Doctor, when can I drive?-the range of elbow motion while driving a car.

BACKGROUND: Immobilization of the upper extremity after an acute injury or postoperatively affects an individual's ability to safely operate a motor vehicle. The elbow is particularly sensitive to immobilization, with subsequent stiffness leading to functional limitations. Most activities of daily living are successfully achieved within a "functional arc" of elbow motion between 30° and 130° of flexion. No objective guidelines exist regarding the range of motion needed to safely operate a vehicle. In this study, we measured the range of motion of right and left elbows while driving a manual-transmission car. MATERIALS AND METHODS: Using electro-goniometers, we measured the flexion and extension, as well as pronation and supination, of the right and left elbows in 20 healthy, right hand-dominant subjects while driving a car. These measurements were recorded on (1) city streets, (2) country roads, and (3) highways. RESULTS: For city streets, the range of motion in terms of flexion and pronation/supination was 15°-105° and 0°-45°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-45°/0°-40°, respectively, for the left. For country roads, it was 10°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-30°/0°-30°, respectively, for the left. For highways, it was 5°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-90° and 0°-30°/0°-25°, respectively, for the left. Mean pronation was significantly higher for the right elbow (P < .01). CONCLUSION: This study describes the range of elbow motion identified to drive a car with a manual transmission and a left-sided steering wheel. Mean pronation of the right elbow is significantly higher than that of the left. Further studies are needed to investigate the relevance of movement restrictions as they relate to handedness, steering-wheel side, and driving impairment.

Fractures of the proximal femur and hip osteoarthrosis - coincidence or coherence?

PURPOSE: The current study aimed to investigate the correlation between the grade of radiographic hip osteoarthritis (OA) and the fracture pattern observed in fragility fractures of the proximal femur. The information may help in cases of occult hip fractures. METHODS: In this retrospective study all 448 patients treated with fragility fractures of the proximal femur in the years 2014-2018 were included. Patients were allocated into two groups: Group I) intracapsular (femoral neck) fractures and Group II) extracapsular (pertrochanteric and subtrochanteric) femoral fractures. The radiographic grade of OA was determined according to Kellgren and Lawrence's classification. One single observer examined all radiographs. RESULTS: Patients' age ranged between 52 and 104 years with a mean of 80.0 years. There was a significant difference in mean age between the two groups (76.9 years intracapsular vs. 83.1 years extracapsular fractures). A total of 250 (55.8%) fractures were intracapsular (femoral neck) and 198 (44.2%) were located extracapsular (pertrochanteric, subtrochanteric). A significant correlation between the degree of OA to fracture pattern was observed: Higher degrees of OA were related to extracapsular fractures and lower degrees of OA to intracapsular fractures. CONCLUSION: The results of this study support the hypothesis that hip osteoarthritis affects the fracture pattern in proximal femur fractures. More severe hip OA is associated with extracapsular fractures that can be treated surgically with lower complication rates compared to intracapsular fractures.

Degenerative changes of the wrist in mixed martial arts and boxing based on the three column theory.

OBJECTIVE: Mixed Martial Arts (MMA) is a relatively young combat sport. In contrast to classic boxing, MMA combines techniques of grappling and striking. However, characteristic long-term effects of MMA on the wrist are discussed controversially. Aim of this study was to elucidate characteristic degenerative changes of the wrist from MMA fighters in comparison to classic boxers. METHODS: In this study, eleven professional MMA fighters and ten professional boxers with chronic wrist pain were examined and compared. Age, weight, number of fights and weekly hours of training were recorded. Wrist and hand of each fighter were examined using a 3T-MR scanner. Degenerations of the radial, central and ulnar column were analyzed according to Navarro's three-column theory and degenerative changes were categorized based on the classification of Fredericson. RESULTS: There was no significant difference of age, weight and number of fights between MMA fighters and boxers (p > 0.15). However, MMA fighters practiced significantly more hours per week (19.5 (MMA) vs. 8.5 (boxing) hours/week, p < 0.001). No significant associations were found between different training times per Week in terms of degenerative changes of the wrist in MMA and boxing based on the three column theory. The comparison of degenerative changes in the columns between MMA and boxing showed no significant differences. The MRI showed a significantly higher degeneration in the radial column compared to the central column among MMA fighters for ligaments (p = 0.01) and bones (p = 0.03). CONCLUSION: Due to different fighting techniques, different physical traumas, including falls, pattern of degenerations of the wrist between MMA fighters and boxers are different. MMA fighters suffer of a highly degenerative radial column and boxers suffer of a homogeneous degeneration of all three columns.

[Degenerative changes in the hand and wrist in elite MMA fighting - an MRI study in comparison to boxing]. / Degenerative Veränderungen an Hand und Handgelenk bei MMA-Kämpfern ­ Eine MRT Studie im Vergleich zu Boxern.

OBJECTIVE: Mixed martial arts (MMA) is a combination of multiple combat sports. Acute injuries in MMA are well known and have been broadly described. However, there is little knowledge about degenerative changes in the musculoskeletal system. The aim of this study was to investigate the impact of techniques used in MMA on the occurrence of degenerative changes in the hand and wrist in comparison to classical boxing. METHODS: 11 MMA fighters and 10 boxers with chronic wrist pain were clinically examined. Age, weight, years of training, number of fights, level of competition and weekly hours of training were recorded. To determine degenerative changes, an MRI of the symptomatic hand was assessed. RESULTS: Years of training, level of competition and number of fights did not show a significant difference between MMA and boxing fighters (p > 0.05), but MMA fighters showed significantly more hours of training per week (p < 0.001). The MMA fighters had more often and more severe degenerative changes of all examined structures (bone, fibrocartilage, ligaments and tendons), with the category "bone" reaching significance (p = 0.002). CONCLUSION: MMA athletes show significantly greater incidence and degree of degeneration in hand and wrist joints. The exact reasons are still unknown and further research is needed to determine the influence of MMA techniques on the severity of degenerative changes in the hand and wrist.