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Background: Childhood brain tumor (BT) survivors have an increased risk of treatment-related late effects, which can reduce health-related quality of life and increase morbidity. This study aimed to investigate lumbar disc degeneration in magnetic resonance imaging (MRI) in adult survivors of radiotherapy-treated childhood BT compared to age and sex-matched population controls. Methods: In this cross-sectional comparative study, 127 survivors were identified from hospital registries. After a mean follow-up of 20.7 years (range 5–33.1), 67 survivors (mean age 28.4, range 16.2–43.5) were investigated with MRI and compared to 75 sex-matched population-based controls. Evaluated MRI phenotypes included Pfirrmann grading, intervertebral disc protrusions, extrusions, and high-intensity-zone-lesions (HIZ). Groups were also compared for known risk factors of lumbar intervertebral disc (IVD) degeneration. Results: Childhood BT survivors had higher Pfirrmann grades than controls at all lumbar levels (all p < 0.001). Lumbar disc protrusions at L4-5 (p = 0.02) and extrusions at L3-4 (p = 0.04), L4-5 (p = 0.004), and L5-S1 (p = 0.01) were significantly more common in the BT group compared to the control. The survivor cohort also had significantly more HIZ-lesons than the controls (n=13 and n=1, p=0.003). Age at diagnosis was associated with lower degree of IVD degeneration (p < 0.01). Blood pressure correlated with IVD degeneration (P < 0.05). Conclusions: Signs of early disc degeneration related to tumor treatment can be seen in the IVDs of survivors. Disc degeneration was more severe in children treated in adolescence.

Introduction: Degenerative changes of the cervical spine often cause disability and flight duty limitations among Finnish Air Force (FINAF) fighter pilots. We aimed to study the effect of +Gz exposure on degenerative changes in the cervical spine by comparing cervical MRIs of FINAF fighter pilots and controls. Methods: At baseline, the volunteer study population consisted of 56 20-year-old FINAF male fighter pilots (exposure group) and 56 21-year-old Army and Navy cadets (control group). Both groups underwent MRI of the cervical spine at the baseline and after 5 years. Degenerative changes evaluated using MRI included intervertebral disc (IVD) degeneration (Pfirrmann classification), disc herniations, uncovertebral arthrosis, Schmorl’s nodes, Modic changes, spinal canal stenosis, kyphosis and scoliosis. Results: The degree of IVD degeneration in the whole cervical spine increased significantly in both populations with no between-group differences. The prevalence of disc herniations also tended to increase in both populations with no difference in the incidence over the follow-up. However, pilots proved to have more disc herniations at the baseline and at the follow-up. There were virtually no between-group differences in other assessed degenerative changes. Discussion: We found that IVD degeneration and the prevalence of disc herniations increased at a similar rate for fighter pilots and non-flying military students when all cervical levels were summed up. The lack of difference may be explained by the relatively low cumulative +Gz exposure during the first 5 years of a pilots’ career.

Distal forearm fractures are common in children and are usually treated nonoperatively. No consensus has been reached on how to perform clinical and radiographic follow-up of these fractures. Our aim was to study whether radiographic and clinical follow-up is justified. We included 100 consecutive patients with non-operatively treated distal forearm fractures who were treated at Oulu University Hospital in 2010–2011. The natural history of the fractures during the nonoperative treatment was analyzed by measuring the potential worsening of the alignment during the follow-up period. The limits of acceptable fracture position were set according to the current literature using “strict” or “wide” criteria for alignment. We determined the rate of worsening fracture position (i.e., patients who reached the threshold of unacceptable alignment). In relation to splinting, we evaluated how many patients benefited from clinical follow-up. Most of the fractures (98%) preserved acceptable alignment during the entire follow-up period when wide criteria were used. The application of stricter criteria for alignment in radiographs showed loss of reduction in 19% of the fractures. Worsening of the alignment was recognized at a mean of 13 days (range 5–29) after the injury. One in three (32%) patients needed some intervention due to splint loosening or failure. Radiographic follow-up of nonoperatively treated distal forearm fractures remains questionable. Instead, clinical follow-up is important, as 32% of patients needed their splints fixed.

