Anders Nordqvist

The incidence of fractures of the clavicle.

The age- and gender-specific incidences were calculated in 2035 cases of fracture of the clavicle. The fractures were classified in three groups according to the Allman system. Each group was further divided into undisplaced and displaced fracture subgroups, with an extra subgroup of comminuted midclavicular fractures in Group I. Seventy-six percent of the fractures were classified as Allman Group I. The median age in this group was 13 years. There were significant differences in age- and gender-specific incidence between the undisplaced, displaced, and comminuted fracture subgroups. Twenty-one percent were classified as Allman Group II. The median age of the patients was 47 years, and there was no difference in age between the undisplaced and displaced fracture subgroups. Three percent were classified as Allman Group III, and the median age of the patients in this group was 59 years. All three groups were characterized by a significant preponderance of men, and there was a significant increase in the incidence of clavicular fracture, both overall and sports-related, between 1952 and 1987.

Mid-clavicle fractures in adults: end result study after conservative treatment.

OBJECTIVE The aim of the present study was to analyze the long-term outcome of mid-clavicle fractures in adults and to evaluate the clinical importance of displacement and fracture comminution. DESIGN Two hundred twenty-five mid-clavicular fractures that had been nonsurgically treated at Malmö University Hospital were retrospectively evaluated, both clinically and radiographically, an average of seventeen years after injury. There were seventy-one undisplaced fractures, sixty-nine displaced two-fragment fractures, and eighty-five displaced and comminuted fractures. The average patient age at the time of trauma was thirty-three years (range 15 to 70 years). Patients were interviewed, and careful clinical and radiological examination of their shoulders was performed. Two patients had experienced transient neuritis, and another two underwent operative treatment because of progressive neuropathy. SETTING All 225 consecutive patients were treated primarily at the Malmö University Hospital, which serves the Malmö city population (250,000). PATIENTS/PARTICIPANTS Since the beginning of this century, all radiographs taken at the Malmö University Hospital have been classified and filed for easy retrieval. In this retrospective study, all patients treated between 1970 and 1979 were identified, and those still living were called for follow-up examination. INTERVENTION Of the 225 fractures reviewed, 197 fractures were originally treated with a figure-of-eight splint for an average period of three weeks without any attempt to reduce the displaced fractures; twenty-four patients were allowed immediate free shoulder mobilization. MAIN OUTCOME MEASUREMENTS Clinical rating and healing were the main outcome measurements. RESULTS At follow-up, 185 shoulders were asymptomatic. Thirty-nine shoulders had moderate pain and were rated as fair, and one patient was rated as poor. One hundred twenty-five of the fractures had healed normally, fifty-three were malunited with persistent fracture displacement, and seven were nonunions; nonunion was significantly more prevalent in cases with displaced fractures. Forty malunited fractures and three nonunions were rated as good. CONCLUSIONS This review demonstrates that few patients with fractures of the mid-part of the clavicle require operative treatment.

Incidence and causes of shoulder girdle injuries in an urban population

In a prospective population-based study of all shoulder injuries seen at Malmö General Hospital during 1987, the incidence and causes of major injuries involving fractures of the clavicle, scapula, or proximal humerus and glenohumeral or acromioclavicular dislocations were investigated in children, adults, and the elderly. Seventy-five shoulder injuries occurred in children. Sixty-five of them were fractures of the clavicle. In this age group no sex-related differences were seen in incidence, and 37 of 73 injuries were related to sports or playing. One hundred eighty-one injuries occurred in adults. Sixty fractures of the proximal humerus, 67 fractures of the clavicle, and 31 primary glenohumeral dislocations were seen. The injuries in this group were significantly more frequent in men, with most of them caused by traffic and sport injuries. Two hundred forty-eight injuries occurred in elderly people. Two hundred one were fractures of the proximal humerus. The incidence was significantly higher in women; 147 of 247 injuries were caused by an indoor fall. The variations among age groups are probably attributable to age-related differences in activity, mobility, and fragility.

Fracture of the Body, Neck, or Spine of the Scapula A Long-Term Follow-Up Study

Fractures of the scapula are often considered benign lesions with a favorable outcome. The aim of the current study was to analyze the long-term results after fracture of the muscle-covered parts of the scapula: its body, neck, and spine. Sixty-eight patients were available for clinical examination 14 years after they had sustained a fracture of the scapula. The fractures had been treated with immobilization and early active motion. The follow-up rating was based on patient satisfaction and shoulder motion. Fifty-one patients were rated good, 15 were rated fair, and two were rated poor. Forty-eight shoulders were roentgenographically reexamined. Fourteen had a moderate and six had a pronounced deformity of the scapula. Scapula deformity was associated with pain in eight of the shoulders. The results of the current study suggest that the long-term course after fracture of the scapula is not uniformly favorable. Fifty percent of the patients with residual scapula deformity have shoulder symptoms. In most cases, however, the shoulder disablement is slight or moderate.

Physical activity, muscle function, falls and fractures

Study design A thematic review. Objectives To evaluate if physical activity enhances muscle strength, improves balance, and reduces the fall frequency and the fracture incidence. Background One of the major medical problems of today is the increasing incidence of fragility fractures. Muscle strength and fall is one of the major determinants of a fracture. If physical activity could increase muscle strength, improve balance and reduce the fall frequency, then training could be recommended as prevention for fractures. Methods The review used Medline (Pub Med) and the search words exercise, physical activity, muscle strength, balance, falls, fractures. Randomized controlled trials (RCT) were predominantly included, although this not is a systematic review. Results The evidence that physical activity modifies the risk factors for fall is compelling, although RCT with fractures as end point are lacking. Physical activity is associated with improved muscle strength, co-ordination and balance. Physical training increases muscle strength also in octogenarians by up to 200%, i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass. There is also evidence that physical activity decreases the actual number of falls. Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk. If exercise reduces the number of vertebral fractures and other fragility fractures are less evaluated. Conclusions Physical activity in older ages can be recommended to improve muscle strength and balance, to reduce the risk to fall and fractures, although the highest level of evidence – RCT with fracture as endpoint – is lacking.

