A retrospective study was performed using the hospital records. The mechanism of injury, the time between injury and surgery, blood transfusion requirements, blood loss, surgical times, time taken to weight bear (for the femoral/
tibial fractures), time for commencement of upper limb use (for humeral fractures), complication rates and the average follow up times were documented. Fifty-seven long bone fractures in 57 patients were included in this study. Complete results including preoperative X-Rays were available for 27 patients. In 30 cases, the actual X-Rays were not located but documentation by the treating surgeons was available.
This study compared the effectiveness of Hawley retainers and two protocols for vacuum-formed retainers (VFRs) in maintaining orthodontic treatment results. 90 patients were randomly assigned to receive either a Hawley retainer, VFRs worn for 4 months full-time then nightly, or VFRs worn for 1 week full-time then nightly. Models at debond and 4 and 8 months post-treatment showed the Hawley group had significantly greater loss of upper arch length and increased crowding compared to the VFR groups, though lower arch measurements were similar. Both VFR protocols were more effective than Hawleys in maintaining the upper arch, and 4 months full-time wear provided better lower incis
This document summarizes a study that evaluated outcomes of treating 38 patients with closed segmental tibial fractures using external fixation. Segmental tibial fractures involve two or more fracture lines separating the tibia into segments. The study assessed time to fracture healing, complications, and functional recovery. Most fractures (68%) healed without issues, while 24 fractures (32%) had complications like delayed or non-union that required further treatment, with most of these ultimately healing. The study concluded that external fixation is a suitable treatment for segmental tibial fractures, achieving an acceptable rate of healing and complications.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
In hospital complications after total joint arthroplastyFUAD HAZIME
The study prospectively collected data on systemic and local complications from 15,383 joint arthroplasty procedures performed over 6 years. There were 486 major systemic complications, most commonly pulmonary embolism (152 cases), tachyarrhythmia (92), and acute myocardial infarction (36). There were also 109 major local complications, including 16 vascular injuries and 29 peripheral nerve injuries. The incidence of complications was higher after knee arthroplasty, bilateral procedures, and revision surgery. This study provides baseline data on the range and frequency of potential in-hospital complications following elective joint arthroplasty.
Key hole surgery - Intertrochanetric femur fracture DeepakTyagi110
This study evaluated outcomes of using a keyhole surgery technique called minimum invasive dynamic hip screw (MIDHS) to treat intertrochanteric femur fractures in elderly patients. 16 patients underwent MIDHS surgery. The mean duration of surgery was 39 minutes, mean blood loss was 31.5 ml, and mean drop in hemoglobin was 0.2g/dl. Keyhole surgery resulted in smaller incisions, less blood loss, and shorter operating times compared to conventional techniques, without any patients requiring blood transfusions. The study concluded that MIDHS is a good option for treating intertrochanteric fractures in elderly patients or those with comorbidities, due to its minimal invasiveness and soft tissue disruption.
This research article studied parameters of the lower lumbar intervertebral foramen related to the superior articular process using X-ray imaging. X-rays of the lumbar spine from 104 adults were analyzed. Measurements were taken of the height, width, and other dimensions of the lower lumbar intervertebral foramen. The results found no significant gender differences in foramen parameters. Parameters related to the superior articular process, such as height and distance from bony landmarks, showed significant age-related differences between those aged 40-60 and over 60. This data supplements the intervertebral foramen database and provides a reference for individualized minimally invasive spine surgeries, especially in elderly patients over 60 years old.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Journal club on Mandibular fracture after third molarDr Bhavik Miyani
1) The document summarizes a journal club presentation on a study analyzing factors leading to mandibular fractures after third molar removal.
2) Six patients who experienced mandibular fractures on average 14 days after third molar surgery were examined. All patients were fully dentulous and between 42-50 years old.
3) The study found that advanced age combined with a full dentition were major risk factors for this complication. Pre-existing bone lesions from cysts or other issues also increased the risk of fracture by weakening the mandible.
This study compared the effectiveness of Hawley retainers and two protocols for vacuum-formed retainers (VFRs) in maintaining orthodontic treatment results. 90 patients were randomly assigned to receive either a Hawley retainer, VFRs worn for 4 months full-time then nightly, or VFRs worn for 1 week full-time then nightly. Models at debond and 4 and 8 months post-treatment showed the Hawley group had significantly greater loss of upper arch length and increased crowding compared to the VFR groups, though lower arch measurements were similar. Both VFR protocols were more effective than Hawleys in maintaining the upper arch, and 4 months full-time wear provided better lower incis
This document summarizes a study that evaluated outcomes of treating 38 patients with closed segmental tibial fractures using external fixation. Segmental tibial fractures involve two or more fracture lines separating the tibia into segments. The study assessed time to fracture healing, complications, and functional recovery. Most fractures (68%) healed without issues, while 24 fractures (32%) had complications like delayed or non-union that required further treatment, with most of these ultimately healing. The study concluded that external fixation is a suitable treatment for segmental tibial fractures, achieving an acceptable rate of healing and complications.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
In hospital complications after total joint arthroplastyFUAD HAZIME
The study prospectively collected data on systemic and local complications from 15,383 joint arthroplasty procedures performed over 6 years. There were 486 major systemic complications, most commonly pulmonary embolism (152 cases), tachyarrhythmia (92), and acute myocardial infarction (36). There were also 109 major local complications, including 16 vascular injuries and 29 peripheral nerve injuries. The incidence of complications was higher after knee arthroplasty, bilateral procedures, and revision surgery. This study provides baseline data on the range and frequency of potential in-hospital complications following elective joint arthroplasty.