Osteoarthritis (OA) is a serious joint disease affecting millions of people globally. Early detection of the disease allows for slowing down its progression, leading to reduced healthcare costs. Furthermore, dental pathological conditions are highly prevalent and often lead to more extensive infection, comorbidities and costly late-stage interventions when left untreated. In this doctoral study, new methods are proposed for OA research and clinical computed tomography (CT) of mineralized tissues using laboratory micro-computed tomography (µCT) imaging and machine learning. First, automated software was developed to assess the histopathologic grade of human osteochondral samples using machine learning and contrast-enhanced µCT. The automated grading performed adequately on independent data and, with further development, could be useful for the development of new OA drugs requiring objective assessment of the tissue changes. In the second sub-study, deep-learning based segmentation and morphological analysis were used to assess the calcified cartilage thickness in New Zealand White rabbit knees. Analysis of µCT reconstructions and histological images could differentiate anatomical surfaces with distinct biomechanical environments. The developed technique is useful in understanding the role of osteochondral junction during mechanical load, aging and disease. Finally, deep-learning based super-resolution models were trained on ex vivo µCT images of human knee samples and extracted teeth. The models were assessed rigorously with independent CT test data for technical image quality, ability to predict trabecular bone microstructure, as well as clinical image quality on the knee, wrist, ankle and maxillofacial region. The super-resolution techniques have the potential for earlier and more accurate diagnostics, treatment planning and dose reductions. In conclusion, the first two sub-studies facilitate a better understanding of OA etiology in basic research. The thi, Tiivistelmä Nivelrikko on maailman yleisin nivelsairaus, joka vaikeuttaa miljoonien ihmisten elämää maailmanlaajuisesti. Sairauden varhainen havaitseminen mahdollistaisi sen etenemisen hidastamisen, mikä edelleen johtaisi terveydenhuollon kustannusten alenemiseen. Hampaiston sairaudet ovat myös erittäin yleisiä ja johtavat hoitamattomina laajempiin tulehduksiin, liitännäissairauksiin ja kalliisiin myöhäisvaiheen toimenpiteisiin. Tässä väitöskirjassa kehitettiin uusia menetelmiä nivelrikon tutkimukseen ja mineralisoituneiden kudosten kliiniseen tietokonetomografiaan (TT) mikrotietokonetomografia (µTT) -laboratoriokuvantamisen ja koneoppimisen avulla. Ensimmäisessä osatyössä kehitettiin automaattinen tietokoneohjelmisto ihmisen luu-rustonäytteiden histopatologiseen arviointiin koneoppimisen ja kontrastitehostetun µTT:n avulla. Automaattiarvioinnin suorituskyky osoittautui hyväksi, ja jatkokehityksen jälkeen menetelmää voitaisiin tulevaisuudessa käyttää esimerkiksi uusien nivelrikkolääkkeiden kehityksessä, missä vaaditaan objektiivista arviota nivelrikon kudosmuutoksille. Toisessa osatyössä kehitettiin syväoppiva kuva-alueen rajausmenetelmä kalkkeutuneen nivelruston paksuuden määrittämiseen jäniksen polvinivelessä. Kehitetyn menetelmän avulla pystyttiin erottamaan anatomiset nivelpinnat, joilla on erilainen biomekaaninen ympäristö. Menetelmä voi auttaa ymmärtämään luun ja ruston liitoskohdan merkitystä mekaanisen rasituksen, ikääntymisen ja nivelrikon aikana. Kolmannessa osatyössä koulutettiin syväoppivia superresoluutiomalleja ihmisen polvinäytteiden ja poistettujen hampaiden µTT-kuville. Mallien tarkkuutta arvioitiin riippumattomalla testiaineistolla teknisen kuvanlaadun, luun mikrorakenteiden ennustamiskyvyn sekä polven, ranteen, nilkan ja hampaiston kliinisen kuvanlaadun määrittämiseksi. Tällaisilla superresoluutiomalleilla tulee mahdollisesti olemaan paljon sovelluksia mm. tehokkaammassa diagnostiikassa ja hoidossa sekä potilaiden säteilyannosten alentamisessa. Yh

