 has increased from relatively low values in the pre-industrial era (1861–1890, one ensemble) and the recent past (1951–1980, all five ensembles) to higher values in the most recent decades (1989–2018). An implication of this is that anthropogenic climate change has strongly increased the probability of a warm summer, such as the one observed 2018, occurring in Sweden. Despite this, we still find such summers in the pre-industrial climate in our simulations, albeit with a lower probability. [ABSTRACT FROM AUTHOR]

Two long-lasting high pressure systems in summer 2018 lead to long lasting heat waves over Scandinavia and other parts of Europe and an extended summer period with devastating impacts on agriculture, infrastructure and human life. We use five climate model ensembles and the unique 263 year long Stockholm temperature time series along with a composite 150 year long time series for whole Sweden to set the latest heat-wave in summer 2018 in historical perspective. With 263 years we are able to grasp the pre-industrial time well and see a clear upward trend in temperature itself as well as heat wave indicators. With five climate model ensembles providing 20 580 simulated summers representing the latest 70 years, we analyse the likelihood of such a heat event and how unusual the 2018 Swedish summer actually was. We find that conditions as those observed in summer 2018 show up in all climate model ensembles. An exception is the monthly mean temperature for May for which 2018 was warmer than any member in one of the five climate model ensembles. However, even if the ensembles generally hold individual years like 2018, the comparison shows that such conditions are rare. For the indices assessed here, anomalies such as observed in 2018 occur maximally in 5 % of the ensemble members, sometimes even in less than 1 %. For all indices evaluated we find that probabilities of a summer like in 2018 have increased from relatively low values for the one ensemble extending back to 1861--90 and for all five ensembles including 1951--80 to the most recent decades (1989--2018). An implication is that anthropogenic climate change has strongly increased the probability of a warm summer such as the one observed 2018 to occur in Sweden. Despite this, we still find such summers also in the pre-industrial climate, however, with a lower probability. [ABSTRACT FROM AUTHOR]

The epidemiology of scaphoid fractures has been described in limited populations, and incidence reports have been inconsistent. We investigated the nationwide incidence of scaphoid fractures by evaluating data on 34,377 patients in the Swedish National Patient Register for the years 2006–2015 regarding diagnosis, age, sex and treatment. The data were validated in 300 random patients, and incidence rates were adjusted accordingly. Forty-one per cent of the initially diagnosed fractures were false positives. The adjusted true fracture incidence rate was 22 per 100,000 person-years. During the decade studied incidence rates decreased in younger men and increased in middle-aged women. The incidence of surgical treatment vs. non-operative treatment did not change over time. Men were treated surgically more often than women (6% vs. 3%) and had a greater risk for nonunion (3% vs. 1%). [ABSTRACT FROM AUTHOR]

Background and purpose The incidence of fractures of the distal radius may have changed over the last decade, and operative treatment has been commoner during that time. We investigated the incidence of fractures of the distal radius and changing trends in surgical treatment during the period 2004-2010. Patients and methods Registry data on 42,583 patients with a fracture of the distal radius from 2004 to 2010 were evaluated regarding diagnosis, age, sex, and surgical treatment. Results The crude incidence rate was 31 per 104 person-years with a bimodal distribution. After the age of 45 years, the incidence rate in women increased rapidly and leveled off first at a very high age. The incidence rate in postmenopausal women was lower than previously reported. In men, the incidence was low and it increased slowly until the age of 80 years, when it amounted to 31 per 104 person-years. The number of surgical procedures increased by more than 40% despite the fact that there was reduced incidence during the study period. In patients ≥ 18 years of age, the proportion of fractures treated with plating increased from 16% to 70% while the use of external fixation decreased by about the same amount. Interpretation The incidence rate of distal radius fractures in postmenopausal women appears to have decreased over the last few decades. There has been a shift in surgical treatment from external fixation to open reduction and plating. [ABSTRACT FROM AUTHOR]

