Injury of the upper trunk of the brachial plexus leads to impaired growth of the biceps and brachialis muscles, which are responsible for elbow flexion contractures, and impaired growth of the subscapularis muscle, which correlates with internal rotation contracture of the shoulder. Shoulder muscle imbalance alone causes neither subscapularis shortening nor internal rotation contracture. Impaired muscle growth cannot be explained solely by absence of functioning satellite cells.

A review of prospectively collected data was done to compare functional outcomes and mortality among patients with different hip fracture types. Five hundred thirty-seven elderly patients who sustained a hip fracture were followed up prospectively. Orthopaedists blinded to treatment and outcome radiographically classified the fractures as either: (1) nondisplaced or impacted femoral neck; (2) displaced femoral neck; (3) stable intertrochanteric; or (4) unstable intertrochanteric fracture. Functional independence measure scores were calculated for preinjury function and at 2and 6-month followups. Comorbidities, operative details, postoperative complications, and deaths were recorded. Six-month mortality was lowest for patients with nondisplaced femoral neck fractures (5.7%) and highest for patients with displaced femoral neck fractures (15.8%), but multivariate analysis only identified preinjury function as an independent predictor of mortality. All preinjury and followup functional independence measure scores were greatest for patients with nondisplaced femoral neck fractures and least for patients with unstable intertrochanteric fractures. However, multivariate analysis identified only patient age and preinjury functional independence measure scores as independent predictors of functional outcome. These data show differences in mortality and functional outcomes among fracture types that can be attributed to differences in functional status before injury.Hip fractures are associated with notable morbidity and mortality in elderly patients. The incidence of hip fractures seems to be increasing as the population ages. 38,59 Many studies have investigated the functional outcomes and mortality of hip fractures in elderly patients, identifying predictors of outcome from patient and treatment characteristics.

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The pathophysiology of paradoxical elbow flexion contractures following neonatal brachial plexus injury (NBPI) is incompletely understood. The current study tests the hypothesis that this contracture occurs by denervation-induced impairment of elbow flexor muscle growth. Unilateral forelimb paralysis was created in mice in four neonatal (5-day-old) BPI groups (C5-6 excision, C5-6 neurotomy, C5-6 neurotomy/repair, and C5-T1 global excision), one non-neonatal BPI group (28-day-old C5-6 excision), and two neonatal muscle imbalance groups (triceps tenotomy AE C5-6 excision). Four weeks post-operatively, motor function, elbow range of motion, and biceps/brachialis functional lengths were assessed. Musculocutaneous nerve (MCN) denervation and reinnervation were assessed immunohistochemically. Elbow flexion motor recovery and elbow flexion contractures varied inversely among the neonatal BPI groups. Contracture severity correlated with biceps/brachialis shortening and MCN denervation (relative axon loss), with no contractures occurring in mice with MCN reinnervation (presence of growth cones). No contractures or biceps/brachialis shortening occurred following non-neonatal BPI, regardless of denervation or reinnervation. Neonatal triceps tenotomy did not cause contractures or biceps/brachialis shortening, nor did it worsen those following neonatal C5-6 excision. Denervation-induced functional shortening of elbow flexor muscles leads to variable elbow flexion contractures depending on the degree, permanence, and timing of denervation, independent of muscle imbalance. Neonatal brachial plexus injury (NBPI) occurs in 1.5 per 1,000 live births. 1 In the 20-30% of children without immediate neurological recovery, 2 secondary contractures occur, most notably shoulder internal rotation contractures and elbow flexion contractures. 3 In contrast to the wealth of literature addressing the shoulder contracture, relatively few studies have addressed the elbow flexion contracture, despite the fact that the latter contracture has been described for over 100 years 4 and affects 62-89% of children following unresolved NBPI. 5,6 These elbow contractures range from mild (10-208) 6,7 to severe (40-908), [8][9][10] limiting the functional range of elbow motion 11 and exacerbating the cosmetic deformity of an already short, malpositioned upper extremity. 9 Recommendations for treatment vary widely, with proponents of no treatment, 12 serial casting, 8 surgical release, 5,13 external fixator distraction, 10 flexor-to-extensor muscle transfers, 14 and humeral osteotomy. 9 Underlying the paucity of literature and lack of treatment consensus is an incomplete understanding of the contracture's etiology. Despite the fact that this paradoxical flexion contracture occurs in the setting of elbow flexor paralysis, 6,15,16 several authors believe muscle imbalance to be the cause, 3,8,10,17 proposing that the imbalance may be caused by earlier 6 or anomalous 1014 reinnervation of the elbow flexors. Additional proposed etiologies of the elbow ...

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Background: Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features. Aims: To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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