Fractures of the forearm represent a significant proportion of injuries in childhood, accounting for up to 40% of all fractures among children under 16. The considerable potential for remodelling of distal forearm fractures often advocates for non-operative treatment. However, solid criteria to determine acceptable alignment remain elusive. Conversely, diaphyseal forearm fractures possess reduced remodelling capacity, obviating operative intervention more frequently. The primary objective of this study was to quantify the significance of radiographic and clinical follow-up in the management of non-operatively treated paediatric distal forearm fractures. Additionally, we aimed to provide a comparative assessment of the long-term outcomes in paediatric patients who underwent treatment for forearm shaft fractures via intramedullary nailing, using either biodegradable (BIN) or elastic stable intramedullary nails (ESIN). One hundred consecutive paediatric patients were retrospectively evaluated to detect deterioration in the alignment of non-operatively treated distal forearm fractures, which are prone to displacement. Predetermined radiographic criteria were used to define the limits of acceptable alignment. Accordingly, the rate of splint repair or renewal was also assessed. A randomised controlled trial was performed to assess the late clinical outcomes of paediatric patients with operative treatment by either ESIN or BIN for forearm shaft fractures. Literature based, age-proportional major or minor limits of displacement for acceptable alignment in distal forearm fractures indicated a loss of reduction during follow-up in 2% and 19% of patients, respectively. Thirty-two per cent of the patients needed some intervention due to splint loosening or failure. There was no clinically significant difference between the long-term recovery of the patients treated with the BIN and those treated with the ESIN for forearm shaft fractures. Radiographic follow-up of non-o, Tiivistelmä Kyynärvarren murtumat ovat tavallisimpia murtumia lapsuusiässä ja kattavat jopa n. 40 % kaikista murtumista. Kyynärvarren ranteen puoleisen pään murtumien asennon hyvä palautuminen kasvun mukana suosii konservatiivista hoitoa. Kirjallisuudessa ei ole yksiselitteisiä röntgenkriteerejä murtuman hoidon valinnalle. Kyynärvarren varsiosan murtumissa asennon korjautuminen kasvun mukana on vähäisempää ja leikkaushoitoa tarvitaan useammin. Tutkimuksen tavoitteena oli selvittää röntgenkuvaseurannan ja kliinisen seurannan hyöty ilman leikkausta hoidetuissa lasten ranteenpuoleisissa kyynärvarsimurtumissa. Lisäksi haluttiin tutkia sulavilla ja joustavilla titaaniydinnauloilla hoidettujen kyynärvarsimurtumien pitkäaikaistuloksia lapsipotilailla, selvittää sulavien naulojen häviäminen luusta sekä leikkaushoitoon liittyvät pehmytkudoslöydökset värttinäluun läheisyydessä. Jälkikäteisesti selvitettiin, kuinka monen ilman leikkausta hoidetun kyynärvarsimurtuman asento huononi seurannassa yli etukäteen määritettyjen röntgenkuvakriteerien (löysä ja tiukka) 100 lapsipotilaan aineistossa. Tutkittiin myös, moniko tarvitsi lastan korjausta tai uusimista. Sulavalla naulalla tai joustavalla titaaniydinnaulalla hoidettujen kyynärvarren varsiosan murtumien pitkäaikaistulokset selvitettiin satunnaistetussa, kontrolloidussa tutkimusasetelmassa. Sulavien naulojen häviäminen luusta, värttinäluun ydinnaulan reitti pehmytkudoksessa ja löydökset pehmytkudosrakenteissa arvioitiin magneettitutkimuksella. Lähes kaikkien (98 %) kyynärvarren ranteenpuoleisen pään murtumien asento säilyi hyväksyttävänä koko seurannan ajan löysillä röntgenkriteereillä. 19 %:lla asento huononi yli tiukkojen asentokriteerien. 32 % potilaista tarvitsi toimenpiteitä lastan vuoksi. Kyynärvarren varsiosan leikkaushoidon pitkäaikaistulokset olivat yhtä hyvät kummallakin naulamateriaalilla. Kaikki sulavat naulat olivat hävinneet täysin tai lähes täysin yli neljän vuoden jälkeen niiden asettamisesta. Kolmasosalla potilai