Introduction: Triangular fibrocartilage complex (TFCC) tear is often considered to be the cause of ulnar wrist pain. The primary treatment typically involves non-operative methods; however, in cases of persistent symptoms, operative intervention has been proposed as a viable option. Depending on the tear's morphology, treatment may involve debridement (central or radial tear) or repair (peripheral tear). Efficacy of operative treatment has not been studied in a randomised controlled trial., Methods and Analysis: This is a prospective, randomised, controlled, blinded multicentre trial, with two randomisation stratums. The first stratum includes central or radial TFCC tears, while the second stratum comprises peripheral TFCC tears. Each stratum consists of two parallel 1:1 arms, comparing the efficacy of (1) debridement of central or radial tear with placebo surgery and (2) repair of peripheral tear with physiotherapy. Participants are recruited from secondary and tertiary referral hospitals in Denmark, Finland and Sweden.Primary outcome is the Patient-Rated Wrist Evaluation (PRWE) at 1 year. Secondary outcomes include subjective and objective outcome measures at 6 months, 1, 2, 5 and 10 years follow-ups., Ethics and Dissemination: The trial was approved by the Pirkanmaa Hospital District Institutional Review Board in March 2020. All participants will be asked to give a written informed consent. The results of the trial will be disseminated as published articles in peer-reviewed journals., Trial Registration Number: NCT04576169., Competing Interests: Competing interests: AK: Consultant fee paid for by KLS Martin, Two Hand and Wrist courses paid for by KLS Martin, and one Hand course paid for by Osteo-Tech. MPR: Shoulder arthroscopy course, and hand and wrist course paid for by Arthrex; and nerve repair course paid for by Axone. TK: no conflict of interest JJ: no conflict of interest. RG: no conflict of interest. MW: No conflict of interest. AR: No conflict of interest. TA: no conflict of interest. AP: no conflict of interest. CL: no conflict of interest. TT: no conflict of interest. VMM: no conflict of interest. Principal investigators do not have any financial or other competing interest for the overall trial and each study site., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Osteoarthritis in the thumb base (trapeziometacarpal joint, CMC-1 joint) is prevalent, particularly among middle-aged and elderly women, causing significant disability. Conservative treatments, including steroid injections, have been questioned for their efficacy, prompting exploration into alternative therapies such as platelet-rich plasma (PRP) injections. This randomized, double-blinded, controlled trial aims to evaluate the effectiveness of high-concentration PRP (platelet-rich plasma) injection compared to saline (placebo) in reducing pain and disability in patients with thumb base osteoarthritis., Methods: Patients meeting inclusion criteria will be randomized and blinded, with injections administered under sterile conditions and radiological guidance. With a planned sample size of 90 patients recruited from the Department of Hand Surgery at Södersjukhuset, Stockholm, the study will assess pain relief and functional improvement at 3, 6, and 12 months post-injection. The primary outcome measure is pain on load (numerical rating scale) at 6 months, with secondary outcomes including patient-reported outcomes, key pinch, grip strength, abduction of the thumb, and time to intervention within 1 year. Statistical analyses will employ non-parametric tests, chi-square tests, and generalized estimating equations to compare outcomes between the PRP and placebo groups., Discussion: The study aims to provide evidence regarding the efficacy of high-concentration PRP injections for thumb base osteoarthritis. If PRP proves superior to saline in reducing pain and improving function, it could offer a promising alternative treatment. Conversely, if PRP does not demonstrate significant benefits over placebo, its use for this condition is not justified. This study seeks to address the current gap in evidence regarding the efficacy of PRP injections for thumb base osteoarthritis., Trial Registration: The study has been approved by the Swedish Ethical Review Authority (2023-06860-01 and 2024-01238-02) and is registered on ClinicalTrials.gov (NCT06193499) 2024-01-04., Competing Interests: Declarations. Ethics approval and consent to participate: The study has been approved by the Swedish Ethical Review Authority (2023–06860-01 and 2024–01238-02), and the study is registered at ClinicalTrials.gov NCT06193499. Changes in the study protocol will be reported to the Swedish Ethical Review Authority and to ClinicalTrials.gov. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

