Occipital condyle fracture-A rare but severe injury in cranial fracture patients

We clarified occurrence, severity, and associated injuries of occipital condyle fractures (OCFs) in a cranial fracture population. Retrospective data of cranial fracture patients were analyzed. The outcome variable was presence of OCF in cranial fracture patients. Predictor variables were type of associated injury, Glasgow Coma Scale (GCS) value under 6, and death during hospital care. In addition, occurrence of OCF was assessed according to cranial fracture subtypes. Explanatory variables were age, sex, injury mechanism, involvement of alcohol, and high-energy injury. Treatment and outcome of OCFs were analyzed. Of 637 cranial fracture patients, 19 (3.0%) sustained an OCF, eight of whom had no other cranial fractures. In the multivariate adjusted model, increased risk for OCF was detected in patients with cervical injuries (OR 18.66, 95% CI 5.52, 63.12; p < 0.001) and facial fractures (OR 5.99, 95% CI 1.01, 35.45; p = 0.049). Patients with fractures not extending to the skull base were less likely to have OCF (OR 0.01, 95% CI 0.001, 0.25; p = 0.004), and fractures localized solely to the base of the skull offered a protective effect for OCF (OR 0.19, 95% CI 0.06, 0.58; p = 0.003). All OCFs were treated non-operatively with a cervical collar without complications. OCF patients typically sustain other severe injuries, particularly cervical injuries and facial fractures. Careful screening for associated injuries is therefore crucial when examining a patient with OCF. The classification scheme of Mueller et al. seems to be useful in guiding the treatment of OCFs, at least type 1 and 2 fractures.

Translation and Validation of the Finnish Version of the Patient-Rated Wrist Evaluation Questionnaire (PRWE) in Patients with Acute Distal Radius Fracture

BACKGROUND AND AIMS

Patient-rated outcome measures have become increasingly important in clinical research. They provide research and clinical tools which can be utilized in the assessment of patient recovery and treatment efficacy. The purpose of our study was to translate and validate the original version of the PRWE form into Finnish.

MATERIAL AND METHODS

We conducted the translation of the PRWE questionnaire according to standardized guidelines. Patients (N = 119) with an acute distal radius fracture were recruited, and they completed the PRWE and QuickDASH questionnaires at 2 months and 4 months after the wrist injury.

RESULTS

The mean answering times were 52 days (standard deviation [SD] 9.8 days) and 116 days (standard deviation [SD] 14.8 days), respectively. Both the internal consistency (Cronbach's alpha) of 0.976 and the intraclass correlation coefficient (ICC) of 0.992 (95% CI 0.966-0.998) showed excellent reliability for the total PRWE score. The correlation coefficients between the total score, the subscales, and for improvement over time for PRWE and QuickDASH were excellent. The responsiveness was good with an effect size of 0.83 and a standard response mean of 1.22.

CONCLUSION

Our study shows that the Finnish version of the PRWE is reliable, valid, and responsive for the evaluation of pain and disability after distal radius fracture.

Changes in agonist-antagonist EMG, muscle CSA, and force during strength training in middle-aged and older people

Effects of 6 mo of heavy-resistance training combined with explosive exercises on neural activation of the agonist and antagonist leg extensors, muscle cross-sectional area (CSA) of the quadriceps femoris, as well as maximal and explosive strength were examined in 10 middle-aged men (M40; 42 +/- 2 yr), 11 middle-aged women (W40; 39 +/- 3 yr), 11 elderly men (M70; 72 +/- 3 yr) and 10 elderly women (W70; 67 +/- 3 yr). Maximal and explosive strength remained unaltered during a 1-mo control period with no strength training. After the 6 mo of training, maximal isometric and dynamic leg-extension strength increased by 36 +/- 4 and 22 +/- 2% (P < 0. 001) in M40, by 36 +/- 3 and 21 +/- 3% (P < 0.001) in M70, by 66 +/- 9 and 34 +/- 4% (P < 0.001) in W40, and by 57 +/- 10 and 30 +/- 3% (P < 0.001) in W70, respectively. All groups showed large increases (P < 0.05-0.001) in the maximum integrated EMGs (iEMGs) of the agonist vastus lateralis and medialis. Significant (P < 0.05-0.001) increases occurred in the maximal rate of isometric force production and in a squat jump that were accompanied with increased (P < 0.05-0. 01) iEMGs of the leg extensors. The iEMG of the antagonist biceps femoris muscle during the maximal isometric leg extension decreased in both M70 (from 24 +/- 6 to 21 +/- 6%; P < 0.05) and in W70 (from 31 +/- 9 to 24 +/- 4%; P < 0.05) to the same level as recorded for M40 and W40. The CSA of the quadriceps femoris increased in M40 by 5% (P < 0.05), in W40 by 9% (P < 0.01), in W70 by 6% (P < 0.05), and in M70 by 2% (not significant). Great training-induced gains in maximal and explosive strength in both middle-aged and elderly subjects were accompanied by large increases in the voluntary activation of the agonists, with significant reductions in the antagonist coactivation in the elderly subjects. Because the enlargements in the muscle CSAs in both middle-aged and elderly subjects were much smaller in magnitude, neural adaptations seem to play a greater role in explaining strength and power gains during the present strength-training protocol.