Introduction: Femoral shaft fractures are commonly thought to be primarily associated with high energy trauma in young persons. Only limited attention has be given to low energy violence as a cause of these fractures among the elderly. National epidemiological data on characteristics of patients with femoral shaft fractures are lacking. So the purpose of this study was to analyse the incidence, admissions, causes of fracture and operations for these fractures on a nationwide basis in Sweden during 1998–2004.

Patients and Methods: Data on all femoral shaft fractures were extracted from the Swedish National Hospital Discharge Registry. Sex- and age-specific fracture incidence, hospital admissions, mechanisms of injury and surgical procedures were analysed using descriptive analysis, linear-regression analysis and other methods as appropriate.

Results: Over a period of 7 years, 6,409 patients with femoral shaft fractures were identified, corresponding to an annual incidence rate of 10 per 100,000 person-years. Men had a younger median age (27 years, IQR 12–68) than women (79 years, IQR 62–86) (p< 0.001). Females (54%) generated more admissions than males (46%). The incident rate ratio between men and women was 0.9 (p< 0.001). Most hospital admissions were generated among females by the 80–89 years age-group and among males < 10 years of age. 2% of the fractures were open shaft fractures. The total number of hospital admissions was stable during 1998–2004. The two major mechanisms of injury were falls on the same level (50%) and transport accidents (17%). A significant number of fractures occured among elderly patients after low-energy trauma. Osteosynthesis with femoral nail (54%) was the prefered operation, followed by osteosynthesis with plate and screws (16%), skeletal traction (14%) and external fixation (6%).

Discussion: This nationwide study on femoral shaft fractures provides an update on incidence, admissions, external causes and surgical procedures. This information assists health care providers in planning hospital beds, surgical interventions and risk preventions. Moreover, these data can be used for power calculations for further clinical studies.

Introduction: Although decompressive surgery of spinal stenosis is a common procedure in spine surgery, there are no studies assessing patients’ perceived health related quality of life (HRQOL) by EQ-5D. An objective was to describe status overall and by analyzing pre- and one year postoperative health related quality of life (HRQOL) by the EQ-5D instrument in patients operated on for lumbar spinal stenosis. This cohort was compared to a Swedish population EQ-5D survey.

Methods: Data were obtained from the National Swed-ish Registry for lumbar spine operations 2001–2002. On 230 patients (mean age 66 years, 53% females) operated on for lumbar spinal stenosis the primary outcome measures were pre- and postoperative EQ-5D data. In addition, patient and disease characteristics (pain and walking ability) were reported. Analysis of variance (ANOVA) was performed and the relative differences pre-and postoperatively compared to a Swedish population survey were calculated.

Results: The majority of patients experienced an improved and their EQ-5D score increased from 0.36 to 0.64 one year after operation. However, they did not reach the level reported by an age- and gender matched population sample (mean difference 0.18). Woman had lower pre- and postoperatively EQ-5D scores than men. Preoperative severe pain was a significant predictor for a lower postoperative EQ-5D score. Four out of ten reported considerable improvement while a similar portion of patients (41%) with high preoperative scores were slightly improved. A third group (14%) were unchanged with low EQ-5D scores, and a few (4%) perceived a decline in their HRQOL. The mean VAS rating of leg- and back pain improved one year after operation by 28 and 29 %, respectively. The proportion of patients able to walk longer than 500 m increased from 25 % preoperatively to 65 % postoperatively.

Conclusions: Our national Swedish representatively cohort of disc herniation patients has a remarkable low EQ-5D scores preoperatively. However their HRQOL improved considerably in 80 % of the patients one year after surgery. The health related quality of life improves after surgery for lumbar spinal stenosis, approaching the population reference level. It is of most importance to further investigate the risk factors behind the less favourable outcomes in health related quality of live (EQ-5D score) in women.

Introduction: Spinal fractures are associated with pain, disability, neurological dysfunction and mortality. Osteoporosis and risky leisure time activities are increasing in the population. New treatment options have been introduced. However, only a few international studies have reported its descriptive epidemiology. There are no clear consensuses regarding the choice of operative interventions versus non-operative treatment in patients with thoracolumbar fractures. Treatment is often based on local traditions, skills and experiences. The aim of this nationwide study is to analyse the incidence, the characteristics of the patients, the subsequent development, surgical incidence and mortality rate among hospitalized patients with thoracolumbar fractures in Sweden.

