Long-term outcomes after different types of Horne and Tanzer olecranon fractures.

BACKGROUND: It is unclear whether the outcomes differ after different Horne and Tanzer types of olecranon fractures. MATERIALS AND METHODS: We evaluated 40 men and 55 women with isolated olecranon fractures, journals and radiographs from fracture event. The fractures were classified according to Horne and Tanzer. After a mean 19 years after the fracture events, we evaluated subjective, clinical and radiographic outcomes, using the uninjured arms as controls. RESULTS: 95% of patients with type I fractures reported, at follow-up, no differences between the elbows, 80% with type II fractures and 95% with type III fractures (p = 0.43). The three types of fractures had no differences in elbow range of motion or hand grip strength (when comparing injured and uninjured arms) and the proportions of individuals with radiographic elbow degenerative changes or joint space reduction were no different (all p > 0.05). Individuals with elbow degenerative changes had no inferior subjective elbow function compared to individuals with normal radiographs (p = 0.66), in contrast to those with joint space reduction compared to individuals with normal radiographs (p < 0.001). INTERPRETATION: All types of Horne and Tanzer olecranon fractures have favourable long-term outcome. Elbow joint space reduction is associated with inferior subjective elbow function while degenerative changes are not.

Risk factors for low back pain and sciatica in elderly men-the MrOS Sweden study.

Introduction: The aim of this study was to identify whether factors beyond anatomical abnormalities are associated with low back pain (LBP) and LBP with sciatica (SCI) in older men. Material and Methods: Mister Osteoporosis Sweden includes 3,014 men aged 69­81 years. They answered questionnaires on lifestyle and whether they had experienced LBP and SCI during the preceding 12 months. About 3,007 men answered the back pain (BP) questions, 258 reported BP without specified region. We identified 1,388 with no BP, 1,361 with any LBP (regardless of SCI), 1,074 of those with LBP also indicated if they had experienced LBP (n = 615), LBP+SCI (n = 459). Results: About 49% of those with LBP and 54% of those with LBP+SCI rated their health as poor/very poor (P < 0.001). Men with any LBP to a greater extent than those without BP had poor self-estimated health, depressive symptoms, dizziness, fall tendency, serious comorbidity (diabetes, stroke, coronary heart disease, pulmonary disease and/or cancer) (all P < 0.001), foreign background, were smokers (all P < 0.01), had low physical activity and used walking aids (all P < 0.05). Men with LBP+SCI to a greater extent than those with LBP had lower education, lower self-estimated health, comorbidity, dizziness and used walking aids (all P < 0.001). Conclusions: In older men with LBP and SCI, anatomical abnormalities such as vertebral fractures, metastases, central or lateral spinal stenosis or degenerative conditions may only in part explain prevalent symptoms and disability. Social and lifestyle factors must also be evaluated since they are associated not only with unspecific LBP but also with LBP with SCI.

The prevalence and severity of low back pain and associated symptoms in 3,009 old men.

PURPOSE: The aim of this study is to evaluate the prevalence and severity of low back pain (LBP) and the influence of sciatica and neurological deficits in old men. MATERIAL AND METHOD: Mister osteoporosis Sweden includes 3,014 community-dwelling men aged 69-81 years. At study start 3,009 participants answered questions on LBP, low back pain and sciatica (LBP + SCI) or low back pain and sciatica with associated neurological deficits (LBP + SCI + NEU) during the preceding 12 months. Data are presented as proportions or medians with mid-quartile ranges. Differences between groups were tested by χ(2) test and Kruskall-Wallis test. RESULTS: 24% had experienced LBP without SCI, 8% LBP + SCI and 14% LBP + SCI + NEU. 10% of the men with LBP, 22% of those with LBP + SCI, and 36% of those with LBP + SCI + NEU rated the pain as severe (p < 0.001). 23% of the men with LBP, 31% of those with LBP + SCI and 50% of those with LBP + SCI + NEU reported limitation in activity of daily living (ADL) (p < 0.001). Men with only LBP had to restrict their activities for 7 days (3-14), those with LBP + SCI 6 days (2-14) and those with LBP + SCI + NEU 10 days (3-30) (p < 0.05). CONCLUSIONS: The 1-year prevalence of LBP in community living men aged 69-81 years was close to 50% but for individuals with LBP or LBP + SCI the morbidity was low with more than two-thirds having no limitations in ADL. In men with LBP + SCI + NEU more than one-third rated the pain as severe and close to half had limitations in ADL.

