Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning.

We performed a prospective, randomised study on 57 patients older than 60 years of age with unstable, extra-articular fractures of the distal radius to compare the outcome of immobilisation in a cast alone with that using supplementary, percutaneous pinning. Patients treated by percutaneous wires had a statistically significant improvement in dorsal angulation (mean 7 degrees), radial length (mean 3 mm) and radial inclination (mean 3 mm) at one year. However, there was no significant difference in functional outcome in terms of pain, range of movement, grip strength, activities of daily living and the SF-36 score except for an improved range of movement in ulnar deviation in the percutaneous wire group. One patient developed a pin-track infection which required removal of the wires at two weeks. We conclude that percutaneous pinning of unstable, extra-articular fractures of the distal radius provides only a marginal improvement in the radiological parameters compared with immobilisation in a cast alone. This does not correlate with an improved functional outcome in a low-demand, elderly population.

Haemodynamic and metabolic effects of xamoterol in exercising dogs.

The effects of xamoterol on the haemodynamic adaptation to graded treadmill exercise were evaluated during five subsequent cycles in chronically instrumented dogs. At rest xamoterol, 0.2 mg/kg i.v., preferentially showed a positive inotropic effect, whereas 1 mg/kg i.v. also exhibited a marked chronotropic effect. The cardiac output and left ventricular power increased dose dependently. The mean left atrial pressure and total peripheral resistance decreased concomitantly. Xamoterol did not produce a noteworthy decrease in heart rate or positive dp/dtmax during exercise, even at a dosage of 1 mg/kg. A beta-adrenoceptor blocking effect could only be seen from the diminution of the exercise-induced changes in heart rate, dp/dtmax, cardiac output, left ventricular power and total peripheral resistance. Determination of the blood glucose, lactate and pyruvate levels before the start of each exercise cycle revealed that the drug induced a decrease in blood glucose and an increase in blood pyruvate. Thus, xamoterol exerted a dose-dependent sympathomimetic effect in dogs at rest. However, there was little evidence for a beta-adrenoceptor blocking action even at higher work loads, although preliminary experiments in conscious dogs showed that xamoterol shifted the isoprenaline dose-response curve to the right by a factor of 1.31 (0.2 mg/kg) and 3.05 (1 mg/kg).

Verapamil abolishes exercise-induced regional contractile dysfunction in dogs.

The effects of the Ca++-antagonist verapamil on hemodynamic and regional myocardial functional parameters were studied in a canine model of exercise-induced myocardial dysfunction which mimics exercise-induced angina pectoris. Six dogs, trained to submit to five treadmill exercise cycles, each consisting of 4 min of running and 11 min of recovery, were chronically instrumented with a microtip manometer in the left ventricle, two pairs of crystals for sonomicrometry, a hydraulic occluder around the circumflex branch of the left coronary artery and arterial and venous catheters. Control experiments with coronary stenosis clarified the reproducibility of exercise-induced regional contractile dysfunction and recovery of function in the intervening resting periods. In each individual dog, the same degree of stenosis was used in the subsequent experiments with verapamil. After two control runs which exhibited regional contractile dysfunction of comparable magnitude, verapamil was administered intravenously at a dosage of 0.3 mg/kg over a period of 5 min. Verapamil induced an increase in heart rate at rest due to sympathetic counterregulation secondary to a reduction of systolic and diastolic blood pressure. The exercise-induced increases in heart rate and rate-pressure product were reduced after verapamil, but the exercise-induced increase in left ventricular dp/dtmax was not significantly diminished. The hemodynamic changes led to a marked improvement of regional function during exercise in the area perfused by the stenosed coronary artery. In a study using identical experimental conditions, the Ca++-antagonist bepridil at a dosage of 2 mg/kg/5 min abolished the exercise-induced regional contractile dysfunction to a similar extent as verapamil.(ABSTRACT TRUNCATED AT 250 WORDS)

Survey of sport injuries in physical education students participating in 13 sports.

