Faculty Bibliography

One hundred and four patients who had a minimally displaced fracture of the proximal part of the humerus (a so-called one-part fracture) were managed with a standardized therapy regimen and followed for more than one year. The clinical outcome was assessed on the basis of pain, function, and the range of motion of the shoulder. The duration of follow-up averaged forty-one months (range, twelve to 117 months). All fractures united without additional displacement. Eighty patients (77 per cent) had a good or excellent result, fourteen (13 per cent) had a fair result, and ten (10 per cent) had a poor result. Ninety four patients (90 per cent) had either no or mild pain in the shoulder, eight (8 per cent) had moderate pain, and two (2 per cent) had severe pain. Functional recovery averaged 94 per cent; forty-eight patients (46 per cent) had 100 per cent functional recovery. At the time of the most recent follow-up, forward elevation of the injured shoulder averaged 89 per cent; external rotation, 87 per cent; and internal rotation, 88 per cent that of the uninjured shoulder. The percentage of good and excellent results was significantly greater (p < 0.01) and external rotation was significantly better (p < 0.01) at the time of the latest follow-up for the patients who had started supervised physical therapy less than fourteen days after the injury than for the patients who had started such therapy at fourteen days or later

OBJECTIVE: To present a consecutive series of older patients with pubic rami fractures and evaluate their long term functional outcome. STUDY DESIGN: Retrospective. METHODS: Sixty-three consecutive community-dwelling, ambulatory patients who sustained a public rami fracture and were treated at one hospital were reviewed. Fifty-two of sixty-three patients (83%) had radiographic evidence of pubic rami fracture at initial presentation; in the remaining eleven patients, the diagnosis of pubic rami fracture was made after additional imaging studies. Sixty patients (95%) required hospitalization for pain control and progressive mobilization. RESULTS: The hospital length of stay for the sixty admitted patients averaged fourteen days; patients who had three or more associated medical comorbidities or required use of a cane or walker for ambulation prior to fracture were more likely to have been hospitalized greater than two weeks. Thirty-eight patients were available for one year minimum follow-up; thirty-five of thirty-eight patients (92%) were living at home, 84% had no or mild complaints of hip/groin pain, 92% had returned to their prefracture ambulatory status, and 95% had returned to their performance function in activities of daily living. CONCLUSIONS: 1) Elderly patients with pubic rami fractures utilize substantial healthcare resources based upon length of stay and need for home care services; and 2) those patients who survive have a good prognosis with regard to long term pain relief and functional outcome

Twenty-six patients with Grade III acromioclavicular joint separations were evaluated to determine the outcomes of nonoperative and operative management. Evaluation consisted of a detailed functional questionnaire, physical examination, and comprehensive isokinetic strength assessment. The patients were divided into two groups: operative (n = 16) and nonoperative (n = 10). Operative management consisted of coracoclavicular stabilization with heavy suture material and with nine of the sixteen patients treatment also consisted of coracoacromial ligament transfer and lateral clavicle resection. Nonoperative management consisted of short-term immobilization with early range of motion and rehabilitation. The two groups were similar in all characteristics except mean age: 30.7 years for the operative group and 49.6 years for the nonoperative group. Follow-up evaluation was performed an average of 32.9 months after either injury (nonoperative group) or surgery. Our results indicated that nonoperative management was superior to operative management with respect to time to return to work (0.8 months vs. 2.6 months), time to return to athletics (3.5 months vs. 6.4 months) and time of immobilization (2.7 weeks vs. 6.2 weeks). However, operative management was superior to nonoperative management in the following parameters: time to attain completely pain-free status, the patient's subjective impression of pain, range of motion, functional limitations, cosmesis, and long-term satisfaction. There were no significant differences between the two groups with respect to shoulder range of motion, manual muscle testing, or neurovascular findings. Isokinetic strength testing of the involved shoulder, expressed as a percentage of the uninvolved shoulder, showed no significant differences in peak torque, total work, or total power between the operative and nonoperative groups. However, comparison of the involved to the uninvolved extremity within each group did reveal a trend toward decreased peak torque, work, and power for abduction in the involved extremity regardless of the treatment used. These findings reached statistical significance only for power at the slower testing speed (60 degrees/sec). There was also a significant decrease in power in the involved extremity for external rotation at the faster speed (120 degrees/sec) in the nonoperative group. Finally, the absolute values for peak torque, work, and power were significantly greater for all motions tested in the operative group as compared to the nonoperative group. This may reflect the difference in age between the two groups. Based upon the patients studied, there are benefits to both nonoperative and operative methods of treatment of Grade III acromioclavicular separations. Recovery of strength did not differ between the two groups and therefore should be viewed as a less important factor in patient selection for operative versus nonoperative management. Careful patient selection should remain an important aspect of treatment for this controversial injury