Key hole surgery - Intertrochanetric femur fracture DeepakTyagi110
This study evaluated outcomes of using a keyhole surgery technique called minimum invasive dynamic hip screw (MIDHS) to treat intertrochanteric femur fractures in elderly patients. 16 patients underwent MIDHS surgery. The mean duration of surgery was 39 minutes, mean blood loss was 31.5 ml, and mean drop in hemoglobin was 0.2g/dl. Keyhole surgery resulted in smaller incisions, less blood loss, and shorter operating times compared to conventional techniques, without any patients requiring blood transfusions. The study concluded that MIDHS is a good option for treating intertrochanteric fractures in elderly patients or those with comorbidities, due to its minimal invasiveness and soft tissue disruption.
This research article studied parameters of the lower lumbar intervertebral foramen related to the superior articular process using X-ray imaging. X-rays of the lumbar spine from 104 adults were analyzed. Measurements were taken of the height, width, and other dimensions of the lower lumbar intervertebral foramen. The results found no significant gender differences in foramen parameters. Parameters related to the superior articular process, such as height and distance from bony landmarks, showed significant age-related differences between those aged 40-60 and over 60. This data supplements the intervertebral foramen database and provides a reference for individualized minimally invasive spine surgeries, especially in elderly patients over 60 years old.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Journal club on Mandibular fracture after third molarDr Bhavik Miyani
1) The document summarizes a journal club presentation on a study analyzing factors leading to mandibular fractures after third molar removal.
2) Six patients who experienced mandibular fractures on average 14 days after third molar surgery were examined. All patients were fully dentulous and between 42-50 years old.
3) The study found that advanced age combined with a full dentition were major risk factors for this complication. Pre-existing bone lesions from cysts or other issues also increased the risk of fracture by weakening the mandible.
This study evaluated the safety and short-term efficacy of laparoscopic complete mesocolic excision (CME) compared to open CME for the treatment of right hemicolon cancer. The study retrospectively reviewed 88 patients - 40 who underwent laparoscopic CME and 48 who underwent open CME. The laparoscopic CME group had a longer operating time but shorter time to first flatus and time to get out of bed compared to the open CME group. There were no significant differences in the number of harvested lymph nodes, hospital stay length, or postoperative complications between the two groups. The study concluded that laparoscopic CME is a safe and effective minimally invasive surgery for right hemicolon cancer.
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: : Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system. Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P<0.001). Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
This document summarizes topics presented at recent hand surgery conferences and articles published in hand surgery journals. It discusses declines in finger replantation rates, factors associated with loss of reduction in distal radius fractures involving the volar ulnar corner, higher complication rates but similar outcomes for surgical versus nonsurgical treatment of distal radius fractures in older patients, the need for caution in hand transplantation, ongoing debates around flexor tendon rehabilitation protocols, advances in extensor tendon rehabilitation using relative motion splinting, and a study showing the efficacy and safety of treating two joints rather than one with collagenase injections for Dupuytren contracture.
The document summarizes research on gait analysis of patients with spina bifida. It describes the three main types of spina bifida and their associated neurological impairments and functional classifications. Instrumental gait analysis is discussed as a tool to objectively measure biomechanical variables during walking. Results from gait analysis can inform treatment through assessing quality of ambulation, effects of orthotics, muscle function, and postoperative changes.
1) Multiple infection prevention measures were used in 54 patients undergoing ACL reconstruction surgery, including preoperative skin washing and bathing, intraoperative use of sterile drapes and instruments soaked in vancomycin solution, and postoperative rehabilitation.
2) No postoperative infections occurred in any patients over 6-18 months of follow-up. Knee function scores improved significantly from pre-operation levels.
3) The study suggests that using multiple prevention measures can successfully prevent infections after ACL reconstruction surgery and allow for good postoperative recovery of knee function.
A prospective observational study on comparing the outcome of patellar resurf...Dr.Avinash Rao Gundavarapu
Introduction: Total Knee Arthroplasty (TKA) has been a very successful surgery in relieving pain and restoring function in osteoarthritis. Conflicting evidence in literature exists regarding the merits of patellar resurfacing during TKA over non-resurfacing. Our aim is to evaluate and compare the difference between patellar resurfaced group and non-resurfaced group in primary TKA.
Materials and Methods: This prospective obsevational study was initiated in May 2016 conducted till April 2008 (2 years) in Yashoda Superspeciality Hospital, Hyderabad. At least 14 mm of patella was ensured to be retained after patellar cut. A total of 40 patients were allocated to receive (n=20) or not to receive patellar resurfacing (n=20) during primary TKA. The data was analyzed statistically using the Student t test. Overall patient satisfaction was recorded using the SF-36 score.
Results: Of the 40 patients, 67.5% females and 32.5 % males underwent TKA. Among those who underwent resurfacement, 40% were males. 75% among the non-resurfaced group were females. Right knee was operated on 37.5% of cases. Mean operative time being 103.9 and 122.5 minutes in nonresurfaced and resurfaced cases respectively. Mean patellar thickness was 22.1mm in nonresurfaced and 23.6mm in resurfaced group. The difference in VAS score, modified HSS score, KSS scores between the two groups were statistically insignificant with p-values of 0.230, 0.0214, 0.2513 respectively at the end of two year,
but there was significant reduction of anterior knee pain in the resurfaced with p-value < 0> Conclusion: The functional outcome was not affected by whether the patella was resurfaced or nonresurfaced. There was no significant difference between the two groups with respect to the prevalence of knee-related readmission, or of subsequent patella-related surgery or patients overall satisfaction. We recommend selective patellar resurfacing at the time of primary total knee replacement.