A protocolled interview was carried out of 150 physical education students to specify retrospectively all sports injuries sustained during their training. This study analyses the frequency, severity and location of injuries sustained by a population group participating in 13 different sports. On average more than three injuries were encountered per student over a mean period of 2.35 years. 74% of all 482 recorded injuries were sustained by males. The sports associated with the highest rate of injuries were gymnastics, skiing and athletics followed by ball games. The most frequently injured body regions were the ankle and the hand. 29% of the injuries were regarded as being severe.

[Effects of 4-week ergometry training at an intensity of 30% versus 50% of maximum performance in an inpatient setting]. / Effekte eines vierwöchigen Ergometertrainings mit einer Intensität von 30% versus 50% der maximalen Leistungsfähigkeit unter stationären Bedingungen.

We investigated the effects of bicycle ergometer training (BET, weekly training time: 120 min, consisting of 8 units of 15 min). In a centre for cardiovascular rehabilitation two groups of 15 patients with coronary heart disease and/or hypertension and/or hyperlipidaemia underwent a four-weeks training period. All patients avoided other training exercises, they all had the same physiotherapy such a massage and the same diet of 800-1200 kcal/day. Current medication was kept constant. The main differences between the groups was the intensity of the training regimes: 30% versus 50% of the individual maximal physical working capacity (PWC), as determined by symptom-limited bicycle ergometry and controlled by an individual training heart rate. The higher intensity of training led to a highly significant increase of 16% in PWC (p < 0.001), whereas the group with the lower training intensity improved by only 5% (p < 0.05). The main effects on body weight (reduction in both groups of about 6%), fat metabolism (significant reduction in cholesterol and low density lipoprotein (LDL) levels in both groups), heart rate and blood pressure (significant decrease in both groups) showed no significant differences between the two groups. In general it can be assumed that the main effects of the 4-week indoor rehabilitation on fat metabolism and blood pressure are due to the diet and weight loss. The 4-week period of endurance training was obviously too short to produce any additional effects. The more intensive aerobic training, which was more effective on PWC, did not reveal better results on fat metabolism, heart rate or blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Elbow revision arthroplasty in the situation of bone loss using an unlinked long-stem prosthesis.

The results of 16 first-revision operations using an unlinked cemented long-stem elbow arthroplasty in the situation of major bone loss are presented. Fifteen patients with a mean age of 62 years and longstanding polyarthritis were monitored for a mean period of 31 months (range, 6-62 months). Seven revision arthroplasties showed a good result and 7 a fair result with improvement of function and pain. Two patients with postoperative instability requiring further surgery had a poor result, with one infected prosthesis and one elbow with persistent instability and ulnar nerve hypersensitivity. Using a visual analog scale, patients documented good pain relief, good subjective independence, and a high level of satisfaction. In the follow-up SF-36 health survey, patients scored low physical function but good mental function. These results show that in the absence of infection and instability, revision elbow arthroplasty, even in the situation of major bone loss, can be a successful treatment option using this unlinked cemented long-stem system.

Bilateral synovitis in symptomatic unilateral transient synovitis of the hip: an ultrasonographic study in 56 children.

56 children with a clinical diagnosis of unilateral transient synovitis of the hip underwent bilateral sonographic assessment. On the anterior scan, the distance between the femoral neck and the fibrous joint capsule was measured. This distance, which we call the synovial capsular complex distance, was compared with age-dependent normal values. An increased distance was found in all 56 symptomatic hips (mean 10 mm, SD 1.8). This distance was also increased in 14 hips on the contralateral side (mean 8 mm, SD 1.6). An effusion was demonstrated in 53 symptomatic hips and in 8 hips on the contralateral side. These findings indicate that in one quarter of children with symptoms of unilateral transient synovitis the contralateral hip may have an increased synovial capsular complex distance due to synovial swelling or joint effusion, suggesting an asymptomatic synovitis. We therefore recommend a comparison of the synovial capsular complex distance on the symptomatic side with age-related normal values, in addition to a comparison with the asymptomatic hip.