Background Repeated exposure to intermittent normobaric hypoxia improves exercise tolerance in cardiac patients. Little is known on the effects of intermittent normobaric hypoxia‐hyperoxia exposure in coronary artery disease (CAD) patients (New York Heart Association II–III). Hypothesis IHHT improves exercise tolerance, cardiometabolic profile, and quality of life in CAD patients. Methods The study design was a nonrandomized, controlled, before‐and‐after trial. Forty‐six CAD patients volunteered to take part in the study: a group of 27 patients undertook the intermittent hypoxia (O2 at 10%)–hyperoxia (O2 at 30%) training (IHHT), whereas a control group (CTRL) of 19 patients, who already completed an 8‐week standard cardiac rehabilitation program, was allocated to sham‐IHHT treatment (breathing room air, O2 at 21%). Exercise performance, blood and metabolic profiles, and quality of life (Seattle Angina Questionnaire [SAQ]) were measured before and after in the IHHT group (IHHG) and sham‐IHHT in the CTRL group. Results The IHHG showed improved exercise capacity, reduced systolic and diastolic blood pressures, enhanced left ventricle ejection fraction, and reduced glycemia, but only at 1‐month follow‐up. Angina as a reason to stop exercising was significantly reduced after treatment and at 1‐month follow‐up. The IHHT SAQ profile was improved in the IHHG and not significantly different to the CTRL group after standard rehabilitation. The IHHG was also compared to the CTRL group at 1‐month follow‐up, and no differences were found. Conclusions In CAD patients, an IHHT program is associated with improved exercise tolerance, healthier risks factors profile, and a better quality of life. Our study also suggests that IHHT is as effective as an 8‐week standard rehabilitation program.

76 patients were examined clinically and radiologically 27 to 36 years after a fracture of the distal radius. The average age was 31 years at the time of injury and 63 years at follow-up. In 81% of the patients there was no difference between the fractured and the non-fractured side. No patient had to change his or her occupation or leisure activities because of the fracture. There were more degenerative changes in the fractured wrist than in the non-injured side. A statistically significant correlation was found between axial compression and the presence of degenerative changes in the radio-carpal and distal radio-ulnar joints. Treatment of the fracture of the distal end of the radius in the young adult should aim to conserve the length of the radius. However, after 30 years, complaints are few and correlate with degenerative changes in the radio-carpal joint only. 47 patients with articular fractures of the distal end of the radius were examined in the same way. The average age at the time of injury was 32 years and 58% of the patients were men. In 87% of the patients there was no difference between the fractured and the non-fractured side. However 37% had minor complaints. A higher proportion of patients with articular fractures developed degenerative changes than those with non-articular fractures. The existence of radiographic signs of osteoarthritis is directly related to axial compression and the persistent incongruity, after reposition, in either the radio-carpal or the distal radio-ulnar joints.

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We compared Norian SRS, an injectable calcium phosphate bone cement, with external fixation in the treatment of redisplaced distal radial fractures by a prospective randomized study in 40 patients (women 50-80 years or men 60-80 years). After rereduction, the fracture was either stabilized by injection of SRS and immobilized with a cast for 2 weeks, or externally fixed with Hoffman's bar for 5 weeks. Each patient was evaluated at 2, 5, 7 weeks and at 3, 6 and 12 months. Functional parameters were grip strength, range of motion and pain. Radiographic parameters were radial angle, ulnar variance and dorsal tilt. The chosen primary effect variable was grip strength at 7 weeks. Patients treated by injection of SRS apatite had better grip strength, wrist extension and forearm supination at 7 weeks. There was no difference in functional parameters at 3 months or later. None of the methods could fully stabilize the fracture: radiographs showed a progressive redislocation over time. The results indicate that SRS can be used in the treatment of unstable distal radial fractures. The more rapid recovery of grip strength and wrist mobility in the SRS group appears to be due to the shorter immobilization time.

Malunion after a distal radius fracture can be treated with an osteotomy of the distal radius. Autologous iliac crest bone graft is often used to fill the gap, but the procedure is associated with donor site morbidity. In this study a novel fast resorbing biphasic bone substitute consisting of a mixture of calcium sulphate and calcium phosphate is used (Cerament BoneSupport AB, Sweden). Fifteen consecutive patients, with a mean age of 52 (27-71) years were included. All had a malunion after a distal radius fracture and underwent an osteotomy. A fragment specific fixation system, TriMed (TriMed, Valencia, CA), consisting of a Buttress Pin and a Radial Pin Plate were used for fixation and a calcium sulphate and calcium phosphate mixture as bone substitute. The patients were followed for 1 year. Grip strength increased from 61 (28-93)% of the contralateral hand to 85 (58-109)%, p < 0.001. DASH scores decreased from 37 (22-61) to 24 (2-49) p = 0.003. Radiographically all osteotomies healed. An increase of ulnar variance was noted during healing from 1.8 mm immediately postoperatively to 2.6 mm at final follow up. Osteotomy can increase grip strength and decease disability after a malunited fracture. In the present series the bone substitute was replaced by bone, but a minor loss of the achieved radiographic correction was noted in some patients during osteotomy healing. A more rigid fixation may improve the radiographic outcome with this kind of bone substitute.