Keywords: TKA, Patellar resurfacement, Non-resurfacement, HSS score, KSS score.
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
This document discusses the buttonhole cannulation technique for vascular access in hemodialysis patients. It provides a history of the technique, beginning in the 1970s in Poland. Early experiences in the US showed benefits like reduced pain, infiltration, and hematoma rates compared to rope-ladder cannulation. The technique involves creating fibrous tracts at constant needle insertion sites using repeated cannulation with sharp then blunt needles. Correct technique includes proper site selection, needle angle/depth, disinfection, and complete scab removal to prevent infection. Larger US studies are still needed to better evaluate risks and benefits.
The document discusses guidelines for deep vein thrombosis (DVT) prophylaxis for orthopedic trauma patients. It notes that many existing guidelines do not adequately address trauma patients, who have higher DVT risks due to immobility from injury. A review found that 77% of patients transferred to the authors' hospitals did not receive pre-transfer DVT prophylaxis, including 67% of hip fracture patients despite being at high risk. The authors developed new DVT prophylaxis guidelines for orthopedic trauma patients to help standardize care and lower DVT risks.
This research article evaluated the efficacy and safety of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation for treating rectal cancer. 211 patients underwent either laparoscopic (131 patients) or open (80 patients) surgery. Results showed that both surgeries were successfully completed with no differences in lymph nodes removed or post-op complications. The laparoscopic group had shorter time to pass gas, get out of bed, and hospital stay. No differences were found in recurrence, mortality, or urinary/sexual dysfunction between groups. The study concludes that laparoscopic D3 lymphadenectomy combined with nerve preservation is a feasible and safe treatment for rectal cancer.
This document summarizes a case report of spontaneous fragmentation of a double J ureteral stent in a 70-year-old patient with a single kidney. The patient had undergone a right nephrectomy two years prior for kidney stones and had a double J stent placed, but did not return for follow up. He presented with flank pain and was found to have the stent fragmented into three pieces. The fragments were extracted endoscopically with ureteroscopy. Stent fragmentation is a rare but serious complication, and this case highlights the importance of patient education and follow up after stent placement.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
This case report describes a patient who underwent orthognathic surgery to correct vertical maxillary excess using a combination of rigid and non-rigid fixation techniques. Specifically, miniplates were used for rigid fixation on the pyriform region bilaterally, while wiring was used for non-rigid fixation on the zygomatic buttresses. This combination approach achieved excellent postoperative stability in correcting the patient's maxillary deformity. The case report discusses debates around rigid versus non-rigid fixation and aims to demonstrate that combining both techniques can optimize stability outcomes for orthognathic surgeries like Le Fort I advancements.
1) The document discusses a study of 75 multiple myeloma patients who underwent surgical treatment for skeletal complications between 1980-2005.
2) The study found that survival after surgery was favorable, with 37% surviving at 5 years and a median survival of 4.7 years.
3) Factors associated with better survival included having a single bone lesion, negative bone marrow biopsy, no paraproteinemia, and lower Salmon-Durie stage (a staging system for multiple myeloma).
This study assessed the stability of crown lengthening procedures over a 6-month period. 25 patients underwent crown lengthening surgery on 43 teeth. Measurements of crown height were taken before and after surgery, and at 1, 3, and 6 months post-op. The results showed a gain in crown height of over 2 mm immediately after surgery, which decreased slightly over time but did not fully stabilize by 6 months. More tissue rebound occurred when the surgical flap was closed closer to the alveolar crest. The amount of bone removed during surgery was also measured and related to the stability of the new crown height over time.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
This study evaluated the safety and short-term efficacy of laparoscopic complete mesocolic excision (CME) compared to open CME for the treatment of right hemicolon cancer. The study retrospectively reviewed 88 patients - 40 who underwent laparoscopic CME and 48 who underwent open CME. The laparoscopic CME group had a longer operating time but shorter time to first flatus and time to get out of bed compared to the open CME group. There were no significant differences in the number of harvested lymph nodes, hospital stay length, or postoperative complications between the two groups. The study concluded that laparoscopic CME is a safe and effective minimally invasive surgery for right hemicolon cancer.
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: : Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system. Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P<0.001). Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
This document summarizes topics presented at recent hand surgery conferences and articles published in hand surgery journals. It discusses declines in finger replantation rates, factors associated with loss of reduction in distal radius fractures involving the volar ulnar corner, higher complication rates but similar outcomes for surgical versus nonsurgical treatment of distal radius fractures in older patients, the need for caution in hand transplantation, ongoing debates around flexor tendon rehabilitation protocols, advances in extensor tendon rehabilitation using relative motion splinting, and a study showing the efficacy and safety of treating two joints rather than one with collagenase injections for Dupuytren contracture.
The document summarizes research on gait analysis of patients with spina bifida. It describes the three main types of spina bifida and their associated neurological impairments and functional classifications. Instrumental gait analysis is discussed as a tool to objectively measure biomechanical variables during walking. Results from gait analysis can inform treatment through assessing quality of ambulation, effects of orthotics, muscle function, and postoperative changes.
1) Multiple infection prevention measures were used in 54 patients undergoing ACL reconstruction surgery, including preoperative skin washing and bathing, intraoperative use of sterile drapes and instruments soaked in vancomycin solution, and postoperative rehabilitation.
2) No postoperative infections occurred in any patients over 6-18 months of follow-up. Knee function scores improved significantly from pre-operation levels.