Background: Early detection of post-traumatic cartilage damage in the ankle joint in magnetic resonance images can be difficult due to disturbances to structures usually appearing over time. Purpose: To study the articular cartilage of unilateral Weber type-B/SER-type ankle fractures shortly post-trauma using T2 relaxation time. Material and Methods: Fifty one fractured ankles were gathered from consecutively screened patients, compiled initially for RCT studies, and treated at Oulu University Hospital and classified as stable (n = 28) and unstable fractures (n = 23) based on external-rotation stress test: medial clear space of ≥5 mm was interpreted as unstable. A control group of healthy young individuals (n = 19) was also gathered. All ankles were imaged on average 9 (range: 1 to 25) days after injury on a 3.0T MRI unit for T2 relaxation time assessment, and the cartilage was divided into sub-regions for comparison. Results: Control group displayed significantly higher T2 values in tibial cartilage compared to stable (six out of nine regions, p-values = .003–.043) and unstable (six out of nine regions, p-values = .001–.037) ankle fractures. No differences were detected in talar cartilage. Also, no differences were observed between stable and unstable fractures in tibial or talar cartilage. Conclusions: Lower T2 relaxation times of tibial cartilage in fractured ankles suggest intact extra cellular matrix (ECM) of the cartilage. Severity of the ankle fracture, measured by ankle stability, does not seem to increase ECM degradation immediately after trauma.

The death of King Charles XII of Sweden has remained as a mystery for more than three centuries. Was he assassinated by his own men or killed by the enemy fire? Charles was killed by a projectile perforating his skull from left to right. In this study, we utilized a Synbone ballistic skull phantom and modern radiological imaging to clarify the factors behind the observed head injuries. We examined whether a musket ball fired from the enemy lines would be the most potential projectile. Our experiments with a leaden 19.5 mm musket ball demonstrated that at velocities of 200 to 250 m/s, it could cause similar type of injuries as observed in the remains of Charles. The radiological imaging supported the theory that the projectile was not a leaden but of some harder metal, as we could detect remnants of lead inside the wound channel unlike in Charles’ case. In addition, our experiments showed that a 19.5mm musket ball produces max. 17mm hole into a felt material . The main evidence supporting 19.5 mm projectile size has been a 19‐19.5mm bullet hole in a hat that Charles was wearing during his death. Additional experiments with a 25.4 mm steel ball produced approximately 20 mm hole in the felt. As our musket ball experiments also resulted in considerably smaller cranial injuries than those in Charles’ case, we can conclude that the deadly projectile wasn’t leaden and was more than 19.5 mm in diameter, potentially an iron cartouche ball that was shot from the enemy lines.

