Prehistoric radio‐ulnar synostosis: implications for function

Proximal radio‐ulnar synostosis (RUS) may occur congenitally, either as an isolated condition or as part of a syndrome, or it may occur as a secondary complication of forearm trauma. We provide a key for the differential diagnosis of congenital versus traumatic RUS, and for differentiation between types of congenital RUS. Congenital cases (CRUS) include absence of fracture, radial head abnormalities, radial shaft bowing, and absence of a sigmoid notch, whereas post‐traumatic RUS results from either radial neck fracture or evulsion of the biceps brachii, followed by ossification of the resulting haematoma or of the interosseous (IO) membrane. Congenital cases include those which result from incompetent differentiation of the single mesenchymal mass that gives rise to the radius and ulna (Type I) and those that result from radial head dislocation in utero, resulting usually from humeral or ulnar defects (Type II). Type II CRUS can be differentiated by the presence of radial overgrowth, among other factors. Following these guidelines, we describe and compare the morphology of three congenital cases from North America. Two present bony fusions and one a functional fusion with radial overgrowth. In each case, CRUS significantly limits both supination and pronation. Despite differences among the cases, several morphological accommodations are shared as a result of fixation in the neutral (semi‐pronated) position. These changes include the ventral migration of the IO crests of the ulnae and enlargement of the dorsal tubercles of the radius. Understanding the pattern of accommodations made in the face of compromised function ultimately increases our understanding of the patterns of growth in normal functional regimes. Copyright © 2000 John Wiley & Sons, Ltd.     

Did Organization Really Matter? Party Organization and Conservative Electoral Recovery, 1945-59

Organizational recovery has traditionally been considered animportant factor in any explanation of the Conservative Party'selectoral recovery during the fifteen years after 1945. Thisarticle examines the extent of this recovery in three marginalseats, which the Conservatives either held or regained to formtheir new parliamentary majority. It demonstrates that, in anumber of constituencies, whatever the wider community mighthave thought, the reality of local organization—whetherin terms of financial health, membership numbers, the deliveryof political education, election campaigning, the effectivenessof party agents, or level of activity—was considered tobe less than impressive to those involved intimately. The articleconcludes that although the value of the Conservative Party'sextensive grass roots should not be denied, the precise roleand effectiveness of local organization should be reconsidered.     

Private Conflict and Policy Passage: Interest-Group Conflict and State Medical Malpractice Reform

James Madison argued in Federalist 10 that "rival political factions" work against the public good. In contrast to Madison's pessimistic account, I suggest that factional conflict can lead to more representative public policy, and thus further the will of the people. I theorize that elected officials often seek a safe political position—one that corresponds to the preferences of the public at large—during periods of high conflict. I assess this theory in one, salient policy area, medical malpractice. I measure conflict with contributions for state candidates given by (i) the health and insurance industries, which generally support malpractice laws, and (ii) lawyers, who frequently oppose the laws. I find that group conflict matters to policy outcomes. I also find evidence that, under conditions of elevated conflict, adopted policies are more likely to move toward the general ideological preferences of the public at large. These results suggest that group conflict affects both the quantity and character of policy in the American states.