3) The study suggests that using multiple prevention measures can successfully prevent infections after ACL reconstruction surgery and allow for good postoperative recovery of knee function.
A prospective observational study on comparing the outcome of patellar resurf...Dr.Avinash Rao Gundavarapu
Introduction: Total Knee Arthroplasty (TKA) has been a very successful surgery in relieving pain and restoring function in osteoarthritis. Conflicting evidence in literature exists regarding the merits of patellar resurfacing during TKA over non-resurfacing. Our aim is to evaluate and compare the difference between patellar resurfaced group and non-resurfaced group in primary TKA.
Materials and Methods: This prospective obsevational study was initiated in May 2016 conducted till April 2008 (2 years) in Yashoda Superspeciality Hospital, Hyderabad. At least 14 mm of patella was ensured to be retained after patellar cut. A total of 40 patients were allocated to receive (n=20) or not to receive patellar resurfacing (n=20) during primary TKA. The data was analyzed statistically using the Student t test. Overall patient satisfaction was recorded using the SF-36 score.
Results: Of the 40 patients, 67.5% females and 32.5 % males underwent TKA. Among those who underwent resurfacement, 40% were males. 75% among the non-resurfaced group were females. Right knee was operated on 37.5% of cases. Mean operative time being 103.9 and 122.5 minutes in nonresurfaced and resurfaced cases respectively. Mean patellar thickness was 22.1mm in nonresurfaced and 23.6mm in resurfaced group. The difference in VAS score, modified HSS score, KSS scores between the two groups were statistically insignificant with p-values of 0.230, 0.0214, 0.2513 respectively at the end of two year,
but there was significant reduction of anterior knee pain in the resurfaced with p-value < 0> Conclusion: The functional outcome was not affected by whether the patella was resurfaced or nonresurfaced. There was no significant difference between the two groups with respect to the prevalence of knee-related readmission, or of subsequent patella-related surgery or patients overall satisfaction. We recommend selective patellar resurfacing at the time of primary total knee replacement.
Keywords: TKA, Patellar resurfacement, Non-resurfacement, HSS score, KSS score.
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
This document discusses the buttonhole cannulation technique for vascular access in hemodialysis patients. It provides a history of the technique, beginning in the 1970s in Poland. Early experiences in the US showed benefits like reduced pain, infiltration, and hematoma rates compared to rope-ladder cannulation. The technique involves creating fibrous tracts at constant needle insertion sites using repeated cannulation with sharp then blunt needles. Correct technique includes proper site selection, needle angle/depth, disinfection, and complete scab removal to prevent infection. Larger US studies are still needed to better evaluate risks and benefits.
The document discusses guidelines for deep vein thrombosis (DVT) prophylaxis for orthopedic trauma patients. It notes that many existing guidelines do not adequately address trauma patients, who have higher DVT risks due to immobility from injury. A review found that 77% of patients transferred to the authors' hospitals did not receive pre-transfer DVT prophylaxis, including 67% of hip fracture patients despite being at high risk. The authors developed new DVT prophylaxis guidelines for orthopedic trauma patients to help standardize care and lower DVT risks.
This research article evaluated the efficacy and safety of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation for treating rectal cancer. 211 patients underwent either laparoscopic (131 patients) or open (80 patients) surgery. Results showed that both surgeries were successfully completed with no differences in lymph nodes removed or post-op complications. The laparoscopic group had shorter time to pass gas, get out of bed, and hospital stay. No differences were found in recurrence, mortality, or urinary/sexual dysfunction between groups. The study concludes that laparoscopic D3 lymphadenectomy combined with nerve preservation is a feasible and safe treatment for rectal cancer.
This document summarizes a case report of spontaneous fragmentation of a double J ureteral stent in a 70-year-old patient with a single kidney. The patient had undergone a right nephrectomy two years prior for kidney stones and had a double J stent placed, but did not return for follow up. He presented with flank pain and was found to have the stent fragmented into three pieces. The fragments were extracted endoscopically with ureteroscopy. Stent fragmentation is a rare but serious complication, and this case highlights the importance of patient education and follow up after stent placement.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
This case report describes a patient who underwent orthognathic surgery to correct vertical maxillary excess using a combination of rigid and non-rigid fixation techniques. Specifically, miniplates were used for rigid fixation on the pyriform region bilaterally, while wiring was used for non-rigid fixation on the zygomatic buttresses. This combination approach achieved excellent postoperative stability in correcting the patient's maxillary deformity. The case report discusses debates around rigid versus non-rigid fixation and aims to demonstrate that combining both techniques can optimize stability outcomes for orthognathic surgeries like Le Fort I advancements.
1) The document discusses a study of 75 multiple myeloma patients who underwent surgical treatment for skeletal complications between 1980-2005.
2) The study found that survival after surgery was favorable, with 37% surviving at 5 years and a median survival of 4.7 years.
3) Factors associated with better survival included having a single bone lesion, negative bone marrow biopsy, no paraproteinemia, and lower Salmon-Durie stage (a staging system for multiple myeloma).
This study assessed the stability of crown lengthening procedures over a 6-month period. 25 patients underwent crown lengthening surgery on 43 teeth. Measurements of crown height were taken before and after surgery, and at 1, 3, and 6 months post-op. The results showed a gain in crown height of over 2 mm immediately after surgery, which decreased slightly over time but did not fully stabilize by 6 months. More tissue rebound occurred when the surgical flap was closed closer to the alveolar crest. The amount of bone removed during surgery was also measured and related to the stability of the new crown height over time.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The study compared cervical laminoplasty using piezosurgery osteotomy versus high-speed drilling in 60 patients. Piezosurgery osteotomy resulted in less intraoperative blood loss and postoperative drainage. Both groups showed improved JOA scores after surgery with no significant differences in outcomes. Piezosurgery osteotomy may be superior for operation time, blood loss, and drainage while providing similar safety and efficacy as high-speed drilling for cervical laminoplasty.
