The outcome of fractures of the proximal humerus after hemiarthroplasty

A research report submitted to the Faculty of Health Sciences, the University of Witwatersrand in partial fulfilment of the requirements for the Degree of Master of Medicine in the branch of Orthopaedic Surgery. Johannesburg, 2017Study design: This is a prospective clinical audit of patient data. Objectives: to determine the clinical outcomes in patients who have undergone hemiarthroplasty surgery of the shoulder. Background: Hemiarthroplasty of the shoulder involves the replacement of the humeral head in patients with fractures of the proximal humerus deemed too severe to fix. It is done routinely at Helen Joseph Hospital. Methods: Our study cohort consisted of 32 patients who had undergone hemiarthroplasty surgery for proximal humerus fractures over a period of four years from 2009 to 2013. All patients were assessed for the following: • The amount of pain they are experiencing in the operated shoulder • Whether their pain post fracture resolved with the surgery • How their activities of daily living are affected • Any functional impairment they are experiencing in the operated shoulder The data that was obtained from the patients included age, gender, Disabilities of Arm, Shoulder and Hand (DASH) score1 and range of motion of both the operated shoulder and the unoperated shoulder. Data was first captured using Microsoft Excel and then Stata 13.0 was used to perform the analysis. Results: Of the 32 patients that participated in the study, there were 12 males and 20 females. The mean age of the patients was 70.5 years (range 51 – 84 years). The mean DASH score was 36.9 (range 18.3 – 53.3). The DASH scores were positively correlated with the ages of the patients. The active range of motion of the operated shoulder was compared to the opposite shoulder in each patient. The range of motion was assessed according to flexion, extension, abduction, internal rotation and external rotation. In each of the 5 movements, the degree of movement in the operated shoulder was less than in the opposite shoulder, which had not been previously operated on. These differences were statistically significant p <0.001. Conclusion: Hemiarthroplasty remains a viable option for the treatment of patients with proximal humerus fractures that are deemed too severe to repair. It provides good pain relief to patients, but the function of the operated shoulder is less than it was pre-injury.MT201

Pledges, Parades, and Mandatory Payments

This Article examines the Supreme Court\u27s treatment of compelled expression cases. It sets forth the speech restraint framework by describing the crucial determinations guiding judicial analysis. It then explains the current results, reasoning, and incoherence of the compelled expression cases. This Article isolates and evaluates the variables that the Court claims are significant to compelled expression analysis. It then adjusts the variables according to the free speech clause values evident in speech restraint analysis to create a coherent doctrine of compelled expression. This doctrine both places past cases within a consistent framework and provides a structure for evaluating future compelled expression cases

Growing a Constitution

Book review: A republic of statutes: The New American Constitution. William N. Eskridge, Jr. and John Ferejohn. New Haven: Yale University Press. 2010. Pp. viii + 582. Reviewed by Leslie Gielow Jacobs

Who\u27s Talking? Disentangling Government and Private Speech

Several different constitutional rules apply to government actions that influence the content of speech. The government has far more discretion to determine speech content when the government itself is the speaker than when it regulates private speakers. Specifically, in the former circumstance, the government can discriminate according to viewpoint, whereas in the latter circumstance it cannot. While the application of the rules may be obvious when either the government or private entities speak alone, increasingly, through various different types of interactions, government and private groups or individuals are speaking together. This circumstance complicates the crucial constitutional determination, which is: who\u27s talking? This Article sets out the analysis necessary to make the speaker determination when government and private entities speak together. The different rules that limit government influence on the content of government and private speech exist because of the different constitutional values that attach to them. These values suggest characteristics that render government speech legitimate. Only when these characteristics exist in a government/private speech interaction should the more lenient constitutional rules-rules that allow viewpoint discriminatory government influence over speech content-apply. Otherwise, the more strict rules should limit government influence over speech content. This Article examines a number of different types of government/private speech interactions, identifying how variations in their structures determine the government\u27s constitutional discretion to influence speech content

Making Sense of Secondary Effects Analysis After Reed v. Town of Gilbert

Making Sense of Secondary Effects Analysis After Reed v. Town of Gilber