This study describes the age and sex distribution, trauma mechanism, treatment and influence of patient-reported outcomes of 6542 carpal fractures from the Swedish Fracture Registry (SFR). The most commonly fractured carpal bone was the scaphoid (60%), followed by the triquetrum (25%), hamate (5%) and trapezium (4%). The mean age at injury was 41 years, and 69% of patients were male. The age and sex distribution of carpal fractures differed substantially between the different carpal bones. Men were more likely to sustain a carpal fracture after high-energy trauma and were more likely to be treated surgically. Carpal fractures had a small negative effect on the Short Musculoskeletal Function Assessment Hand/Arm Index and EQ-5D scores 1 year after the injury. Level of evidence: IV., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: There is a lack of detailed epidemiological studies of finger fractures, the most common fracture of the upper extremity., Methods: Based on data of 21 341 finger fractures in the Swedish Fracture register, a national quality registry that collects data on all fractures, this study describes anatomical distribution, cause, treatment, age distribution, and result in terms of patient related outcome measures (PROMs)., Results: The most common finger fracture was of the base of the 5th finger, followed by the distal phalanx in the 4th finger. Open fractures were most common in the distal phalanges, especially in the 3rd finger. Intraarticular fractures were most frequent in the middle phalanges. Fall accidents was the most common cause of a fracture. The mean age at injury was 40 years (38 for men, 43 for women). 86% of finger fractures in adults were treated non-operatively. Men were more frequently operated than women. Finger fractures did not affect hand function or quality of life and there were no relevant differences in PROMs between fracture type, treatment, or sex., Conclusion: This study presents detailed information about the various types of finger fractures which can be used as point of reference in clinical work and for future studies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Alfort et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The epidemiology of scaphoid fractures has been described in limited populations, and incidence reports have been inconsistent. We investigated the nationwide incidence of scaphoid fractures by evaluating data on 34,377 patients in the Swedish National Patient Register for the years 2006-2015 regarding diagnosis, age, sex and treatment. The data were validated in 300 random patients, and incidence rates were adjusted accordingly. Forty-one per cent of the initially diagnosed fractures were false positives. The adjusted true fracture incidence rate was 22 per 100,000 person-years. During the decade studied incidence rates decreased in younger men and increased in middle-aged women. The incidence of surgical treatment vs. non-operative treatment did not change over time. Men were treated surgically more often than women (6% vs. 3%) and had a greater risk for nonunion (3% vs. 1%).

The patient-rated wrist evaluation (PRWE) form is an established outcome questionnaire designed to measure wrist pain and disabilities in activities of daily living. We translated and validated this score for use in Sweden. The original PRWE score was translated forwards and backwards, and then the responsiveness, validity, and reliability of the Swedish version were tested in 99 patients who were recovering from a fracture of the distal radius. The patients completed the PRWE questionnaire 7 weeks and 4 to 6 months after the injury. Responsiveness was assessed by Standard Response Mean and Effect Size. Content validity was evaluated by examining the proportion of best and worse possible scores. Construct validity was assessed by comparing scores twice after the injury and by comparing patients with fractures of different severity. Criterion validity was evaluated by correlating the PRWE with another upper extremity score: the disability of the arm, shoulder, and hand (DASH) score. Reliability was evaluated with a test-retest and by internal consistency. Responsiveness was excellent (SRM = 1.4-1.7, ES = 1.3). Five patients reported the best possible result after 4 to 6 months but none at 7 weeks, and no patient reported the worst score at any time. The PRWE score corresponded well with improvement and showed good correlation with severity of fracture. The PRWE showed a strong correlation with DASH score (Spearman's rank coefficient = 0.86). Intraobserver reliability of the test-retest and internal consistency was good (Kendall W coefficient = 0.79, Spearman's rank coefficient = 0.99, Cronbach's alpha = 0.94-0.97). We found this Swedish version of the PRWE to be responsive, valid, and reliable for evaluating the patient-rated outcome after a fracture of the distal radius.