This document summarizes developments in direct visual internal urethrotomy (DVIU) for treating urethral strictures. It discusses techniques for DVIU, factors that influence outcomes, and the long-term efficacy of DVIU. While initial studies reported high success rates of around 80%, more recent long-term studies have found much lower success rates of only around 8-30%. Recurrence rates are higher for longer strictures, greater spongiofibrosis, distal strictures, and when DVIU is repeated for recurrent strictures. Overall, DVIU has relatively poor long-term outcomes for treating urethral strictures.
This study examines the surgical management of ameloblastoma in 15 Taiwanese children between 1991-2004. The average patient age was 13.7 years. Most lesions were located in the mandible. Treatment methods included enucleation with peripheral ostectomy, decompression before enucleation, and segmental resection with bone grafting. The unicystic type lesions did not recur, while 3 of the multicystic cases recurred. Complications included numbness and facial deformity. The study concludes conservative surgery can achieve good results for ameloblastoma in children, and secondary surgery is effective for recurrence. Careful long-term follow-up is important.
Treatment of displaced midshaft clavicle fracture with locking compression plate provides better biomechanical stability, good fracture union rates, high post-operative constant score, early pain resolution, early return to activity, high patient satisfaction rates and excellent functional outcome. These benefits of plating overweigh complications when used in specific indications like displaced with or without comminuted middle third clavicle fracture (Robinson Type 2B1, 2B2).
ABSTRACT- Urinary tracts stone diseases are one of the most common afflictions of modern society and it has
witnessed much advancement in its management. Keeping in view various aspects of management we carried out a
comparatively newer study called Transperitoneal Ureterolithotomy. This study was carried out to evaluate Laparoscopic
Transperitoneal Ureterolithotomy (TPUL) as a viable option to open surgical ureterolithotomy, Laparoscopic
Retroperitoneal Ureterolithotomy (RPUL) & endoscopic urology and to assess its place in the spectrum of various surgical
interventions for ureteric calculi in a tertiary care center. This study was conducted on 25 selected patients of a single large
impacted calculus of size more than 10mm in upper and middle ureter. It was observed that conversion to open
ureterolithotomy was observed in 4 cases and excessive bleeding in one case. No major perioperative complications were
seen. The procedure has definitely shown decreased post-operative discomfort, decreased requirement of post-operative
analgesia, better cosmesis, early return to work and less morbidity.
Key-words- Transperitoneal ureterolithotomy (TPUL), Retroperitoneal ureterolithotomy (RPUL), Extracorporeal
shockwave lithotripsy (ESWL), Open surgical ureterolithotomy
1. The document describes three cases of patients with giant aneurysmal bone cysts (ABCs) that were treated with en bloc resection and reconstruction with non-vascularized fibular bone grafts.
2. All patients achieved bony union following the procedure and had no recurrence of the cysts or limitations in range of motion.
3. Non-vascularized fibular grafts provided an effective reconstruction method for large bone defects left after resection of giant ABCs.
Management of compound fracture tibia in children with titanium elastic nailsApollo Hospitals
Tibia fractures in the skeletally immature patient can usually be treated without surgery. The purpose of this study was to assess the use of flexible titanium nails in the open fracture tibia that requires operative stabilization.
This document provides a literature review on pelvic complex fractures and rehabilitation. It discusses the epidemiology, mechanisms of injury, classifications, complications, management, and rehabilitation of pelvic fractures. Evidence is presented from several studies on topics like venous thromboembolism rates after pelvic fractures, urethral injuries associated with pelvic fractures, and mobility outcomes in elderly patients with pelvic fractures. The review covers classifications including Tile's and Young-Burgess systems and classifications of acetabular and sacral fractures. Rehabilitation protocols are summarized from studies on postoperative management and mobilization after surgical fixation of pelvic fractures.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
The document describes a retrospective case series of 10 patients with post-traumatic radioulnar synostosis who were treated using a triple therapy combination of preoperative radiotherapy, resection of heterotopic ossification and insertion of an anconeus interposition flap, and postoperative indomethacin. All 10 patients reported excellent postoperative Mayo elbow performance scores and significant improvements in range of motion compared to preoperatively. One patient experienced a complication that resolved with follow-up. The triple therapy combination was found to provide good functional outcomes and prevent recurrence of radioulnar synostosis.
This study compared donor-site morbidity after harvesting iliac bone grafts as either vascularized or nonvascularized transplants. An age-matched comparison of 34 patients in each group found that while no significant differences in donor-site morbidity existed between the groups if a similar amount of bone was taken, harvesting a vascularized bone graft was associated with higher rates of leg pain, functional disturbances, and sensory disturbances. Additionally, patients receiving a vascularized graft had longer hospital stays on average. However, no patients in either group experienced serious long-term complications, suggesting the iliac crest is a suitable donor site for both vascularized and nonvascularized bone grafts up to 10x3 cm in size.
