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Background: Proximal fifth metatarsal fractures are common fractures. Treatment strategies have been debated. We wanted to investigate whether Lawrence and Botte’s classification has prognostic value because of time to fracture union, and evaluate if weightbearing as tolerated (WBAT) and nonweightbearing (NWB) treatment strategy had effect on time to fracture union in nonoperatively treated fractures. Methods: Computerized database search, patients diagnosed between January 1, 2003, and December 31, 2015. Results: We identified 834 fractures; 510 (61.2%) zone 1, 157 (18.8%) zone 2, and 167 (20.0%) zone 3. Most (94.4%) were treated nonoperatively; time to fracture union was 7.5 (SD 7.7), 7.7 (5.6), and 9.2 (8.1) weeks for zone 1, 2, and 3, respectively, which gave a significant longer time to union for zone 3 compared to zone 1 fractures ( P = .04). There was no difference in time to fracture union when comparing WBAT and NWB for all fracture zones. Failure to union, defined as crossover to surgery and/or delayed union, was found in 13 (2.7%) zone 1, 5 (3.2%) zone 2, and 6 (3.8%) zone 3 fractures. Refracture during follow-up was found in 3 (0.6%) zone 1 and 14 (8.9%) zone 3 fractures. Conclusion: Proximal fifth metatarsal fractures have high union rates with nonoperative treatment. No difference in time to union could be found between WBAT and NWB treatment strategies for all fracture zones. We observed a significantly longer time to fracture union for zone 3 fractures compared to zone 1 fractures. Refracture occurs in a nonnegligible share of nonoperatively treated zone 3 fractures.

Background Posttraumatic stiffness of the elbow is a common finding after elbow trauma. Restoration of motion in the posttraumatic stiff elbow is difficult, time consuming, and requires high patient compliance. We have evaluated the long-term effect of an open elbow arthrolysis in the posttraumatic stiff elbow. Methods We evaluated 43 patients (14 women, 29 men) with a median age of 47(16–78) years operated with open arthrolysis for a posttraumatic stiff elbow. The median follow-up time was 41(12–204) months. The patients were hospitalized median 12(4–14) days, with daily physiotherapy and NSAID. 36 patients tolerated continuous passive motion (CPM) for 11(0–42) days. 35 patients had a well-functioning brachial plexus anesthesia for median 7(1–18) days. We used the paired 2-tailed T-test in our statistical analysis. Results Preoperatively the patients had a median flexion of 110(30–160)°, extension 40(10–90)°, and the total flexion-extension sector (F/E) was 50(0–110)°. At follow-up the patients had a median flexion of 132(75–151)° and extension of 23(8–84)°, which indicate a median gain of 42(−50–114)°. The subjective functional scores (Mayo Elbow Score, EQ5D, Q-Dash, and VAS for pain) were satisfying, and most of the patients (81 %) would have done the operation once again knowing the outcome. We had 5 temporary ulnar neuropraxias, one became permanent and in addition ankylotic, one temporary radial neuropraxia, two superficial wound infections, and one transient hematoma. Conclusion Open arthrolysis of the posttraumatic stiff elbow is associated with reliable clinical and functional long-term outcomes.

The aim of the study was to assess if lung function at birth predicts lung function at 2 yr and secondly, if lung function development was influenced by the common phenotypes of recurrent bronchial obstruction (rBO) or atopic eczema (AE) by 2 yr. Lung function was assessed at birth (n = 802) and at 2 yr within the prospective birth cohort study 'the Environment and Childhood Asthma Study' in Oslo. The 135 children with lung function measured at birth by tidal flow volume (TFV) loops and passive respiratory mechanics, who were included in a nested case-control study were reinvestigated at 2 yr with clinical examination, TFV loops (n = 90) (mean age 26.6 (3.7 s.d.) months), skin prick test and parental interview. Children were categorized into quartiles (lower, middle two, upper) according to time to peak tidal expiratory flow/total expiratory time (t(PTEF)/t(E)) at birth as well as clinical phenotype based on the presence of rBO and/or AE (ever) by 2 yr. The observed reduction in mean t(PTEF)/t(E) from birth to 2 yr within the quartiles, were not significantly different after controlling for 'regression to the mean'. t(PTEF)/t(E) at birth correlated significantly with t(PTEF)/t(E) at 2 yr, (r = 0.475, p < 0.001). Children with both rBO and AE by 2 yr had significantly lower t(PTEF)/t(E) at 2 yr (p = 0.002) and at birth (p = 0.027), compared with children with no rBO or AE. Clinical phenotype at 2 yr did not influence the change in t(PTEF)/t(E) from birth to 2 yr. This study demonstrates a clear tracking of lung function from birth, not influenced by rBO or AE by 2 yr.