Methods: All discharges between 1997 and 2000 with diagnoses of thoracic or lumbar vertebrae fracture according to ICD 10 classification were selected from the National Inpatient Register. Surgery in these patients was categorised by procedure codes indicating spine operations. In order to calculate the risk of patients dying, linkage was performed to the Swedish Death Register using the unique personal identification number.

Results: We identified 13, 496 admissions during the study period. This corresponds to an incidence rate of 30 per 100, 000 person-years and the occurrence was stable during 1997 and 2001 for patients younger than 50 years but decreased for patients above 50 years. The incidence of spine surgery among all patients was 1.9 per 100, 000 person-years, ranging from 1.6 per 100, 000 inhabitants per year to 2.6 per 100, 000 in the different region of Sweden. The most common causes of the fracture were falls (53 %) followed by vehicle accidents (37%). Almost two thirds of the patients operated on were men (63 %) and two thirds had lumbar vertebral fractures (66 %). The median age of the patients operated on was 42 years. The median length of stay was eight days. Among those who was operated the 30 days case fatality rate was 0.7 %. Median age for death was 64 years. Operations were less common in women (OR 0.79). The number of patients operated on during the last study year 2001 was significantly increased (OR 1.29). The probability of being operated on was highest in the more urban and densely populated regions of Stockholm and southern Sweden.

Discussion: This national study based study showed a stable cumulative incidence of thoracolumbar fractures over the year 1997–2000. However, the two last year of this study an increased incidence of operation was observed. A possible explanation of this finding could be the new percutaneus technique for verterbroplasty. We find it of most importance to further investigate the reasons behind the gender differences in surgical incidence in patients with vertebral fractures

We investigated the pre-operative and one-year post-operative health-related quality of life (HRQoL) outcome by using a Euroqol (EQ-5D) questionnaire in 230 patients who underwent surgery for lumbar spinal stenosis. Data were obtained from the National Swedish Registry for operations on the lumbar spine between 2001 and 2002. We analysed the pre- and postoperative quality of life data, age, gender, smoking habits, pain and walking ability. The relative differences were compared to a Swedish EQ-5D population survey.

The mean age of the patients was 66 years, and there were 123 females (53%). Before the operation 62 (27%) of the patients could walk more than 500 m. One year after the operation 150 (65%) were able to walk 500 m or more.

The mean EQ-5D score improved from 0.36 to 0.64, and the HRQoL improved in 184 (80%) of the patients. However, they did not reach the level reported by a matched population sample (mean difference 0.18). Women had lower pre- and post-operative EQ-5D scores than men. Severe low back pain was a predictor for a poor outcome.

We suggest that different mechanisms underlie joint pain at rest and on movement in osteoarthritis and that separate assessment of these two features with a visual analogue scale (VAS) offers better information about the likely effect of a total knee replacement (TKR) on pain. The risk of persistent pain after TKR may relate to the degree of central sensitisation before surgery, which might be assessed by determining the pain threshold to an electrical stimulus created by a special tool, the Pain Matcher. Assessments were performed in 69 patients scheduled for TKR. At 18 months after operation, separate assessment of pain at rest and with movement was again carried out using a VAS in order to enable comparison of pre- and post-operative measurements. A less favourable outcome in terms of pain relief was observed for patients with a high pre-operative VAS score for pain at rest and a low pain threshold, both features which may reflect a central sensitisation mechanism.

We investigated the pre-operative and one-year post-operative health-related quality of life (HRQOL) outcome by using a Euroqol (EQ-5D) questionnaire in 263 patients who had undergone surgery for herniation of a lumbar disc. Data from the National Swedish Register for lumbar spinal surgery between 2001 and 2002 were used and, in addition, a comparison between our cohort and a Swedish EQ-5D population survey was performed. We analysed the pre- and post-operative quality of life data, age, gender, smoking habits, pain and walking capacity.

The mean age of the patients was 42 years (20 to 66); 155 (59%) were men and 69 (26%) smoked. Pre-operatively, 72 (17%) could walk at least 1 km compared with 200 (76%) postoperatively.

The mean EQ-5D score improved from 0.29 to 0.70, and the HRQOL improved in 195 (74%) of the patients. The pre-operative score did not influence the post-operative score. In most patients, all five EQ-5D dimensions improved, but did not reach the level reported by an age- and gender-matched population sample (mean difference 0.17). Predictors for poor outcome were smoking, a short pre-operative walking distance, and a long history of back pain.