Purpose: Unstable forearm shaft fractures in children are preferably treated surgically using elastic stable intramedullary nails. The radius is nailed retrograde from the distal metaphysis. There is a risk of surgery-related soft-tissue complications during the operation. Close evaluation of occult surgery-related soft-tissue lesions has not been possible previously, due to the titanium alloy hardware used in the process. The aim of the present study was to evaluate the potential findings in the surrounding soft tissues after intramedullary nailing of the radius, by using magnetic resonance imaging. Methods: The study population comprised 15 pediatric patients with forearm shaft fractures treated by polylactide-co-glycolide biodegradable intramedullary nails and postoperatively evaluated via magnetic resonance imaging. The main outcome was signal abnormality in any tendon at the entry point postoperatively. Secondarily, other changes in the soft tissues related to nailing were determined. Furthermore, the precise location of the entry point and the anatomic characteristics of the soft-tissue tunnel were described. Results: In total, 5 of 15 patients (33.3%) had transient signal pathology in a tendon postoperatively. Edema around the superficial radial nerve was detected in 13 of 15 patients (86.7%). The most common surgical approach was between the extensor pollicis brevis and the extensor carpi radialis longus tendons, which was applied in 10 of 15 patients (66.7%). Conclusions: One in three patients exhibited transient and occult surgery-related intraparenchymal signal pathology in a tendon, after forearm intramedullary nailing. Caution with surgical prepare of the soft-tissue cleavage is recommended.

Gestation increases the biomechanical loading of lower extremities. Gestational loading may influence anthropometrics of articular surfaces in similar means as bone diaphyseal properties. This study aimed to investigate whether gravidity (i.e. number of pregnancies) and parity (i.e. number of deliveries) is associated with knee breadth among middle-aged women. The study sample comprised 815 women from the Northern Finland Birth Cohort 1966. The median parity count of our sample was 2 and the median gravidity count 3. At the age of 46, questionnaires were used to enquire gravidity and parity, and posteroanterior knee radiographs were used to obtain two knee breadth parameters (tibial plateau mediolateral breadth (TPML) and femoral condylar mediolateral breadth (FCML)) as representatives of articular size. The associations of gravidity and parity with knee breadth were analyzed using general linear models with adjustments for height, weight, leisure-time physical activity, smoking, and education years. Individuals with osteoarthritic changes were excluded from our sample. The mean TPML in our sample was 70.3 mm and the mean FCML 71.6 mm respectively. In the fully adjusted models, gravidity and parity showed positive associations with knee breadth. Each pregnancy was associated with 0.11–0.14% larger knee breath (p < 0.05), and each delivery accounted for an increase of 0.20% in knee breadth (p < 0.01). Between-group comparisons showed that multiparous women had 0.68–1.01% larger knee breath than nulli- and primiparous women (p < 0.05). Pregnancies and deliveries seem to increase the mediolateral breadth of the knee. This increase is potentially associated with increased biomechanical loadings during gestation.

Background: Articular surface size is traditionally considered to be a relatively stable trait throughout adulthood. Increased joint size reduces bone and cartilage tissue strains. Although physical activity (PA) has a clear association with diaphyseal morphology, the association between PA and articular surface size is yet to be confirmed. This cross-sectional study aimed to clarify the role of moderate-to-vigorous PA (MVPA) in knee morphology in terms of tibiofemoral joint size. Methods: A sample of 1508 individuals from the population-based Northern Finland Birth Cohort 1966 was used. At the age of 46, wrist-worn accelerometers were used to monitor MVPA (≥3.5 METs) during a period of two weeks, and knee radiographs were used to obtain three knee breadth measurements (femoral biepicondylar breadth, mediolateral breadth of femoral condyles, mediolateral breadth of the tibial plateau). The association between MVPA and knee breadth was analyzed using general linear models with adjustments for body mass index, smoking, education years, and accelerometer weartime. Results: Of the sample, 54.8% were women. Most individuals were non-smokers (54.6%) and had 9—12 years of education (69.6%). Mean body mass index was 26.2 (standard deviation 4.3) kg/m2. MVPA was uniformly associated with all three knee breadth measurements among both women and men. For each 60 minutes/day of MVPA, the knee breadth dimensions were 1.8—2.0% (or 1.26—1.42 mm) larger among women (p < 0.001) and 1.4—1.6% (or 1.21—1.28 mm) larger among men (p < 0.001). Conclusions: Higher MVPA is associated with larger tibiofemoral joint size. Our findings indicate that MVPA could potentially increase knee dimensions through similar biomechanical mechanisms it affects diaphyseal morphology, thus offering a potential target in reducing tissue strains and preventing knee problems. Further studies are needed to confirm and investigate the association between articulation area and musculoskeletal health

