Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures

The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain, decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the exiting roots, the need for only minimum external fixation, the possibility for early mobilisation and clearly decreased nursing problems. There are some reasons why those goals can be reached better by anterior surgery. Usually the bony compression of the cord and roots comes from the front therefore anterior decompression is usually the procedure of choice. Also, the anterior stabilisation with a plate is usually simpler than a posterior instrumentation. It needs to be stressed that closed reduction by traction can align the fractured spine and indirectly decompress the neural structures in about 70%. The necessary weight is 2.5 kg per level of injury. In the upper cervical spine, the odontoid fracture type 2 is an indication for anterior surgery by direct screw fixation. Joint C1/C2 dislocations or fractures or certain odontoid fractures can be treated with a fusion of the C1/C2 joint by anterior transarticular screw fixation. In the lower and middle cervical spine, anterior plating combined with iliac crest or fibular strut graft is the procedure of choice, however, a solid graft can also be replaced by filled solid or expandable vertebral cages. The complication of this surgery is low, when properly executed and anterior surgery may only be contra-indicated in case of a significant lesion or locked joints.

Greenstick fractures of the middle third of the forearm. A prospective multi-centre study

Greenstick fractures suffered during growth have a high risk for refracture and posttraumatic deformity, particularly at the forearm diaphysis. The use of a preemptive completion of the fracture by manipulation of the concave cortex is controversial and data supporting this approach are few.

Prediction accuracy of young and middle-aged adults in memory for familiar and unfamiliar texts

This study investigated the influence of age, familiarity, and level of exposure on the metamemorial skill of prediction accuracy on a future test. Young (17 to 23 years old) and middle-aged adults (35 to 50 years old) were asked to predict their memory for text material. Participants made predictions on a familiar text and an unfamiliar text, at three different levels of exposure to each. The middle-aged adults were superior to the younger adults at predicting performance. This finding indicates that metamemory may increase from youth to middle age. Other findings include superior prediction accuracy for unfamiliar compared to familiar material, a result conflicting with previous findings, and an interaction between level of exposure and familiarity that appears to modify the main effects of those variables.

Identification of speeded and slowed familiar melodies by younger, middle-aged, and older musicians and nonmusicians

There is a range of tempos within which listeners can identify familiar tunes (around 0.8 to 6.0 notes/s). Faster and slower tunes are difficult to identify. The authors assessed fast and slow melody-identification thresholds for 80 listeners ages 17–79 years with expertise varying from musically untrained to professional. On fast-to-slow (FS) trials the tune started at a very fast tempo and slowed until the listener identified it. Slow-to-fast (SF) trials started slow and accelerated. Tunes either retained their natural rhythms or were stylized isochronous versions. Increased expertise led to better performance for both FS and SF thresholds (r = .45). Performance declined uniformly across the 62-year age range in the FS condition (r = .27). SF performance was unaffected by age. Although early encoding processes may slow with age, expertise has a greater effect. Musical expertise involves perceptual learning with melodies at a wide range of tempos.