To find out how the site and type of condylar fracture are affected by its aetiology and the age and sex of the patient.
Retrospective study.
Tertiary referral centre, Finland.
Radiographs of 101 children (aged 15 years or less) with 119 condylar fractures.
Site of fracture and degree of displacement.
A total of 26 of the 119 fractures were intracapsular (22%) and 93 (78%) extracapsular. Only among patients less than 6 years of age was there a preponderance of intracapsular fractures (7/12 fractures in 10 patients, 58%). In the older children 78% (83/107) were in the condylar neck. There were few subcondylar fractures (5/119, 4%). Only 6 fractures were displaced (5%). Dislocation of the condyle from the glenoid fossa was common in all age groups.
The site of condylar fracture is age related, but not associated with sex or aetiology.
Division of Plastic Surgery, University of British Columbia, Burn, Plastic and Trauma Unit, Vancouver General Hospital, Vancouver, BC, Canada. SallyLHynes@gmail.com
Bilateral anterior temporomandibular joint dislocation is very rare, with only 2 reported cases published. In the present report, we describe a healthy 25-year-old man from Haida Gwaii, in British Columbia, Canada, who was transferred to our tertiary trauma center with life-threatening complications of a bilateral anterior temporomandibular joint dislocation with locked mandibular impaction.
Emergency and primary care physicians are often asked to estimate patients' likely duration of sickness absence or temporary disability following work-related injury or illness. However, return to work is a complex interaction of multiple factors and often difficult to predict accurately.
To compare physician estimates of expected time away from work and severity of injury, made at the time of the initial presentation, with actual duration of temporary disability following work-related shoulder or knee injury.
Patients aged 18-65 with work-related shoulder or knee injuries who attended one of three Edmonton Emergency Departments were recruited. For each participant the treating physician made an estimate of severity and expected time before they would return to their work. This was compared with information on actual temporary disability (TDdays) obtained from the Alberta Workers' Compensation Board (WCB) data.
Over the study period, 443 (88%) of 501 patients were enrolled into the study; however, only 177 (35%) agreed to linking their data with WCB. Median TDdays increased with the physicians' estimates of both severity and likely temporary disability. Physicians tended to underestimate time off work for those with long duration of TDdays, but overestimated this for those with short durations.
Emergency physicians' estimates of expected lost work time and severity of injury were correlated with actual temporary disability, although their accuracy was fairly low. Further work to define why differences between estimated and actual temporary disability occur could help physicians and others planning return to work.
The study aimed to examine possible time trends in the prevalence of clinical signs indicative of temporomandibular disorder (TMD) in an adult population, to analyse possible associations between TMD signs and associated factors and to estimate the need for TMD treatment. Three independent, stratified and randomly selected samples of around 100 individuals in the age groups of 20, 30, 40, 50, 60 and 70 years participated in the Jönköping studies in 1983,1993 and 2003. The study material consisted of 1,693 subjects who, after answering a questionnaire and being interviewed about the presence of TMD symptoms, were clinically examined in terms of the presence of TMD signs according to the Clinical Dysfunction Index (Di) by Helkimo. Associations between clinical signs and the Di as dependent variables and each of the independent variables of age group, gender, reported bruxism, trauma, self-perceived healthiness and the year of investigation were analysed in binary logistic regression models. Estimates of the need for TMD treatment were based on the presence of a combination of severe symptoms and clinical signs. The prevalence of severely impaired jaw movement capacity, relating to horizontal movements, had increased in 2003. The prevalence of muscle pain and temporomandibular joint pain upon posterior palpation was found to vary statistically significantly between 1993 and 2003. Gender differences were noted in these changes overtime. Female gender, advancing age, awareness of bruxism, self-perceived health impairment and the wearing of complete dentures were associated with TMD signs and a higher degree of clinical dysfunction. The estimated need for TMD treatment increased from 5% in 1983 to 8% in 2003 and was higher in women than in men. In conclusion, the results indicate that the prevalence of some TMD signs and of estimated treatment need increased during the period 1983-2003.
Although overuse injuries are common among recreational exercise-takers, in most cases they are treatable in primary care. It is important to evaluate both intrinsic and extrinsic aetiological factors underlying the development of overuse injuries. Treatment should always be focused on the aetiological factors, rather than solely on the symptoms. After an initial period of rest, a supervised rehabilitation programme, combined with correction of intrinsic and extrinsic factors, is the optimal treatment for most overuse syndromes. Surgery is only rarely necessary.
Division of Occupational and Environmental Medicine, Department of Health and Environment, Faculty of Health Sciences, Linköping University, Sweden. asa.reckner-olsson@ymk.liu.se
OBJECTIVE: To evaluate the influence of lifestyle, reproduction, and some external factors on the development of rheumatoid arthritis (RA) and to describe its comorbidity. METHODS: Cases were identified retrospectively from 1980 to 1995 at the University Hospital in Link?ping, Sweden. The study comprised 422 cases and 859 randomly selected population referents. Data on possible aetiological factors and comorbidity were collected by postal questionnaire. RESULTS: The response rates were 67% among cases and 59% among referents. A decrease in the occurrence of atopic allergy was seen in the cases (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4 to 1.0). There was a positive association between RA and insulin treatment (OR 10.2, 95% CI 1.7 to 60.8) in women, and women with a short fertile period had an increased risk of RA (OR 2.5, 95% CI 1.1 to 5.4). Current and previous smoking were associated with increased risks for RA in both sexes, and in men a dose-response relationship was found with number of tobacco pack years (p for trend
Low-trauma fractures (also called osteoporotic fragility fractures or fall-induced fractures) of older adults are a serious public health problem. However, very little population-based information is available on the nationwide numbers, incidences, and especially secular trends of elderly people's low-trauma fractures of the distal humerus.
We assessed the current trends in the number and incidence of these fractures in 60-year-old or older women in Finland by taking into account all women who were admitted to Finnish hospitals for primary treatment of such fracture in 1970-2014.
The annual number of low-trauma distal humeral fractures among Finnish women 60 years of age or older rose over fivefold between 1970 and 1998 (from 42 to 224 fractures), but thereafter, the number decreased down to 198 fractures in 2014. The age-adjusted incidence (per 100,000 persons) of these fractures also increased in 1970-1998 (from 12 to 35) but decreased thereafter to 23 in 2014. The finding was similar in the age-specific patient groups (60-69, 70-79, and 80+): The incidence rose from 1970 till 1998 and decreased thereafter.
The steep rise in the rate of low-trauma distal humeral fractures in 60-year-old or older Finnish women from 1970 till late 1990s has been followed by a clearly declining fracture rate. The exact reasons for this secular change are unknown, but a cohort effect toward improved functional ability among elderly women, as well as measures to prevent falls and alleviate fall severity, could partly explain the phenomenon.
The objective of this study was to compare ranges of motion (ROM) between dominant and nondominant sides for the joints of the upper and lower extremities.
Ninety healthy white women from 18 to 59 years of age were measured in this study. Active and passive ROM were measured for the ankle, knee, hip, shoulder, elbow, and wrist using a standard goniometer. The order of the joints, motion, sides, and active or passive motion testing was randomly selected. A paired t test was used for the comparison between sides.
The results of this study showed a statistically significant difference between dominant and nondominant sides for 34 of the 60 ROM measured. The maximum mean difference between sides for all ROM measured was 7.5 degrees .
The results of this show that some ROM are different between body sides and that when these differences exist they are minimal and may not be clinically insignificant. These results support the practice of using the opposite side of the body as an indicator of preinjury or normal extremity ROM.