There is a possibility of harm associated with all human activity. Adverse events in imaging are related to the radiation equipment’s, image interpretation and various other aspects of the imaging process. Adverse events in imaging occur infrequently compared to the number of examinations however the effect on the patient may be substantial. The purpose of this study was to form a vision of the harmful incidents related to imaging by analysing how frequently adverse events, harms and near misses occur in Finnish public and private health care imaging units. The research material consisted of statistics obtained from three different authorities. The data of the Radiation and Nuclear Safety Authority consisted of 293 reports of adverse events of radiological examinations and measures. The statistics of the Patient Insurance Center included 1054 injury claims made by patients. In addition, the third data consisted of 7287 claims made by healthcare personnel to the electronic patient safety incident reporting system. The highest incidence of unnecessary or excessive radiation occurred in computed tomography (CT) scans. Injury reports made by patients were mostly related to incorrect or delayed diagnosis. Of the adverse events reported by staff, 75% caused some degree of harm to the patient, and 25% were near misses. Supervisors rated the risks associated with the adverse event as low (47.7%), insignificant (35%), or tolerable (15.7%). Investigating imaging incidents is significant and useful. The information generated by the research can be utilized in the systematic reduction and prevention of incidents related to various imaging processes. The research will increase the national development of patient safety in Finnish healthcare in the future., Tiivistelmä Kaikessa inhimillisessä toiminnassa on mahdollisuus tapahtua vahinko. Lääkinnällisen kuvantamisen vaaratapahtumat liittyvät tutkimuksessa käytettävään säteilyyn, laitteisiin kuvantulkintaan ja muihin kuvantamisprosessin vaiheisiin. Kuvantamisen vaaratapahtumia on suhteellisen vähän (alle 4 %), mutta haitan vaikutus saattaa olla potilaalle suuri. Tämän tutkimuksen tarkoituksena oli muodostaa näkemys kuvantamiseen liittyvistä vaaratapahtumista analysoimalla Suomen julkisen ja yksityisen terveydenhoidon kuvantamisyksiköiden vaara-, haitta- ja läheltä piti -tapahtumia. Tutkimuksen aineisto koostui säteilyturvakeskuksen (293 kpl) ja potilasvakuutuskeskuksen (1054 kpl) aineistosta sekä asiakas- ja potilasturvallisuuskeskuksen hallinnoimista terveydenhuoltohenkilökunnan sosiaali- ja terveydenhuollon vaaratapahtumajärjestelmään tekemistä ilmoituksista (7287 kpl). Tutkimuksen perusteella tietokonetomografiatutkimuksissa (TT) tapahtui useimmin turhaan tai liialliseen säteilyyn liittyviä poikkeavia tilanteita. Potilaiden tekemät vahinkoilmoitukset liittyivät virheelliseen tai viivästyneeseen diagnostiikkaan. Henkilökunnan ilmoittamista vaaratapahtumista 75 % aiheutti potilaalle jonkin asteisen haitan ja 25 % oli läheltä piti -tilanteita. Esimiehet arvioivat haittatapahtumaan liittyneet riskit vähäisiksi (47,7 %), merkityksettömiksi (35 %) tai kohtalaisiksi (15,7 %). Tutkimus osoitti, että kuvantamisen potilasturvallisuuteen liittyvien vaaratilanteiden analysointi on tarpeellista. Tutkimuksen tuottamaa tietoa voidaan hyödyntää kuvantamisen eri prosesseihin liittyvien vaaratapahtumien suunnitelmallisessa vähentämisessä ja ennaltaehkäisyssä. Tutkimus lisää Suomen terveydenhuollon potilasturvallisuuden kansallista kehitystä tulevaisuudessa.

