OBJECTIVES: To assess elbow function, complications, and problems of radial head fractures associated with elbow dislocation receiving surgical treatment with a floating prosthesis. DESIGN: Prospective clinical study. SETTING: University Hospital, Orthopaedic Department, Sart Tilman, Liège, Belgium. PATIENTS: Eleven consecutive adult patients were treated with a floating prosthesis for acute radial head fractures associated with elbow dislocation from January 1994 to September 1996. INTERVENTION: The floating radial head prosthesis (Tornier SA, Saint-Ismier, France) was used in all our patients. The implant is in two parts: a radial head made of high-density polyethylene enclosed in a cobalt-chrome cup, which articulates in a semiconstrained manner with the spherical end of a cemented intramedullary stem. The implants were inserted within the first week following the injury (range 2 to 7 days). Three cases also required internal fixation of the coronoid process of the ulna; in one case plate fixation of an olecranon fracture was also performed. MAIN OUTCOME MEASUREMENTS: Patients were assessed by physical examination, a functional rating index (Morrey et al.), and radiographs. The parameters evaluated were motion, stability, pain, and grip strength. Potential complications such as infection, prosthetic failure, or dislocation were investigated. RESULTS: The minimum follow-up time was two years (mean 32 months, range 24 to 56 months). Four patients were considered to have excellent results, four patients were considered to have good results, two patients had fair results, and one patient had a poor result. There were no cases of infection, prosthetic failure, or dislocation. No patient required prosthetic revision. CONCLUSION: The basic principle of maintaining anatomic and physiologic relationships applies when deciding on treatment for radial head fractures with associated elbow dislocation. The loss of lateral osseous support will render the elbow grossly unstable. We believe that a floating prosthesis may be indicated in Mason Type III radial head fractures associated with elbow dislocation, especially in the presence of associated destabilizing fractures. Well-controlled comparative randomized studies will be needed to delineate the optimal treatment for a given situation.

Adult↗

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[The flow of venous blood in the obese].

The increase of adipose tissue disturbs the cutaneous venous circulation. In the normal subject, this flow, in the subcutaneous space, occurs between two networks joined by drainage veins. The responsible motor forces are multiple (residual arteriolar pressure, negative transmural pressure) (effect of compression). In the obese patient, hypertrophy of the adipose tissue-mass damages the drainage veins and provokes stasis, evolving in two stages: at first the disorders are reversible (venous dilatation); then definitive tissular damage occurs (epidermis, plexus, veins, muscles, fatty masses). This disintegration accounts for the clinical symptoms (oedema, varicose veins, trophic disorders). There are three conclusions to be drawn from this: adiposity will always be accompanied by venous insufficiency; it is dangerous to make a long-overweight patient reduce weight; adiposity must be treated very early on.

Blood Circulation↗

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[Mechanical problems in cerebral venous circulation].

Generally speaking, the cerebral circulation is not well known. This lack of knowledge causes problems for the physicians nad here are two examples: 1) resistance of the cerebral circulation. It is an accepted fact that the blood flow in the brain is particularly rapid. Classical anatomical data and recent mechanical notions invalidate this statement. With an average speed in the veins, the blood cannot, in a given time, complete such a long and complex course. What hypothesis could be expressed to find a solution? 2) The physiological role of the spinal fluid. It is an accepted fact that the spinal fluid is only a protecting device of the nerve centers. Recent studies let to believe that it could also have a role in the regulation of the venous flow. There are other mechanical problems: what are the characteristics of the flow in the venous sinus? in the venous junctions? in the venous dilations? Although lesions of the venous cerebral circulation present clinical manifestations to which the vein specialists are not accustomed to, they cannot deny the fact that this is a familiar pathology.

Blood Flow Velocity↗

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[Metabolic functions of the skin].

20 percent of the skin's energy expenditure goes on metabolic exchanges. It is in the microcirculation that the metabolic flow can be identified. The pre-terminal structures responsible for the variability of the outflow must be distinguished from the terminal structures where the hydraulic translations take place. In the network stereo-composed of terminal capillaries may be seen incidental flux (from the arteriole to the venule), interrupted transitory flux, and inverted flux. These circulatory mechanisms are admirably adapted to the variable and rhythmic needs of the metabolism. But the whole mechanism is fragile.

Biomechanical Phenomena↗