High patient satisfaction after arthroscopic subacromial decompression for shoulder impingement : A prospective study of 50 patients

Background Arthroscopic subacromial decompression (ASD) for shoulder impingement has gained popularity. We evaluated the result of this common procedure prospectively, from a patient perspective. Method We used the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Visual Analogue Scale (VAS) to evaluate 50 patients with a mean age of 49 (27–72) years. All patients had undergone 6 months of failed nonoperative treatment prior to surgery. Exclusion criteria were total rotator cuff rupture, shoulder instability, clinically verified acromioclavicular joint osteoarthritis, calcifying tendonitis or neurological symptoms. All the decompressions were done by experienced shoulder arthroscopists. Results A significant improvement in both the median DASH score and the VAS had occurred 6 months after surgery. Interpretation ASD for impingement in properly selected patients performed by experienced surgeons gives a high degree of patient satisfaction 6 months after surgery. ▪

Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients.

Background Although arthroscopic subacromial decompression (ASD) is a common procedure for treatment of shoulder impingement, few long term results have been published. In this prospective study, we determined whether the high degree of patient satisfaction at 6 months postoperatively reported by us earlier remained at the 6-year follow-up. Patients and methods We originally reported high patient satisfaction 6 months after ASD for shoulder impingement in 50 prospectively studied patients using the Disability of the Arm Shoulder and Hand questionnaire (DASH) and the Visual Analog Scale (VAS). Patients with associated shoulder disorders were excluded. The surgeons were experienced shoulder arthroscopists. 6 years after surgery, the DASH questionnaire and the VAS were sent to these 50 patients. 2 patients had other medical problems of the upper extremity that affected the DASH and VAS scores, 1 patient was lost to follow-up, and another refused to participate. Thus, 46 patients with a mean age of 55 (33–78) years were included in this 6-year evaluation. Results The considerable improvement in both the DASH score and the VAS that was observed 6 months after surgery persisted or had even improved 6 years after surgery. Interpretation Properly selected patients with shoulder impingement treated with ASD remain satisfied 6 years after surgery.

Mason type IV fractures of the elbow: A 14- TO 46-YEAR FOLLOW-UP STUDY

A total of 14 women and seven men with a mean age of 43 years (18 to 68) who sustained a Mason type IV fracture of the elbow, without an additional type II or III coronoid fracture, were evaluated after a mean of 21 years (14 to 46). Primary treatment included closed elbow reduction followed by immobilisation in a plaster in all cases, with an additional excision of the radial head in 11, partial resection in two and suturing of the annular ligament in two. Delayed radial head excision was performed in two patients and an ulnar nerve transposition in one. The uninjured elbows served as controls. Nine patients had no symptoms, 11 reported slight impairment, and one severe impairment of the elbow. Elbow flexion was impaired by a mean of 3 degrees (sd 4) and extension by a mean of 9 degrees (sd 4) (p < 0.01). None experienced chronic elbow instability or recurrent dislocation. There were more degenerative changes in the formerly injured elbows, but none had developed a reduction in joint space. We conclude that most patients with a Mason type IV fracture of the elbow report a good long-term outcome.

Comminuted fractures of the radial head.

Background There have been few reports on the long-term outcome of comminuted radial head fractures in adults. Method 10 women and 9 men with a mean age of 45 (21–65) years when they sustained a comminuted fracture of the radial head were re-evaluated after 15–25 years. 6 patients had been nonoperatively (NO) treated while 13 had had a radial head excision. The uninjured elbow served as a control. Results At follow-up, 11 patients (4 NO patients) rated their fractured elbow as being without deficits, 7 (1 NO) as being slightly impaired, and 1 (NO) as being severely impaired. Range of motion and elbow strength were not impaired, and even though there were more degenerative changes such as cysts, osteophytes, and sclerosis in the injured elbows by radiography, the prevalence of joint space reduction was not higher. Interpretation Most patients with an isolated comminuted fracture of the radial head treated nonoperatively or with a radial head excision report no or only minor long-term complaints.

Long-term outcome of displaced radial neck fractures in adulthood

Background There have been no reports on the long-term outcome of radial neck Mason type IIIb fractures in adults. Methods 3 women and 2 men, aged 46 (22–69) years when they sustained a radial neck Mason type IIIb fracture, were evaluated after an average of 18 (16–21) years. All had been treated with radial head excision. Results 3 individuals had no subjective elbow complaints while 2 reported occasional weakness. None had severe elbow complaints. The maximum elbow-to-elbow difference in range of motion was a deficit of mean 10° in extension in the injured elbow. Mean deficits in elbow flexion, forearm pronation, and forearm supination were below 5° and the mean difference in cubitus valgus angle was only 2°. There was no instability and no recurrent elbow dislocations. Radiographically, there were cysts, sclerosis, and osteophytes in all formerly injured elbows but none in the uninjured elbows. We found reduced joint space in 1 elbow that had been formerly injured. Interpretation Mason type IIIb fracture in adults, treated with radial head excision, appears to have a favorable long-term outcome.