The objectives of the study were to characterize events related to patient safety reported by medical imaging personnel in Finland in 2007–2017, the number and quality of reported injuries, the risk assessment, and the planned improvement of operations. The information was collected from a healthcare patient safety incident register system. The data contained information on the nature of the patient safety errors, harms and near-misses in medical imaging, the factors that lead to the events, the consequences for the patient, the level of risks, and future measures. The number of patient safety incident reports included in the study was 7,287. Of the incident reports, 75% concerned injuries to patients and 25% were near-misses. The most common consequence of adverse events and near-misses were minor harm (37.2%) related to contrast agent, or no harm (27.9%) related to equipment malfunction. Supervisors estimated the risks as low (47.7%) e.g., data management, insignificant (35%) e.g., verbal communication or moderate (15.7%) e.g., the use of contrast agent. The most common suggestion for learning from the incident was discussing it with the staff (58.1%), improving operations (5.7%) and submitting it to a higher authority (5.4%). Improving patient safety requires timely, accurate and clear reporting of various patient safety incidents. Based on incident reports, supervisors can provide feedback to staff, develop plans to prevent accidents, and monitor the impact of measures taken. Information on the development of occupational safety should be disseminated to all healthcare professionals so that the same mistakes are not repeated.

Background: Although it has been suggested that lumbar disc degeneration (LDD) is a significant risk factor for low back pain (LBP), its role remains uncertain. Our objective was to clarify the association between LDD and LBP and whether mental distress modifies the association. Methods: Participants of a birth cohort underwent 1.5-T lumbar magnetic resonance imaging at the age of 47. The association between the sum score of LDD (Pfirrmann classification, range 0–15) and LBP (categorized into “no pain”, “mild-to-moderate pain”, “bothersome-and-frequent pain”) was assessed using logistic regression analysis, with sex, smoking, body mass index, physical activity, occupational exposure, education, and presence of Modic changes and disc herniations as confounders. The modifying role of mental distress (according to the Hopkins Symptom Check List-25 [HSCL-25], the Beck Depression Inventory and the Generalized Anxiety Disorder Scale) in the association was analyzed using linear regression. Results: Of the study population (n = 1505), 15.2% had bothersome and frequent LBP, and 29.0% had no LBP. A higher LDD sum score increased the odds of belonging to the “mild-to-moderate pain” category (adjusted OR corresponding to an increase of one point in the LDD sum score 1.11, 95% CI 1.04–1.18, P = 0.003) and the “bothersome-and-frequent pain” category (adjusted OR 1.20, 95% CI 1.10–1.31, P < 0.001), relative to the “no pain” category. Mental distress significantly modified the association between LDD and LBP, as a linear positive association was consistently observed among individuals without mental distress according to HSCL-25 (adjusted B 0.16, 95% CI 0.07–0.26, P < 0.001), but not among individuals with higher mental distress. Conclusions: LDD was significantly associated with both mild-to-moderate and bothersome-and-frequent LBP. However, the co-occurrence of mental distress diminished the association between LDD and LBP bothersomeness. Our results strongly sugg

