Mason type IV fractures of the elbow: a 14- to 46-year follow-up study.

A total of 14 women and seven men with a mean age of 43 years (18 to 68) who sustained a Mason type IV fracture of the elbow, without an additional type II or III coronoid fracture, were evaluated after a mean of 21 years (14 to 46). Primary treatment included closed elbow reduction followed by immobilisation in a plaster in all cases, with an additional excision of the radial head in 11, partial resection in two and suturing of the annular ligament in two. Delayed radial head excision was performed in two patients and an ulnar nerve transposition in one. The uninjured elbows served as controls. Nine patients had no symptoms, 11 reported slight impairment, and one severe impairment of the elbow. Elbow flexion was impaired by a mean of 3 degrees (sd 4) and extension by a mean of 9 degrees (sd 4) (p < 0.01). None experienced chronic elbow instability or recurrent dislocation. There were more degenerative changes in the formerly injured elbows, but none had developed a reduction in joint space. We conclude that most patients with a Mason type IV fracture of the elbow report a good 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-IIb 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-IIb fractures have an excellent long-term outcome if operation is undertaken when the displacement of the fracture exceeds 4 mm.

Periprosthetic bone resorption. Particles versus movement.

Using a rat model, we created a bone-to-titanium interface and applied phagocytosable high-density polyethylene particles between the bone and implant, either initially or when the interface had matured. No fibrous membrane developed and no bone resorption was found. If sliding movements were initiated at the interface after two weeks, there was formation of a fibrous membrane. The additional application of particles did not change the thickness of the membrane, and there were only minor qualitative changes. Creation of a membrane by movement followed by cessation of movement and the application of particles caused the membrane to persist, whereas in a particle-free control group bone-to-metal contact was re-established. Our findings suggest that mechanical stimuli are of primary importance for prosthetic loosening, and that particles may modulate the later stages of the loosening process.

Effects of verapamil and atenolol on exercise tolerance in 5,000 m cross-country running: a double-blind cross-over study in normal humans.

The effects on exercise tolerance of 7-day treatment with a calcium channel blocker, verapamil 160 mg twice daily (b.i.d.), and a beta 1-selective blocker, atenolol 50 mg b.i.d., were compared in 10 healthy and physically active young subjects in 5,000-m cross-country running at high intensity. The study was a double-blind cross-over trial. Comparison was made with a single-blind placebo as well. Performance time was measured every 1,000 m in seven 5,000-m runs, in which subjects were instructed to keep to a constant fatigue perception (Borg scale rating). Both drugs significantly (p = 0.001) increased the performance time over the first 1,000 m as compared with placebo. However, running time after 1,000, 2,000, and 3,000 m was prolonged significantly less (p less than 0.05) by verapamil than by atenolol. For the entire 5,000-m run, atenolol caused a significant increase (p = 0.001) in mean running time by 1 min 34 s (i.e., 7.5%; 95% confidence interval 48 s to 2 min 21 s) as compared with placebo, whereas verapamil caused no significant change (+46 s).