Long-term outcome of displaced radial neck fractures in adulthood: 16–21 year follow-up of 5 patients treated with radial head excision

Background There have been no reports on the long-term outcome of radial neck Mason type IIIb fractures in adults

Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: Data From the Swedish Knee Ligament Register.

BACKGROUND: Female gender is a risk factor for sustaining anterior cruciate ligament (ACL) injury. However, little is known about possible sex differences in patients with ACL injury/reconstruction. PURPOSE: To study sex differences in patient-reported outcomes before and at 1 and 2 years after ACL reconstruction and to present reference values. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 2005 and 2008, 10 164 patients (mean age, 27 years; SD, 9.8; 42% females) with primary ACL reconstruction were registered in the Swedish national knee ligament register. There were 4438 (44%) of these patients (42% females) who had completed the knee-specific questionnaire, Knee injury and Osteoarthritis Outcome Score (KOOS), and 5255 (52%) who had completed the generic score of health status, EQ-5D, before surgery and were included in this study. Independent t tests were used to study sex differences in KOOS and EQ-5D preoperatively, 1 and 2 years postoperatively, and over time. RESULTS: Preoperatively, female patients reported worse scores than male patients in 4 KOOS subscales (pain, symptoms, sport/recreation, quality of life) and EQ-5D, with the largest difference seen in KOOS sport/recreation (mean difference, 4.7; 95% confidence interval [CI], 3.0-6.3). At 1 year postoperatively, female patients reported worse scores than male patients in KOOS pain (mean difference, 1.4; 95% CI, 0.4-2.4) and KOOS sport/recreation (mean difference, 2.7; 95% CI, 0.9-4.4) and at 2 years postoperatively in KOOS sport/recreation (mean difference, 4.4; 95% CI, 2.1-6.7) and KOOS quality of life (mean difference, 2.4; 95% CI, 0.4-4.4). Female patients reported less improvement from 1 to 2 years postoperatively than male patients in KOOS sport/recreation (mean difference, 3.2; 95% CI, 0.3-6.1). In some age groups, female patients reported a clinically relevant worse KOOS sport/recreation score than male patients (mean difference >/=8). CONCLUSION: Female patients reported statistically significant worse outcomes than male patients before and at 1 and 2 years after ACL reconstruction. In some age groups, this difference was also clinically relevant. There were no clinically relevant sex differences in improvements over time. We suggest that possible sex differences be analyzed in future studies on evaluation after ACL injury/reconstruction

Displaced Mason type I fractures of the radial head and neck in adults: A fifteen- to thirty-three-year follow-up study

Undisplaced radial head and neck fractures are consistently described with no long-term deficits. The aim of this study was to evaluate specifically the long-term outcome of displaced Mason type I fractures, which have not previously described. Twenty women and twelve men, with a mean age of 46 years (range, 22-69 years) when they sustained a displaced Mason type I fracture, were reexamined at a mean of 21 years (range, 15-33 years) after injury. All were treated nonoperatively. Twenty-nine individuals had no subjective complaints, whereas three had occasional elbow pain. There was no objective impairment, and none had elbow osteoarthritis, defined as reduced joint space, whereas there was more radiographic degeneration in the formerly fractured elbow than in the uninjured elbow (85% vs 4%, P < .001). We conclude that the long-term results of nonoperatively treated displaced Mason type I fractures of the radial head and neck are predominantly favorable

Fracture of the radial head and neck of Mason types II and III during growth: a 14-25 year follow-up

Twenty-four individuals, who were 16 years of age or younger when they sustained a fracture of the radial head or neck, were examined at a mean of 19 years (range 14-25 years) after injury. The 12 girls and 12 boys were a mean age of 11 years (range 5-16 years) when the fracture was sustained. Two were excluded due to late resection of the radial head following persisting pain. The fractures, which were of Mason type II in 19 and type III in three cases, were treated by mobilization in eight cases, plaster in eight, open reduction and internal fixation in three and closed reduction and plaster in three. At the follow-up examination, 19 (86%) had no complaints, while three (14%) had occasional pain. Flexion was decreased in the formerly injured compared with the uninjured elbow (139 + 8degrees versus 142+/-5degrees; P<0.05). None had developed elbow osteoarthritis. Isolated, closed fracture of the radial head and neck during growth has a favourable, long-term outcome

Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study.