Comminuted fractures of the radial head.

BACKGROUND: There have been few reports on the long-term outcome of comminuted radial head fractures in adults. METHOD: 10 women and 9 men with a mean age of 45 (21-65) years when they sustained a comminuted fracture of the radial head were re-evaluated after 15-25 years. 6 patients had been nonoperatively (NO) treated while 13 had had a radial head excision. The uninjured elbow served as a control. RESULTS: At follow-up, 11 patients (4 NO patients) rated their fractured elbow as being without deficits, 7 (1 NO) as being slightly impaired, and 1 (NO) as being severely impaired. Range of motion and elbow strength were not impaired, and even though there were more degenerative changes such as cysts, osteophytes, and sclerosis in the injured elbows by radiography, the prevalence of joint space reduction was not higher. INTERPRETATION: Most patients with an isolated comminuted fracture of the radial head treated nonoperatively or with a radial head excision report no or only minor long-term complaints.

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up.

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.

Primary nonoperative treatment of moderately displaced two-part fractures of the radial head.

BACKGROUND: Moderately displaced two-fragment fractures of the radial head have been treated predominantly nonoperatively. Recently, however, open reduction and internal fixation has gradually gained interest, without clear evidence that initial nonoperative treatment leads to an unfavorable outcome. As a consequence, the purpose of the present study was to evaluate the long-term outcome after the initial nonoperative treatment of this type of fracture. METHODS: Fifteen men and thirty-four women, with a mean age of forty-nine years at the time of the injury, were included in the study. All patients initially had been managed nonoperatively for a two-fragment fracture of the radial head that was displaced 2 to 5 mm and that included >/=30% of the joint surface (a Mason type-IIa fracture). Early mobilization had been used for twenty-seven patients, and cast immobilization for a mean of two weeks (range, one to four weeks) had been used for twenty-two. All patients were reevaluated with a questionnaire after a mean of nineteen years, and thirty-four also had a clinical and a radiographic evaluation. Six patients had had a delayed radial head excision because of an unsatisfactory primary outcome. RESULTS: Forty of the forty-nine patients had no subjective complaints, eight were slightly impaired as the result of occasional elbow pain, and one had daily pain. Flexion was slightly impaired in the injured elbows as compared with the uninjured elbows (137 degrees +/- 8 degrees compared with 139 degrees +/- 7 degrees ), as was extension (-3 degrees +/- 7 degrees compared with 1 degrees +/- 5 degrees ) and supination (86 degrees +/- 7 degrees compared with 88 degrees +/- 4 degrees ) (p < 0.05 for all comparisons). The prevalence of degenerative changes on radiographs was higher for the injured elbows than for the uninjured elbows (82% [twenty-eight of thirty-four] compared with 21% [seven of thirty-four]; p < 0.01). CONCLUSIONS: The initial nonoperative treatment of Mason type-IIa fractures of the radial head that are displaced by 2 to 5 mm is associated with a predominantly favorable outcome, especially if a delayed radial head excision is performed in the few cases in which the early outcome is unsatisfactory. LEVEL OF EVIDENCE: Therapeutic Level IV.

Characteristics of Prevalent Vertebral Fractures Predict New Fractures in Elderly Men.

