BackgroundPosttraumatic stiffness of the elbow is a common finding after elbow trauma. Restoration of motion in the posttraumatic stiff elbow is difficult, time consuming, and requires high patient compliance. We have evaluated the long-term effect of an open elbow arthrolysis in the posttraumatic stiff elbow.MethodsWe evaluated 43 patients (14 women, 29 men) with a median age of 47(16–78) years operated with open arthrolysis for a posttraumatic stiff elbow. The median follow-up time was 41(12–204) months. The patients were hospitalized median 12(4–14) days, with daily physiotherapy and NSAID. 36 patients tolerated continuous passive motion (CPM) for 11(0–42) days. 35 patients had a well-functioning brachial plexus anesthesia for median 7(1–18) days. We used the paired 2-tailed T-test in our statistical analysis.ResultsPreoperatively the patients had a median flexion of 110(30–160)°, extension 40(10–90)°, and the total flexion-extension sector (F/E) was 50(0–110)°. At follow-up the patients had a median flexion of 132(75–151)° and extension of 23(8–84)°, which indicate a median gain of 42(−50–114)°. The subjective functional scores (Mayo Elbow Score, EQ5D, Q-Dash, and VAS for pain) were satisfying, and most of the patients (81 %) would have done the operation once again knowing the outcome. We had 5 temporary ulnar neuropraxias, one became permanent and in addition ankylotic, one temporary radial neuropraxia, two superficial wound infections, and one transient hematoma.ConclusionOpen arthrolysis of the posttraumatic stiff elbow is associated with reliable clinical and functional long-term outcomes.

Background: Proximal fifth metatarsal fractures are common fractures. Treatment strategies have been debated. We wanted to investigate whether Lawrence and Botte’s classification has prognostic value because of time to fracture union, and evaluate if weightbearing as tolerated (WBAT) and nonweightbearing (NWB) treatment strategy had effect on time to fracture union in nonoperatively treated fractures. Methods: Computerized database search, patients diagnosed between January 1, 2003, and December 31, 2015. Results: We identified 834 fractures; 510 (61.2%) zone 1, 157 (18.8%) zone 2, and 167 (20.0%) zone 3. Most (94.4%) were treated nonoperatively; time to fracture union was 7.5 (SD 7.7), 7.7 (5.6), and 9.2 (8.1) weeks for zone 1, 2, and 3, respectively, which gave a significant longer time to union for zone 3 compared to zone 1 fractures ( P = .04). There was no difference in time to fracture union when comparing WBAT and NWB for all fracture zones. Failure to union, defined as crossover to surgery and/or delayed union, was found in 13 (2.7%) zone 1, 5 (3.2%) zone 2, and 6 (3.8%) zone 3 fractures. Refracture during follow-up was found in 3 (0.6%) zone 1 and 14 (8.9%) zone 3 fractures. Conclusion: Proximal fifth metatarsal fractures have high union rates with nonoperative treatment. No difference in time to union could be found between WBAT and NWB treatment strategies for all fracture zones. We observed a significantly longer time to fracture union for zone 3 fractures compared to zone 1 fractures. Refracture occurs in a nonnegligible share of nonoperatively treated zone 3 fractures.

97En studie fra britisk allmennpraksis viser at den primaerforebyggende behandling av hjerneslag er for dårlig.

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er lege i spesialisering i ortopedisk kirurgi ved Sykehuset Østfold, fast medarbeider i Tidsskriftet og medlem av Fragility Fracture Network Norge. Forfatter har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Fragility Fracture Network Norge har mottatt støtte fra Lilly, Takeda, Amgen og Zimmer Biomet til å arrangere faglige møter. Firmaene leverer produkter som brukes hos pasienter med hoftebrudd. FREDE FRIHAGEN Frede Frihagen er overlege ved Seksjon for traumatologi ved Ortopedisk klinikk, Oslo universitetssykehus. Han er leder i Faggruppe for osteoporose og benhelse, leder i Fragility Fracture Network Norge og bidragsyter til de nye retningslinjene for hoftebruddsbehandling. Forfatter har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Fragility Fracture Network Norge har mottatt støtte fra Lilly, Takeda, Amgen og Zimmer Biomet til å arrangere faglige møter. Firmaene leverer produkter som brukes hos pasienter med hoftebrudd.