Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up).

The 2-year results of a randomized, prospective, controlled trial of minimally displaced proximal humeral fractures treated either by immediate physiotherapy (group A) or after 3 weeks of immobilization (group B) are reported. At 1 year shoulder disability, as measured with the Croft shoulder disability questionnaire, was found in 42.8% of patients in group A and 72.5% in group B (P < .01). By 2 years, shoulder disability in group A remained unchanged (43.2%) but had reduced in group B (59.5%). This difference was not statistically significant. Immediate physiotherapy after a minimally displaced proximal humeral fracture results in faster recovery, with maximal functional benefit being achieved at 1 year. Delayed rehabilitation by 3 weeks of shoulder immobilization produces a slower recovery, which continues for at least 2 years after the time of injury.

Rehabilitation after two-part fractures of the neck of the humerus.

We undertook a prospective, controlled trial which compared two rehabilitation programmes for 86 patients who sustained two-part fractures of the proximal humerus. Patients were randomised either to receive immediate physiotherapy within one week (group A) or delayed physiotherapy after three weeks of immobilisation in a collar and cuff sling (group B). At 16 weeks after the fracture, patients in group A had less pain (p < 0.01) and had greater shoulder function (p < 0.001) than those in group B. At 52 weeks, the differences between the groups had reduced. Although group A still had greater shoulder function and less pain, there was no statistical difference when compared with group B. By analysis of the area under the curve, an overall measure up to the 52-week period, group A experienced less pain as measured by the SF36 general health questionnaire and had improved shoulder function. Our results show that patients with two-part fractures of the proximal humerus who begin immediate physiotherapy, experience less pain. The gains in shoulder function persist at 52 weeks which suggests that patients do not benefit from immobilisation before beginning physiotherapy.

Serological evidence that dry heating of clotting factor concentrates prevents transmission of non-A, non-B hepatitis.

A new test for antibodies specific for an agent causing non-A, non-B hepatitis (NANBH) was used to screen 45 children with coagulation disorders who received factor concentrates. It was found that the test results correlated with clinical evidence of NANBH and that heat treatment of concentrates (80 degrees C for 72 hours) appears to have prevented transmission of NANBH.