Background: The purpose of this study was to evaluate the incidence and the long-term results of closed uncomplicated Mason type-II and III fractures in a defined population of adults. Methods: Seventy women and thirty men who were a mean of forty-seven years old when they sustained a fracture of the radial head or neck (a Mason type-II fracture in seventy-six patients and a Mason type-III fracture in twenty-four) were reexamined after a mean of nineteen years. Radiographic signs of degenerative changes of the elbow were recorded. The fracture had been treated with an elastic bandage or a collar and cuff sling with mobilization for forty-four individuals, with cast immobilization for thirty-four, with resection of the radial head in nineteen, with open reduction of the radial head in two, and with a collateral ligament repair in one. Secondary excision of the radial head was performed because of residual pain in nine patients, and a neurolysis of the ulnar nerve was performed in one patient. Results: Seventy-seven individuals had no symptoms in the injured elbow at the time of follow-up, twenty-one had occasional pain, and two had daily pain. The injured elbows had a slight flexion deficit compared with the uninjured elbows (mean and standard deviation, 138° ± 8° compared with 140° ± 7°) as well as a small extension deficit (mean and standard deviation, –4° ± 8° compared with –1° ± 6°) (p < 0.001 for both). The prevalence of degenerative changes was higher in the injured elbows than in the uninjured ones (76% compared with 16%, p < 0.001). Conclusions: The results following uncomplicated Mason type-II and III fractures are predominantly favorable. A secondary radial head resection is usually effective for patients with an unfavorable outcome (predominantly long-standing pain). Levels of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence

Primary nonoperative treatment of moderately displaced two-part fractures of the radial head

Background: Moderately displaced two-fragment fractures of the radial head have been treated predominantly nonoperatively. Recently, however, open reduction and internal fixation has gradually gained interest, without clear evidence that initial nonoperative treatment leads to an unfavorable outcome. As a consequence, the purpose of the present study was to evaluate the long-term outcome after the initial nonoperative treatment of this type of fracture. Methods: Fifteen men and thirty-four women, with a mean age of forty-nine years at the time of the injury, were included in the study. All patients initially had been managed nonoperatively for a two-fragment fracture of the radial head that was displaced 2 to 5 mm and that included >= 30% of the joint surface (a Mason type-IIa fracture). Early mobilization had been used for twenty-seven patients, and cast immobilization for a mean of two weeks (range, one to four weeks) had been used for twenty-two. All patients were reevaluated with a questionnaire after a mean of nineteen years, and thirty-four also had a clinical and a radiographic evaluation. Six patients had had a delayed radial head excision because of an unsatisfactory primary outcome. Results: Forty of the forty-nine patients had no subjective complaints, eight were slightly impaired as the result of occasional elbow pain, and one had daily pain. Flexion was slightly impaired in the injured elbows as compared with the uninjured elbows (137 degrees +/- 8 degrees compared with 139 degrees +/- 7 degrees) as was extension (-3 degrees +/- 7 degrees compared with 1 degrees +/- 5 degrees) and supination (86 degrees +/- 7 degrees compared with 88 degrees +/- 4 degrees) (p < 0.05 for all comparisons). The prevalence of degenerative changes on radiographs was higher for the injured elbows than for the uninjured elbows (82% [twenty-eight of thirty-four] compared with 21% [seven of thirty-four]; p < 0.01). Conclusions: The initial nonoperative treatment of Mason type-IIa fractures of the radial head that are displaced by 2 to 5 mm is associated with a predominantly favorable outcome, especially if a delayed radial head excision is performed in the few cases in which the early outcome is unsatisfactory. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence

Assessment of GPS derived speed for verification of speed measuring devices

Speed information from GPS is increasingly used and provides an alternative to conventional methods such as wheel speed sensors. We investigate the possibility to use GPS derived speed as a reference when verifying laser and radar-based speed measuring devices used in traffic enforcement. We have set up a realistic test scenario where a GPS equipped vehicle was driven at three different speeds (40, 90 and 130 km/h) through a pre-defined measurement zone. An independent and traceable reference speed was calculated by accurately measuring the length of the measurement zone (approximately 15 metres), and the time it took to pass through it. The reference speed was compared to the average GPS speed for each passage. This comparisons show that the standard uncertainty of such GPS speed measurements is less than 0.05 km/h. Hence, GPS derived speed meets the accuracy requirements for verification of laser and radar based speed measuring devices

Comminuted fractures of the radial head.

BACKGROUND: There have been few reports on the long-term outcome of comminuted radial head fractures in adults. METHOD: 10 women and 9 men with a mean age of 45 (21-65) years when they sustained a comminuted fracture of the radial head were re-evaluated after 15-25 years. 6 patients had been nonoperatively (NO) treated while 13 had had a radial head excision. The uninjured elbow served as a control. RESULTS: At follow-up, 11 patients (4 NO patients) rated their fractured elbow as being without deficits, 7 (1 NO) as being slightly impaired, and 1 (NO) as being severely impaired. Range of motion and elbow strength were not impaired, and even though there were more degenerative changes such as cysts, osteophytes, and sclerosis in the injured elbows by radiography, the prevalence of joint space reduction was not higher. INTERPRETATION: Most patients with an isolated comminuted fracture of the radial head treated nonoperatively or with a radial head excision report no or only minor long-term complaints