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

Radial head and neck fractures

All elbow fractures between 1969 – 1979 (n=2965) registered at the radiographic archives at the Malmö University Hospital, where all radiographs are saved since a century, were evaluated. Fractures of the radial head and neck were classified according to the by Broberg and Morrey modified Mason classification. A Mason type I fracture is a less than 2 mm displaced fracture of the radial head or neck, a Mason type II fracture is a 2 mm or more displaced fracture, a Mason type III fracture is a comminuted fracture and a Mason type IV fracture is a radial head or neck fracture in addition with an elbow dislocation. Radial head or neck fractures were found in 756 individuals, in 480 (64%) a Mason type I fracture, in 222 (29%) a Mason type II fracture, in 36 (5%) a Mason type III fracture and in 18 (2%) a Mason type IV fracture. The annual incidence of radial head and neck fractures were 2.6 out of 10 000 in all individuals, 2.9 out of 10 000 in adults and 1.4 out of 10 000 in children. As to increase the sample size, when evaluating individuals with a Mason type IV fracture and individuals treated with an extirpation of the radial head, we included individuals found in the out- and in clinic registers and the operation registers during the years 1957 – 1990. All former patients, still living in Malmö, were after mean 11 – 46 years subjectively, objectively and radiographically re-evaluated. The 32 individuals with a displaced Mason type I fractures had all with conservative treatment predominantly a favourable outcome, no objective deficits, a higher prevalence of radiographic degenerative changes but no higher prevalence of elbow osteoarthritis (OA). The 22 children (below age 16) with a Mason type II or III fracture had a predominantly favourable outcome, an impaired flexion but no higher prevalence of radiographical degenerative changes or elbow OA, when a reduction of the fracture was undertaken if the fractured radial head was tilted more than 30 degrees. The 100 adults (16 years or older) with a Mason type II or III fracture had a predominantly acceptable outcome, an impaired flexion and extension, a higher prevalence of radiographic degenerative changes but no higher prevalence of elbow OA, if a late radial head excision was undertaken in cases with an unfavourable primary outcome. There were no differences in subjective, objective and radiographical outcome when comparing 43 individuals treated with a primary radial head excision with 18 individuals treated with a delayed radial head excision following a Mason type II – IV fracture. The 21 individuals with a Mason type IV fracture seemed to have a trend towards a higher proportion of unsatisfied individuals when compared with a Mason type I - III fracture. Although the majority still had an acceptable outcome, an impaired flexion and extension, a higher prevalence of radiographic degenerative changes but no higher prevalence of elbow OA, and none had experienced recurrent elbow dislocations

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

A longitudinal study on cardiac effects of deconditioning and physical reconditioning using the anterior cruciate ligament injury as a model.

BACKGROUND: Studies of cardiovascular deconditioning are primarily carried out after experimental bed rest. No previous study has followed the cardiovascular effects of decreased and resumed physical activity in athletes after acute physical injury and convalescence. Anterior cruciate ligament (ACL) injury causes a significantly decreased activity level over a long period, making it an ideal model for studying effects of deconditioning and reconditioning. Therefore, the aim of this study was to investigate how cardiac dimensions and maximal exercise capacity change after an ACL-injury. METHOD: Seventeen athletes (5 women) were included. Cardiac magnetic resonance (CMR) was performed within 5 days of the injury (CMR1), before endurance training was resumed (CMR2) and 6 months after the second scan (CMR3). Maximal exercise testing was performed on the same day as CMR2 and 3. RESULTS: The deconditioning phase between CMR1 and CMR2 was 59 ± 28 days. Total heart volume (THV) decreased with -3·1 ± 6·7%, P = 0·056. Between CMR2 and 3 (reconditioning), THV increased significantly (2·5 ± 4·6%, P<0·05). Left and right ventricular EDV decreased during deconditioning (-3·0 ± 5·6% and -4·7 ± 6·6%) and increased during reconditioning (1·7 ± 3·9% and 2·6 ± 6·2%) however not statistically significant. Left ventricular mass (LVM) remained unchanged. VO2 peak (mlmin(-1) kg(-1) ) increased significantly during the reconditioning phase (6·1 ± 5·3%, P<0·001). CONCLUSION: Physiological cardiac adaptation to deconditioning and reconditioning caused by severe knee injury with maintained normal daily living during convalescence was smaller than previously shown in bed rest studies. Total heart volume and VO2 peak were significantly affected by reconditioning whilst LVEDV, RVEDV and LVM remained unchanged over the study period

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

Displaced fractures of the neck of the radius in adults - An excellent long-term outcome

We have reviewed 20 women and three men aged 22 to 73 years, who had sustained a Mason type-lib fracture of the neck of the radius 14 to 25 years earlier. There were 19 patients with displacement of the fractures of 2 mm to 4 mm, of whom 13 had been subjected to early mobilisation and six had been treated in plaster for one to four weeks. Of four patients with displacement of 4 mm to 8 mm, three had undergone excision and one an open reduction of the head of radius. A total of 21 patients had no subjective complaints at follow-up, but two had slight impairment and occasional elbow pain. The mean range of movement and strength of the elbow were not impaired. The elbows had a higher prevalence of degenerative changes than the opposite side, but no greater reduction of joint space. Mason type-lib fractures have an excellent long-term outcome if operation is undertaken when the displacement of the fracture exceeds 4 mm

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