BACKGROUND: Studies have shown that specific characteristics of prevalent vertebral fractures are associated with a markedly low bone mineral density. This study evaluates if these characteristics also predict subsequent fractures. METHODS: MrOS (Mister Osteoporosis) Sweden is a population-based, prospective observational study that includes 3014 community-living men who are sixty-nine to eighty-one years of age. At baseline, 1453 men underwent lateral thoracic and lumbar spine radiography; radiographs of 1427 men were readable. A radiologist identified and characterized prevalent vertebral fractures. Incident fractures during the next five and ten years were objectively registered with use of radiographs. The annual fracture incidence and relative risk of sustaining new fractures were assessed for men with and without baseline prevalent vertebral fracture. Data are presented as the mean and the 95% confidence interval. RESULTS: There were 215 men (15.1%) with at least one prevalent vertebral fracture. During the five-year follow-up, these men had a relative risk of 3.3 (95% confidence interval, 2.6 to 4.3) of sustaining new fractures. The relative risk of sustaining any fracture was especially high in men with two or more prevalent vertebral fractures at 5.5 (95% confidence interval, 3.7 to 7.8), in men with different types of prevalent vertebral fractures at 5.7 (95% confidence interval, 3.6 to 8.5), in men with prevalent fractures in both the thoracic and lumbar regions at 6.4 (95% confidence interval, 4.5 to 8.8), and in men with prevalent fractures with a degree of vertebral body compression in the three worst quartiles, with the relative risk for the worst quartile at 4.0 (95% confidence interval, 2.6 to 5.9). CONCLUSIONS: Older men with a prevalent vertebral fracture have three times increased risk of sustaining new fractures compared with men without a vertebral fracture. Older men with two or more prevalent vertebral fractures, different types of fractures (wedge, biconcave, and/or crush), fractures in both the thoracic and lumbar regions, and a degree of vertebral body compression in the three worst quartiles are at an especially high risk of sustaining new fractures. Older men with prevalent vertebral fractures should be considered for fracture-prevention efforts.

[Treatment of osteoporotic vertebral compression. Explosive interest for vertebroplasty and kyphoplasty]. / Behandling av osteoporotisk kotkompression. Explosionsartat intresse för vertebroplastik och kyfoplastik.

During the last 15 years, two new treatment strategies have gained worldwide attention in the treatment of osteoporotic vertebral fractures. The exponential increase in the use of percutaneous vertebro- or kyphoplasty has up to now not been supported by scientific sound evidence-based data. There exist no prospective randomised controlled trials (RCT) that support the efficacy of the treatments, not even adequate controlled studies. Instead we have to rely on prospective and retrospective uncontrolled short-term observational studies and case-control studies. These studies consistently indicate that the short-term results after the procedures in the treatment of osteoporotic vertebral fractures are favourable, regarding both pain relief and functional status. However, if a vertebro- or a kyphoplasty produces a better outcome than conservative treatment, and if the long-term results are as favourable as the short-term results in the treatment of osteoporotic vertebral fractures, is currently unknown.

Low clinical relevance of a prevalent vertebral fracture in elderly men--the MrOs Sweden study.

BACKGROUND CONTEXT: The epidemiology, the fracture pattern, and the clinical relevance of prevalent vertebral fractures in old men are debated wherefore we set out to clarify these issues. METHODS: Mister Osteoporosis (MrOs) Sweden is a population-based cohort of community-living men aged 69-81 years that includes 3,014 men. Out of these, 1,453 men underwent a lateral radiograph of the thoracic and lumbar spine of which 1,427 were readable and classified by a radiologist, that is the sample size in this study. The men also answered a questionnaire evaluating back pain and limitation in activities of daily living (ADLs) because of back pain during the preceding 12 months in addition with fracture history and life style. RESULTS: Fifteen percentage of the men had at least one prevalent vertebral fracture, but only 1/10th of these were aware of their fracture. Among the men with a fracture, 58% had one, 21% two, 9% three, and 11% four or more fractures. In men with only one fracture, 70% of the fractures were located in the thoracic and 30% in the lumbar spine, 85% had a wedge, 13% a biconcave, and 2% a crush-type configuration; one-quarter had a maximum vertebral body compression degree of less than 24% and one-quarter of more than 38%. Among the men with one or several vertebral fracture, 57% reported back pain compared with 55% in those without a fracture (p=.53). Most ADL functions were similar in the men with or without a prevalent vertebral fracture. In the men with one fracture, there was no difference in the occurrence of back pain depending on the fractured region (p=.49), type of the fracture (p=.77), or degree of compression (p=.85). In men with one or several fractures, there were no significant differences in the presence of back pain in any ages (p=.08), nor there were differences in presence of back pain regarding type (p=.08) or number of fractures (p=.21). CONCLUSIONS: A prevalent vertebral fracture is common in old men but has low clinical relevance. There does not seem to be a specific fracture pattern that predisposes for back pain.

