Background and purpose Posttraumatic stiffness is a common complication of elbow injury and can result in considerable impairment in daily life. We assessed the outcome in 21 patients treated by a column procedure.Patients and methods We followed 21 patients (average age 40 (10-76) years, 11 women) for 2 years after surgery for a stiff elbow. Range of motion (ROM) and function (EFA score) were measured preoperatively and at 3, 12, and 24 months postoperatively.Results Before surgery, the mean ROM was 69° (SD 24) and the mean EFA score was 74 (SD 13), which improved significantly to 104° (17) and 91 (6), respectively, after release. There were no significant differences between the postoperative measurements at 3, 12, and 24 months. No neurovascular complications were noted; 2 patients developed periarticular ossifications postoperatively.Interpretation A column procedure results in an increase in motion and functional scores at 2-year follow-up. Outcome at 3 months after treatment is the same as after 2 years.

A 5-month-old boy presented with swelling and discoloration of the right third toe because of hair-thread tourniquet syndrome. This was treated by urgent surgical release of the constricting band, with a successful outcome. The authors stress the importance of recognizing this rare condition and of prompt, complete, surgical release.

Background Radiographic measurements of shortening and vertical displacement in the fractured clavicle are subject to a variety of factors such as patient positioning and projection. The aims of this study were (1) to quantify differences in shortening and vertical displacement in varying patient positions and X-ray projections, (2) to identify the view and patient positioning indicating the largest amount of shortening and vertical displacement, and (3) to identify and quantify the inter- and intraobserver agreement. Methods A prospective clinical measurement study of 22 acute Robinson type 2B1 clavicle fractures was performed. Each patient underwent 8 consecutive standardized and calibrated X-rays in 1 setting. Results In the upright patient position, the difference of absolute shortening was 4.5 mm (95% confidence interval [CI]: 3.0-5.9, P < .0001) larger than in the supine patient position. For vertical displacement, the odds of being scored a category higher in the upright patient position were 4.7 (95% CI: 2.2-9.8) times as large as the odds of being scored a category higher in supine position. The odds of being scored a category higher on the caudocranial projection were 5.9 (95% CI: 2.8-12.6) times as large as the odds of being scored a category higher on the craniocaudal projection. Conclusion Absolute shortening, relative shortening, and vertical displacement were found to be the greatest in the upright patient positioning with the arm protracted orientation on a 15° caudocranial projection. No statistically significant differences were found for a change in position of the arm between neutral and protracted.

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