Most coronoid fractures and fracture-dislocations with no radial head involvement can be treated nonsurgically with elbow immobilization.

HYPOTHESIS: Conservative treatment of isolated coronoid fractures and fracture-dislocations focused on soft-tissue healing can provide good clinical results in the majority of patients. Our aims were (1) to evaluate the outcome of a conservative treatment protocol designed for isolated coronoid fractures with or without associated elbow dislocations (ICFs) and (2) to characterize the fractures with a dedicated image analysis protocol. METHODS: Of 38 consecutive patients sustaining acute ICFs, 28 were treated nonsurgically after meeting specific inclusion criteria, prospectively followed up, and clinically evaluated at least 1 year after sustaining their injuries. All cases underwent elbow computed tomography scans with tri-plane and 3-dimensional reconstructions according to a specific protocol referenced to the proximal ulna. RESULTS: The study included 15 male and 13 female patients, with a mean follow-up period of 32 ± 14 months (range, 12-61 months). An associated dislocation was presented in 8 (29%). Mean extension and flexion were 2° ± 8° (range, -10° to 30°) and 139° ± 11° (range, 110°-155°), respectively. Mean pronation and supination were 74° ± 3° (range, 60°-75°) and 83° ± 9° (range, 40°-85°), respectively. Of the patients, 78% rated their elbow as being normal or nearly normal. The mean Mayo Elbow Performance Score was 95 ± 9 (range, 70-100). The mean Disabilities of the Arm, Shoulder and Hand score was 7 ± 13 (range, 0-57). The mean coronoid fracture height was 5.7 ± 1.2 mm (range, 3.7-7.9 mm). The mean percentage of coronoid height fractured was 33% ± 6% (range, 23%-43%). Mean fracture displacement was 2.7 ± 2 mm (range, 1-9 mm). Of the fractures, 23 (82%) were located at the anteromedial coronoid. CONCLUSION: An ICF with a perfectly reduced ulnohumeral joint, a competent sublime tubercle, and a fractured coronoid height up to 50% can be treated without surgery with excellent or good results in more than 90% of cases regardless of the location of the fracture in the coronoid or the type of soft tissue-associated disruptions.

Upper age limits in studies submitted to a research ethics committee.

BACKGROUND AND AIMS: Discrimination in research of new drugs for older people is frequent. We examined research protocols submitted to a research ethics committee, to ascertain whether they stipulated unjustified upper age limits, and whether these age limits are changing in time. METHODS: Systematic review of protocols of studies submitted to the Research Ethics Committee of a public university hospital, in four different years, looking for unjustified upper age limits. Studies that dealt with topics or conditions that automatically excluded older people were not examined. RESULTS: In the first three cohorts of protocols of intervention studies (1994, 1999, 2004), 36% to 40% stipulated an upper age limit. In 2007, only 19% of the protocols showed an unjustified limit. Non-intervention trials rarely had upper age limits. Age limits were arbitrarily chosen (65, 70, 75 or 80 years were chosen as cut-off points in most cases). Five to 6% of the protocols specifically concerned older persons, with no change in time. CONCLUSIONS: Unjustified age limits are frequent in the protocols of intervention studies, although the numbers have been falling recently. Ethics research committees are in a strong position to influence research practice and to reduce unethical age discrimination.