Fractures of the radial head and neck treated with radial head excision.

BACKGROUND: The reported long-term outcomes of the treatment of radial head and neck fractures with excision of the radial head have been mixed. The purpose of the present study was to evaluate the long-term outcomes of primary or delayed radial head excision for the treatment of these fractures. METHODS: Sixty-one individuals (mean age, forty-four years) with thirty-nine Mason type-II, ten Mason type-III, and twelve Mason type-IV fractures were evaluated subjectively, objectively, and radiographically at a mean of eighteen years (range, eleven to thirty-three years) after treatment. Forty-three fractures were treated with primary radial head excision, and the remaining eighteen were treated with delayed radial head excision at a median of five months (range, one to 238 months) after the injury. RESULTS: At the time of follow-up, twenty-eight individuals had no symptoms, twenty-seven had occasional elbow pain, and six had daily pain. Four individuals with daily pain had had a Mason type-IV fracture. The range of motion of the formerly injured upper extremities was slightly less than that of the uninjured upper extremities in terms of flexion (139 degrees +/- 11 degrees compared with 142 degrees +/- 8 degrees ), extension (-7 degrees +/- 12 degrees compared with -1 degrees +/- 6 degrees ), and supination (77 degrees +/- 20 degrees compared with 85 degrees +/- 10 degrees ) (all p < 0.01). A higher percentage of formerly injured elbows than uninjured elbows had cysts, sclerosis, and osteophytes (73% compared with 7%; p < 0.001), but none had a reduced joint space. No differences were found between the outcomes for individuals treated with a primary radial head excision and those for individuals treated with a delayed excision. CONCLUSIONS: Following a displaced radial head or neck fracture, excision of the radial head often leads to a good or fair result. We found no differences in outcome between primary and delayed radial head excisions following a Mason type-II, III, or IV fracture. The outcomes are associated with the type of fracture, with Mason type-IV fractures having the worst results, rather than with the timing of the radial head excision (primary or delayed).

Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study.

BACKGROUND: The purpose of this study was to evaluate the incidence and the long-term results of closed uncomplicated Mason type-II and III fractures in a defined population of adults. METHODS: Seventy women and thirty men who were a mean of forty-seven years old when they sustained a fracture of the radial head or neck (a Mason type-II fracture in seventy-six patients and a Mason type-III fracture in twenty-four) were reexamined after a mean of nineteen years. Radiographic signs of degenerative changes of the elbow were recorded. The fracture had been treated with an elastic bandage or a collar and cuff sling with mobilization for forty-four individuals, with cast immobilization for thirty-four, with resection of the radial head in nineteen, with open reduction of the radial head in two, and with a collateral ligament repair in one. Secondary excision of the radial head was performed because of residual pain in nine patients, and a neurolysis of the ulnar nerve was performed in one patient. RESULTS: Seventy-seven individuals had no symptoms in the injured elbow at the time of follow-up, twenty-one had occasional pain, and two had daily pain. The injured elbows had a slight flexion deficit compared with the uninjured elbows (mean and standard deviation, 138 degrees +/- 8 degrees compared with 140 degrees +/- 7 degrees ) as well as a small extension deficit (mean and standard deviation, -4 degrees +/- 8 degrees compared with -1 degrees +/- 6 degrees ) (p < 0.001 for both). The prevalence of degenerative changes was higher in the injured elbows than in the uninjured ones (76% compared with 16%, p < 0.001). CONCLUSIONS: The results following uncomplicated Mason type-II and III fractures are predominantly favorable. A secondary radial head resection is usually effective for patients with an unfavorable outcome (predominantly long-standing pain). LEVELS OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Fracture of the radial head and neck of Mason types II and III during growth: a 14-25 year follow-up.

