The “floating forearm” injury in a child: a case report

The case of a eleven-year-old girl who had a fracture dislocation of the left elbow with entrapment of the ulnar nerve into the dislocated ulnar epicondyle anlage and unstable forearm fracture of the ipslateral upper extremity is described. This severe injury to the elbow and the ipsilateral forearm is termed “floating forearm” injury. The forearm was stabilized percutaneously and the elbow fracture dislocation, remaining unstable after internal fixation was treated with a pediatric elbow fixator with motion capacity

Efficacy of the A-V Impulse System versus cryotherapy in the reduction of postoperative oedema of the hand: a prospective randomised trial

In a prospective randomised trial, the effects of an intermittent compression hand pump vs. cryotherapy were compared on reduction of postoperative hand swelling and gain in finger movement after distal radius fractures. Although intermittent compression as a physical method for thromboprophylaxis and swelling reduction in orthopaedic and trauma patients of the lower leg are established, a prospective randomised trial for an objective evaluation of the effects of intermittent compression in the upper extremity has not been previously performed. Forty-three subjects (63±33 years, 32 women, 11 men) with a unilateral distal radius fracture treated with transarticular external fixation were randomised into two treatment groups. In group A 21 patients were treated with cryotherapy. In group B 22 patients were treated with an intermittent compression hand pump. Reduction in swelling of the treated hand and MP and PIP joint movement were recorded with computerised assessment software (EVAL Hand Evaluation System) in comparison to the uninjured contralateral side. Reduction of swelling in group A was not statistically significant (28.5% of total swelling or 0.61 cm, SD 0.39, p=0.42), but in group B it was significant (92% of total swelling, 3.62 cm, SD 1.48, p<0.001). Comparison of increases in MP and PIP joint movement (p<0.0016) showed statistically significant differences in favour of the intermittent compression pump. This study demonstrates that intermittent compression is more effective in the reduction of postoperative oedema and gain of finger movement of the hand than cryotherapy

Locally Trivial W*-Bundles

We prove that a tracially continuous W$^*$-bundle $\mathcal{M}$ over a compact Hausdorff space $X$ with all fibres isomorphic to the hyperfinite II$_1$-factor $\mathcal{R}$ that is locally trivial already has to be globally trivial. The proof uses the contractibility of the automorphism group $\mathrm{Aut}({\mathcal{R}})$ shown by Popa and Takesaki. There is no restriction on the covering dimension of $X$.Comment: 20 pages, this version will be published in the International Journal of Mathematic

A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

Background: Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design. The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36). Discussion. The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator. Trial Registration. The trial is registered at the Netherlands Trial Register (NTR1996)

Railway noise annoyance: Exposure-response relationships and testing a theoretical model by structural equation analysis

In some regions the exposure to railway noise is extremely concentrated, which may lead to high residential annoyance. Nonacoustical factors contribute to these reactions, but there is limited evidence on the interrelations between the nonacoustical factors that influence railway noise annoyance. The aims of the present study were (1) to examine exposure-response relationships between long-term railway noise exposure and annoyance in a region severely affected by railway noise and (2) to determine a priori proposed interrelations between nonacoustical factors by structural equation analysis. Residents (n = 320) living close to railway tracks in the Middle Rhine Valley completed a socioacoustic survey. Individual noise exposure levels were calculated by an acoustical simulation model for this area. The derived exposure-response relationships indicated considerably higher annoyance at the same noise exposure level than would have been predicted by the European Union standard curve, particularly for the night-time period. In the structural equation analysis, 72% of the variance in noise annoyance was explained by the noise exposure (Lden) and nonacoustical variables. The model provides insights into several causal mechanisms underlying the formation of railway noise annoyance considering indirect and reciprocal effects. The concern about harmful effects of railway noise and railway traffic, the perceived control and coping capacity, and the individual noise sensitivity were the most important factors that influence noise annoyance. All effects of the nonacoustical factors on annoyance were mediated by the perceived control and coping capacity and additionally proposed indirect effects of the theoretical model were supported by the data

Wirkung von Flugzeuginnenlärm auf den Passagierkomfort

In zwei empirischen Studien wurde die Wirkung von Flugzeuginnengeräuschen auf den Komfort und das subjektive Wohlbefinden von Passagieren untersucht. An den Versuchen nahmen insgesamt 199 Personen teil, die neun verschiedenen Lärmexpositionsmustern (3 Schallpegel von 66 bis 78 dB(A) x 3 Frequenzspektren) ausgesetzt wurden. Die Probanden bewerteten jedes Geräusch hinsichtlich seiner Lästigkeit sowie Geräuschqualität und schätzten ihr aktuelles Wohlbefinden während der Geräuschexposition ein. Studie 1 fand im Schalllabor am Institut für Luft- und Raumfahrtmedizin in Köln statt. Studie 2 validierte die Ergebnisse des ersten Experiments im Flugzeugversuchträger Do 728 am DLR Göttingen. Regressionsbasierte Verfahren zeigten eine signifikante Abnahme des Komfortempfindens mit steigendem Schallpegel. Darüber hinaus hatte auch die spektrale Zusammensetzung der Geräusche, die sich je nach Sitzposition (vorne, Mitte, hinten in der Flugzeugkabine) unterschied, einen signifikanten Einfluss auf den Passagierkomfort. Das höchste Wohlbefinden und die geringste Belästigung konnte für das hintere Geräusch festgestellt werden