Objective: Autologous bone has been the gold standard of cranioplasty materials for decades. Unique to autologous cranioplasty, bone flap resorption is a poorly understood and unclearly defined complication. Even further, it has been unclear, whether the resorption process eventually stabilizes over time. Thus, the sufficient follow-up period after autologous cranioplasty is unknown. The Oulu Resorption Score (ORS) is a straight-forward classification system for the radiological interpretation of bone flap resorption. The aims of the present study were to evaluate the reliability of the ORS using intra-class correlation coefficient (ICC) and to assess the temporal progression of the resorption process. Methods: We identified 108 consecutive autologous cranioplasty patients treated between 2005 and 2018 in two tertiary referral centers. All 365 head CT scans the patients had undergone were evaluated using the ORS in a blinded, independent two-center setting. Intra- and inter-observer reliabilities were calculated. The ORS was applied to study the temporal progression of the resorption process. Results: The intra-observer reliability of the ORS was excellent (ICC 0.94, 95%CI 0.93–0.95). Inter-observer reliability was good-to-excellent (ICCs 0.87 and 0.89, 95%CIs 0.84–0.89 and 0.87–0.91, respectively). In scatterplot smoothing analyses, the progression of bone flap resorption appeared to stabilize 12–24 months after cranioplasty. Conclusions: ORS is the only validated radiological tool for the standardized analysis of bone flap resorption after autologous cranioplasty. Evaluated using the ORS, the resorption process seemed to stabilize during the first two postoperative years after cranioplasty, suggesting that the sufficient follow-up time after autologous cranioplasty is two years.

Study Design: A cross-sectional study of the Northern Finland Birth Cohort 1966 (NFBC1966). Objective: To evaluate the association of lumbosacral transitional vertebrae (LSTV) with low back pain (LBP) and associated degenerative findings using magnetic resonance (MR) imaging. Summary of Background Data: LSTV is a common finding with a prevalence of 10% to 29%. LSTV causes biomechanical alterations leading to accelerated lumbar degeneration. However, its association with degenerative findings on MRI and LBP is unclear. Methods: One thousand four hundred sixty eight lumbar spine MRI scans from the NFBC1966 acquired at a mean age of 47 years were assessed for the presence of LSTV and degenerative changes. Castellvi classification was utilized to identify LSTV anatomy. Additionally, 100 controls without LSTV were collected. Self-reported LBP with a duration of more than 30 days in the past year was deemed clinically relevant. For the statistical analyses, chi square test, independent samples t test and multinomial logistic regression analyses were used. Results: LSTV was found in 310 (21.1%) subjects. After adjusting for age, sex, and disc degeneration (DD) sum, subjects with Castellvi type III reported prolonged LBP significantly more frequently than the controls (odds ratio [OR] = 8.9, P = 0.001). We observed a higher prevalence of facet degeneration (FD) at all levels from L3/L4 to L5/S1 in type I, and L3/L4 to L4/L5 in types II–IV. DD was more prevalent at L4/L5 in types II–IV. Disc protrusion/extrusion occurred more frequently at L3/L4 and L4/L5 in type II, and at L3/L4 in type III. Castellvi type II had a higher prevalence of type 1 Modic changes at levels from L3/L4 to L4/L5. Conclusions: LSTVs were a common finding within this study, and Castellvi type III LSTVs were associated with LBP. Degenerative findings were associated with LSTV anatomy and occurred more commonly above the transitional level.

Background: The clinical relevance and treatment of syndesmosis injury in supination-external rotation (SER) ankle fractures are controversial. Methods: After malleolar fixation 24 SER 4 ankle fracture patients with unstable syndesmosis in external rotation stress test were randomised to syndesmosis transfixation with a screw (13 patients) or no fixation (11 patients). Mean follow-up time was 9.7 years (range, 8.9–11.0). The primary outcome measure was the Olerud-Molander Ankle Outcome Score (OMAS). Secondary outcome measures included ankle mortise congruity and degenerative osteoarthritis, 100-mm visual analogue scale for function and pain, RAND 36-Item Health Survey, and range of motion. Results: Mean OMAS in the syndesmosis transfixation group was 87.3 (SD 15.5) and in the no-syndesmosis-fixation group 89.0 (SD 16.0) (difference between means 1.8, 95% CI −10.4–14.0, P = 0.76). There were no differences between the two groups in secondary outcome measures. Conclusions: With the numbers available, SER 4 ankle fractures with unstable syndesmosis can be treated with malleolar fixation only, with good to excellent long-term functional outcome.