Summary Background Several candidate genes have been implicated in the etiology of asthma, including the gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR). Mutations in the CFTR gene result in derangements of mucociliary clearance. Homozygotes for CFTR mutations develop cystic fibrosis (CF), a disorder characterized mainly by lung and pancreas disease. Objective To investigate whether there was an increased frequency of CFTR mutations in asthma patients. Methods Seven hundred and three subjects aged 10–11 years from the environment and childhood asthma (ECA) study were included in the present study. Possible associations between asthma, reduced lung function, bronchial hyperresponsiveness (BHR), and increased or decreased nitrogen oxide (NO) levels (based on structural parental interview, spirometry, PD 20 methacholine challenge test and exhaled NO measurements), and the five most common CFTR mutations in Norway (ΔF508, R117H, R117C, 4005+2T→C, 394delTT), the modulating polymorphisms IVS8(TG) m T n and the IVS8-5T were investigated. Results No association were found between asthma, reduced lung function, BHR or exhaled NO levels and CF heterozygosity. However, the IVS8(TG) 11 T 7 haplotype was associated with normal lung function. Conclusions Our results do not support the hypothesis that CFTR mutations or polymorphisms play a role in the pathogenesis of asthma in children. However, the distribution of Tn(TG)m haplotypes differed between individuals with reduced lung function and individuals with normal lung function.

Factors that might influence lung function bronchodilator response by 2 yr of age is largely unknown, thus we aimed to assess this in the 'Environment and Childhood asthma' (ECA) study in Oslo. A clinical investigation at mean age 26 months was attended by 516 (84%) children included in a nested case-control study [children with recurrent bronchial obstruction (rBO)] (n = 265) and controls without a history of lower respiratory disease (n = 251). Tidal lung function measures before and after inhaled nebulized salbutamol (bronchodilator response) (when clinically without BO) were obtained in 46%. Clinical characteristics and personal and family history of allergic/respiratory diseases (asthma risk factors) were ascertained by structured interview and clinical examination. Allergic sensitization was assessed by skin prick test/specific IgE antibody analyses to common allergens. Mean (95% CI) per cent change in time to reach peak flow/total expiratory time (t(PTEF)/t(E)) from before to after salbutamol was significantly larger in children with rBO [17.3 (9.4-25.3) than controls (-2.2 (-7.7 to 3.0)]. The bronchodilator response increased significantly (p = 0.001) with increasing number of asthma risk factors, but was not significantly associated with allergic sensitization, parental 'atopy', or maternal smoking alone. Children treated with inhaled corticosteroids had greater bronchodilator response than those treated with bronchodilators alone. Bronchodilator response in asymptomatic 2-yr-old children was most closely associated with the presence of rBO, but increasing number of asthma risk factors and treatment with inhaled corticosteroids were associated with increased bronchodilator response.

The objectives of the present study were to determine the use of inhaled corticosteroids (ICS) for treating recurrent bronchial obstruction (rBO) in young children up to 2 yrs of age and to assess possible modifying effects of ICS on lung function in young children with rBO. From an observational, noninterventional birth cohort of 3,754 newborn children (3,697 with complete questionnaire data by 2 yrs of age), 306 children with documented rBO by age 2 yrs (cases) were identified along with 306 matched controls. Two tidal flow/volume measurements were taken, one at presentation of disease (children were steroid naive) and one at 2 yrs of age (mean age 11.2 and 25.6 months, respectively), from: 21 cases who subsequently received ICS (ICS+); 33 who did not (ICS−); and in 15 controls. The mean±sd duration of ICS treatment was 10.3±6.5 months. The main outcomes were treatment with ICS and baseline ratio of time to peak expiratory flow/total expiratory time ( t PTEF / t E ). From the entire cohort, 77 children (2.1%) and 21% of children with rBO had received ICS by 2 yrs of age. Baseline t PTEF / t E was significantly lower at the first visit only in ICS+ as compared to ICS− subjects, as well as in ICS+ and ICS- as compared to controls. The mean difference in baseline t PTEF / t E from first to second visit was borderline statistically significant in the ICS+ group only and correlated significantly with duration of ICS treatment. The present observational cohort study demonstrated that one-fifth of young children with recurrent bronchial obstruction had received inhaled corticosteroids. Early inhaled corticosteroid treatment improved lung function by age 2 yrs, mostly in those with the longest duration of treatment.