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Fibula Nail for Unstable Ankle FracturesArun Shanbhag
Ankle fractures are becoming more common, especially in elderly females. While open reduction and internal fixation is often used in younger patients, complications are higher in elderly patients. The fibula nail provides a minimally invasive technique for unstable ankle fractures in elderly patients. It involves inserting a nail into the distal fibula through a small incision. This affords stable fixation with less soft tissue disruption and prominent hardware, leading to lower complication rates compared to open plating. The fibula nail is well-suited for unstable ankle fractures in elderly patients who are at higher risk for complications from traditional open procedures.
Changes in psychological adjustment of female - MedCrave Online PublishingMedCrave
Problems of studying failure in the form of breaks and prolonged studying are increasingly taking place in contemporary research. The reason for this lies in the observations that 30% to 50% of enrolled students do not finish studies and at the same time three quarters of them break studying during the first two years of study.
http://medcraveonline.com/JPCPY/JPCPY-02-00051.pdf
Developing comprehensive health promotion - MedCrave Online PublishingMedCrave
As the global prevalence of obesity and chronic diseases continues to rise, the need for effective health promotion programs is imperative. Whilst research into effectiveness of health promotion programs is needed to improve population health outcomes, translation of these research findings into policy and practice is crucial. Translation requires not only efficacy data around what to implement, but also information on how to implement it.
http://medcraveonline.com/MOJPH/MOJPH-02-00007.pdf
Ebola Associated Genes in the Human Genome Implications for Novel TargetsMedCrave
Ramaswamy Narayanan, Ph.D., professor in the Charles E. Schmidt College of Science at Florida Atlantic University, is working to blend the power of computers with biology to use the human genome to remove much of the guesswork involved in discovering cures for diseases.
Medcrave - Vertical distribution of different forms of potassiumMedCrave
Potassium is a major constituent of the earth crust contained more in igneous rocks than the sedimentary rocks. Potassium comprise on an average of 2.6 % of the earth crust, making it the seventh most abundant element and fourth most abundant mineral nutrient in the lithosphere .
This case report describes a 10 month old male child who presented with a left inguinal hernia and an empty right hemiscrotum. Diagnostic tests including ultrasound and laparoscopy confirmed that both testes had migrated to the left side, representing a rare condition known as transverse testicular ectopia (TTE). During surgery, one testis was found in the left hemiscrotum and the other in the left inguinal canal. Both testes shared a common proximal structure and were separated by 4 cm. The testes were repaired through an orchiopexy procedure involving placement into their anatomically correct positions.
Medcrave Group - Microfluidic technologiesMedCrave
Exosomes are cell-released small membrane vesicles derived from the endolysosomal pathway with a size range of 30-150 nm. Since the first discovery in 1981, exosomes have been found to be released from various cell types and present in many biological fluids, including blood, urine, erebrospinal fluid and ascites. Significant attention has been focused on exosome molecular components (e.g. roteins, mRNA and miRNA) which have been implicated in a variety of physiological functions and pathological disease states.
Medcrave - MERS coronavirus - current statusMedCrave
CDC: Centers for Disease Control; MERS-CoV: Middle
East Respiratory Syndrome Coronavirus; RT-PCR: Reverse
Transcriptase Polymerase Chain Reaction; VLP: Virus Like
Particles.
Recently, a new virus started to infect certain individuals in the Middle-East. It was soon identified as a previously unknown coronavirus that caused severe respiratory disease with a high rate of mortality. This virus, MERS-CoV, is still closely watched by health authorities as it has the potential to evolve and cause a major epidemic.
Medcrave - Long term follow up of regnauld’s procedureMedCrave
We performed a retrospective study to assess the long-term outcome of regnauld’s procedure, as originally described by Regnauld [1], for the treatment of hallux valgus. This procedure includes the treatment of hallux limitus, hallux rigidus and hallux valgus with associated degenerative joint disease.
Since the first heart transplant, refinement of donor and recipient selection methods, better donor heart management, and advances in immunosuppression have
significantly improved survival. In this first of two articles, a perspective of the current realities of cardiac transplantation is shown, as well as the challenges to sustain services worldwide, and some of the new developments, both resently available and just beyond the horizon. Topics that will be covered in this first part include the donor and recipient demographics, as well as recent advances in transplantation immunology, allograft vasculopathy, and immune tolerance.
Medcrave Group - Association analysis of the polymorphismMedCrave
This study analyzed the association between human leukocyte antigen (HLA) alleles (HLA-A, HLA-B, HLA-E) and Behcet's disease in a Japanese cohort. Sequencing-based typing was performed on 382 Behcet's disease patients and 382 healthy controls. The results showed that HLA-B*51 is strongly associated with Behcet's disease in the Japanese cohort. HLA-A*26 was also significantly associated, while HLA-E*01:01 was not observed to have any significant association. Analysis of linkage disequilibrium structures between the Japanese and Han Chinese cohorts found differences in the HLA-A and HLA-E regions that could explain differences in susceptibility between
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)eitps1506
Description:
Dive into the fascinating realm of solid-state physics with our meticulously crafted online PowerPoint presentation. This immersive educational resource offers a comprehensive exploration of the fundamental concepts, theories, and applications within the realm of solid-state physics.
From crystalline structures to semiconductor devices, this presentation delves into the intricate principles governing the behavior of solids, providing clear explanations and illustrative examples to enhance understanding. Whether you're a student delving into the subject for the first time or a seasoned researcher seeking to deepen your knowledge, our presentation offers valuable insights and in-depth analyses to cater to various levels of expertise.
Key topics covered include:
Crystal Structures: Unravel the mysteries of crystalline arrangements and their significance in determining material properties.
Band Theory: Explore the electronic band structure of solids and understand how it influences their conductive properties.