Twenty-four individuals, who were 16 years of age or younger when they sustained a fracture of the radial head or neck, were examined at a mean of 19 years (range 14-25 years) after injury. The 12 girls and 12 boys were a mean age of 11 years (range 5-16 years) when the fracture was sustained. Two were excluded due to late resection of the radial head following persisting pain. The fractures, which were of Mason type II in 19 and type III in three cases, were treated by mobilization in eight cases, plaster in eight, open reduction and internal fixation in three and closed reduction and plaster in three. At the follow-up examination, 19 (86%) had no complaints, while three (14%) had occasional pain. Flexion was decreased in the formerly injured compared with the uninjured elbow (139 +/- 8 degrees versus 142+/-5 degrees; P<0.05). None had developed elbow osteoarthritis. Isolated, closed fracture of the radial head and neck during growth has a favourable, long-term outcome.

Fractures of the olecranon during growth: a 15-25-year follow-up.

Ten girls and 13 boys with mean age 11 years when sustaining a fracture of the olecranon were examined at a mean of 19 years after the injury. Ten fractures were displaced less than 2 mm, three 2-3 mm, eight more than 3 mm and two were multifragmental. The treatment consisted of mobilization in three cases, plaster treatment in nine and open reduction and internal fixation in 11 cases. At follow-up, 21 children had no subjective complaints while two had occasional mild pain. The upper arm circumference was thinner in the former injured extremities than in the uninjured (P<0.05). No other objective deficits were found. None had developed non-union or elbow osteoarthritis. Olecranon fractures during growth have an excellent long-term outcome.

Body appearance and quality of life in adult patients with adolescent idiopathic scoliosis treated with a brace or under observation alone during adolescence.

STUDY DESIGN: The Scoliosis Research Society (SRS) brace study (published in the JBJS-A, 1995) was comprised of patients with adolescent idiopathic scoliosis with moderate curve sizes (25°-35°). Forty observed and 37 braced patients (77% of the original group) attended a follow-up, a mean of 16 years after onset of maturity. OBJECTIVE: To analyze whether the subjectively evaluated present body appearance affects outcome as measured by quality of life in adult patients, previously treated by observation alone (nonbraced) or with a brace during adolescence. SUMMARY OF BACKGROUND DATA: Few reports exist where validated outcome measures for body appearance have been used. METHODS: Two quality-of-life questionnaires, the Scoliosis Research Society-22 (SRS-22) questionnaire and the 36-Item Short-Form Survey Instrument (SF-36), were answered. The patient's opinion on body appearance was evaluated pictorially (i.e., sketches) using the spinal appearance questionnaire, in which 7 aspects of asymmetry are graded. These scores were compared with curve sizes, scoliometer measurements for grading trunk asymmetry, and quality-of-life measures. RESULTS: At follow-up, both groups were similar in terms of age (mean = 32 years) and curve size (mean = 35°). Distortion was inversely related to SRS-22 total score and satisfaction/dissatisfaction with management subscore, but not related to the SRS-22 function subscore. No difference was found between the groups in terms of trunk rotation, where the means were 10.7° and 10.8° for the nonbraced and braced patients, respectively. The nonbraced patients estimated that their body appearance was significantly less distorted than the braced patients (mean = 12.9 and 15.0, respectively; P = 0.0028). CONCLUSION: Patients who experienced less body asymmetry were more satisfied with treatment and had a better quality of life. In spite of similar curve sizes and trunk rotation in both groups, the nonbraced patients felt that their body appearance was less distorted than that of the braced patients.

Health-related quality of life in untreated versus brace-treated patients with adolescent idiopathic scoliosis: a long-term follow-up.

STUDY DESIGN: The previous Scoliosis Research Society brace study (JBJS-A, 1995) included patients with adolescent idiopathic scoliosis (AIS) with moderate curve sizes (25 degrees -35 degrees). The Swedish patients in this study were examined in a long-term follow-up. OBJECTIVE: The aim was to analyze and compare quality of life in adulthood between AIS patients who were only observed or treated with a brace during adolescence. SUMMARY OF BACKGROUND DATA: Quality of life as measured by the SRS-22 has not previously been presented for adult untreated AIS patients. METHODS: Forty patients who were only observed (due to a curve increase of less than 6 degrees until maturity), and 37 brace-treated patients attended the complete follow-up, including clinical and radiologic examination, and answered 2 quality of life questionnaires (SRS-22 and Short Form-36 [SF-36]). RESULTS: No differences were found between the groups in terms of age at follow-up (mean: 32 years), follow-up time after maturity (mean: 16.0 years), and curve size at inclusion (mean: 30 degrees) or at follow-up (mean: 35 degrees). The SRS-22/total score was a mean of 4.2 for braced patients and 4.1 for only observed patients. Neither total scores/subscales of the SRS-22 or SF-36 differed significantly between the groups. For the SF-36, no differences in relation to the Swedish age-matched norm scales were found for either group. CONCLUSION: Patients with moderate AIS report good quality of life in their 30s, as measured by both the SRS-22 and SF-36, regardless of whether they received no active treatment or were brace treated during adolescence. Neither of the groups displayed any difference compared with the age-matched norm groups for the SF-36.

Measurement of vertebral rotation in adolescent idiopathic scoliosis with low-dose CT in prone position - method description and reliability analysis.

BACKGROUND: To our knowledge there is no report in the literature on measurements of vertebral rotation with low-dose computed tomography (CT) in prone position. AIMS: To describe and test the reliability of this new method, compare it with other methods in use and evaluate the influence of body position on the degree of vertebral rotation measured by different radiological methods. STUDY DESIGN: Retrospective study. METHODS: 25 consecutive patients with adolescent idiopathic scoliosis scheduled for surgery (17 girls, 8 boys) aged 15 +/- 2 years (mean +/- SD) were included in the analysis of this study. The degree of the vertebral rotation was in all patients measured according to the method of Perdriolle on standing plain radiographs and on supine CT scanogram, and according to the method of Aaro and Dahlborn on axial CT images in prone position and on magnetic resonance imaging (MRI) in supine position. The measurements were done by one neuroradiologist at two different occasions. Bland and Altman statistical approach was used in the reliability assessment. RESULTS: The reliability of measuring vertebral rotation by axial CT images in prone position was almost perfect with an intraclass correlation coefficient of 0.95, a random error of the intraobserver differences of 2.3 degrees , a repeatability coefficient of 3.2 degrees and a coefficient of variation of 18.4%. Corresponding values for measurements on CT scanogram were 0.83, 5.1 degrees , 7.2 degrees , and 32.8%, respectively, indicating lower reliability of the latter modality and method. The degree of vertebral rotation measured on standing plain radiographs, prone CT scanogram, axial images on CT in prone position and on MRI in supine position were 25.7 +/- 9.8 degrees , 21.9 +/- 8.3 degrees , 17.4 +/- 7.1 degrees , and 16.1 +/- 6.5 degrees , respectively. The vertebral rotation measured on axial CT images in prone position was in average 7.5% larger than that measured on axial MRI in supine position. CONCLUSIONS: This study has shown that measurements of vertebral rotation in prone position were more reliable on axial CT images than on CT scanogram. The measurement of vertebral rotation on CT (corrected to the pelvic tilt) in prone position imposes lower impact of the recumbent position on the vertebral rotation than did MRI in supine position. However, the magnitude of differences is of doubtful clinical significance.

Long-term outcome of displaced radial neck fractures in adulthood: 16-21 year follow-up of 5 patients treated with radial head excision.

BACKGROUND: There have been no reports on the long-term outcome of radial neck Mason type IIIb fractures in adults. METHODS: 3 women and 2 men, aged 46 (22-69) years when they sustained a radial neck Mason type IIIb fracture, were evaluated after an average of 18 (16-21) years. All had been treated with radial head excision. RESULTS: 3 individuals had no subjective elbow complaints while 2 reported occasional weakness. None had severe elbow complaints. The maximum elbow-to-elbow difference in range of motion was a deficit of mean 10 degrees in extension in the injured elbow. Mean deficits in elbow flexion, forearm pronation, and forearm supination were below 5 degrees and the mean difference in cubitus valgus angle was only 2 degrees. There was no instability and no recurrent elbow dislocations. Radiographically, there were cysts, sclerosis, and osteophytes in all formerly injured elbows but none in the uninjured elbows. We found reduced joint space in 1 elbow that had been formerly injured. INTERPRETATION: Mason type IIIb fracture in adults, treated with radial head excision, appears to have a favorable long-term outcome.