Semiconductor Physics: Delve into the behavior of semiconductors, including doping, carrier transport, and device applications.
Magnetic Properties: Investigate the magnetic behavior of solids, including ferromagnetism, antiferromagnetism, and ferrimagnetism.
Optical Properties: Examine the interaction of light with solids, including absorption, reflection, and transmission phenomena.
With visually engaging slides, informative content, and interactive elements, our online PowerPoint presentation serves as a valuable resource for students, educators, and enthusiasts alike, facilitating a deeper understanding of the captivating world of solid-state physics. Explore the intricacies of solid-state materials and unlock the secrets behind their remarkable properties with our comprehensive presentation.
Discovery of An Apparent Red, High-Velocity Type Ia Supernova at 𝐳 = 2.9 wi...Sérgio Sacani
We present the JWST discovery of SN 2023adsy, a transient object located in a host galaxy JADES-GS
+
53.13485
−
27.82088
with a host spectroscopic redshift of
2.903
±
0.007
. The transient was identified in deep James Webb Space Telescope (JWST)/NIRCam imaging from the JWST Advanced Deep Extragalactic Survey (JADES) program. Photometric and spectroscopic followup with NIRCam and NIRSpec, respectively, confirm the redshift and yield UV-NIR light-curve, NIR color, and spectroscopic information all consistent with a Type Ia classification. Despite its classification as a likely SN Ia, SN 2023adsy is both fairly red (
�
(
�
−
�
)
∼
0.9
) despite a host galaxy with low-extinction and has a high Ca II velocity (
19
,
000
±
2
,
000
km/s) compared to the general population of SNe Ia. While these characteristics are consistent with some Ca-rich SNe Ia, particularly SN 2016hnk, SN 2023adsy is intrinsically brighter than the low-
�
Ca-rich population. Although such an object is too red for any low-
�
cosmological sample, we apply a fiducial standardization approach to SN 2023adsy and find that the SN 2023adsy luminosity distance measurement is in excellent agreement (
≲
1
�
) with
Λ
CDM. Therefore unlike low-
�
Ca-rich SNe Ia, SN 2023adsy is standardizable and gives no indication that SN Ia standardized luminosities change significantly with redshift. A larger sample of distant SNe Ia is required to determine if SN Ia population characteristics at high-
�
truly diverge from their low-
�
counterparts, and to confirm that standardized luminosities nevertheless remain constant with redshift.
PPT on Alternate Wetting and Drying presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...Sérgio Sacani
Context. The observation of several L-band emission sources in the S cluster has led to a rich discussion of their nature. However, a definitive answer to the classification of the dusty objects requires an explanation for the detection of compact Doppler-shifted Brγ emission. The ionized hydrogen in combination with the observation of mid-infrared L-band continuum emission suggests that most of these sources are embedded in a dusty envelope. These embedded sources are part of the S-cluster, and their relationship to the S-stars is still under debate. To date, the question of the origin of these two populations has been vague, although all explanations favor migration processes for the individual cluster members. Aims. This work revisits the S-cluster and its dusty members orbiting the supermassive black hole SgrA* on bound Keplerian orbits from a kinematic perspective. The aim is to explore the Keplerian parameters for patterns that might imply a nonrandom distribution of the sample. Additionally, various analytical aspects are considered to address the nature of the dusty sources. Methods. Based on the photometric analysis, we estimated the individual H−K and K−L colors for the source sample and compared the results to known cluster members. The classification revealed a noticeable contrast between the S-stars and the dusty sources. To fit the flux-density distribution, we utilized the radiative transfer code HYPERION and implemented a young stellar object Class I model. We obtained the position angle from the Keplerian fit results; additionally, we analyzed the distribution of the inclinations and the longitudes of the ascending node. Results. The colors of the dusty sources suggest a stellar nature consistent with the spectral energy distribution in the near and midinfrared domains. Furthermore, the evaporation timescales of dusty and gaseous clumps in the vicinity of SgrA* are much shorter ( 2yr) than the epochs covered by the observations (≈15yr). In addition to the strong evidence for the stellar classification of the D-sources, we also find a clear disk-like pattern following the arrangements of S-stars proposed in the literature. Furthermore, we find a global intrinsic inclination for all dusty sources of 60 ± 20◦, implying a common formation process. Conclusions. The pattern of the dusty sources manifested in the distribution of the position angles, inclinations, and longitudes of the ascending node strongly suggests two different scenarios: the main-sequence stars and the dusty stellar S-cluster sources share a common formation history or migrated with a similar formation channel in the vicinity of SgrA*. Alternatively, the gravitational influence of SgrA* in combination with a massive perturber, such as a putative intermediate mass black hole in the IRS 13 cluster, forces the dusty objects and S-stars to follow a particular orbital arrangement. Key words. stars: black holes– stars: formation– Galaxy: center– galaxies: star formation
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆Sérgio Sacani
Context. The early-type galaxy SDSS J133519.91+072807.4 (hereafter SDSS1335+0728), which had exhibited no prior optical variations during the preceding two decades, began showing significant nuclear variability in the Zwicky Transient Facility (ZTF) alert stream from December 2019 (as ZTF19acnskyy). This variability behaviour, coupled with the host-galaxy properties, suggests that SDSS1335+0728 hosts a ∼ 106M⊙ black hole (BH) that is currently in the process of ‘turning on’. Aims. We present a multi-wavelength photometric analysis and spectroscopic follow-up performed with the aim of better understanding the origin of the nuclear variations detected in SDSS1335+0728. Methods. We used archival photometry (from WISE, 2MASS, SDSS, GALEX, eROSITA) and spectroscopic data (from SDSS and LAMOST) to study the state of SDSS1335+0728 prior to December 2019, and new observations from Swift, SOAR/Goodman, VLT/X-shooter, and Keck/LRIS taken after its turn-on to characterise its current state. We analysed the variability of SDSS1335+0728 in the X-ray/UV/optical/mid-infrared range, modelled its spectral energy distribution prior to and after December 2019, and studied the evolution of its UV/optical spectra. Results. From our multi-wavelength photometric analysis, we find that: (a) since 2021, the UV flux (from Swift/UVOT observations) is four times brighter than the flux reported by GALEX in 2004; (b) since June 2022, the mid-infrared flux has risen more than two times, and the W1−W2 WISE colour has become redder; and (c) since February 2024, the source has begun showing X-ray emission. From our spectroscopic follow-up, we see that (i) the narrow emission line ratios are now consistent with a more energetic ionising continuum; (ii) broad emission lines are not detected; and (iii) the [OIII] line increased its flux ∼ 3.6 years after the first ZTF alert, which implies a relatively compact narrow-line-emitting region. Conclusions. We conclude that the variations observed in SDSS1335+0728 could be either explained by a ∼ 106M⊙ AGN that is just turning on or by an exotic tidal disruption event (TDE). If the former is true, SDSS1335+0728 is one of the strongest cases of an AGNobserved in the process of activating. If the latter were found to be the case, it would correspond to the longest and faintest TDE ever observed (or another class of still unknown nuclear transient). Future observations of SDSS1335+0728 are crucial to further understand its behaviour. Key words. galaxies: active– accretion, accretion discs– galaxies: individual: SDSS J133519.91+072807.4
(June 12, 2024) Webinar: Development of PET theranostics targeting the molecu...Scintica Instrumentation
Targeting Hsp90 and its pathogen Orthologs with Tethered Inhibitors as a Diagnostic and Therapeutic Strategy for cancer and infectious diseases with Dr. Timothy Haystead.
Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...Creative-Biolabs
Neutralizing antibodies, pivotal in immune defense, specifically bind and inhibit viral pathogens, thereby playing a crucial role in protecting against and mitigating infectious diseases. In this slide, we will introduce what antibodies and neutralizing antibodies are, the production and regulation of neutralizing antibodies, their mechanisms of action, classification and applications, as well as the challenges they face.
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptxgoluk9330
Ahota Beel, nestled in Sootea Biswanath Assam , is celebrated for its extraordinary diversity of bird species. This wetland sanctuary supports a myriad of avian residents and migrants alike. Visitors can admire the elegant flights of migratory species such as the Northern Pintail and Eurasian Wigeon, alongside resident birds including the Asian Openbill and Pheasant-tailed Jacana. With its tranquil scenery and varied habitats, Ahota Beel offers a perfect haven for birdwatchers to appreciate and study the vibrant birdlife that thrives in this natural refuge.
Evidence of Jet Activity from the Secondary Black Hole in the OJ 287 Binary S...Sérgio Sacani
Wereport the study of a huge optical intraday flare on 2021 November 12 at 2 a.m. UT in the blazar OJ287. In the binary black hole model, it is associated with an impact of the secondary black hole on the accretion disk of the primary. Our multifrequency observing campaign was set up to search for such a signature of the impact based on a prediction made 8 yr earlier. The first I-band results of the flare have already been reported by Kishore et al. (2024). Here we combine these data with our monitoring in the R-band. There is a big change in the R–I spectral index by 1.0 ±0.1 between the normal background and the flare, suggesting a new component of radiation. The polarization variation during the rise of the flare suggests the same. The limits on the source size place it most reasonably in the jet of the secondary BH. We then ask why we have not seen this phenomenon before. We show that OJ287 was never before observed with sufficient sensitivity on the night when the flare should have happened according to the binary model. We also study the probability that this flare is just an oversized example of intraday variability using the Krakow data set of intense monitoring between 2015 and 2023. We find that the occurrence of a flare of this size and rapidity is unlikely. In machine-readable Tables 1 and 2, we give the full orbit-linked historical light curve of OJ287 as well as the dense monitoring sample of Krakow.
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
Medcrave Group - Open Locked Nailing Using an Expandable Nail
1. MOJ Orthop Rheumatol 2014, 1(1): 00004Submit Manuscript | http://medcraveonline.com
MOJ Orthopedics & Rheumatology
used to inflate the nail once it is in the appropriate position across
the reduced fracture site [1,3]. Unlike most authors, sterile water
was used in this study to facilitate inflation. The four external
bars are forced against the endosteal surface of both cortical and
cancellous bone. This allows for the nail to adapt to the native
endosteum throughout its length for the more stable fracture
patterns. The abutment of the 4 bars against the endosteum
provides fracture fixation via a self locking mechanism. These
bars provide rotational stability, and the large frictional area
allows for pressure to be evenly distributed throughout the nail.
This is in contrast to interlocking nails which rely mainly on
interlocking screws for axial and rotational stability. In this case,
most of the strain is on the interlocking screws. A pressure gauge
allows for continuous monitoring of pressure during inflation [6].
Material and Methods
The data was collected retrospectively by reviewing the
medical records of all patients who had undergone open
intramedullary nailing for femoral, tibial and humeral fractures
at this institution. The 57 patients included in the study all
had the following documentation in their medical records: the
mechanism of injury, the time between injury and surgery, blood
transfusion requirements, blood loss, time taken to weight bear
(for the femoral/tibial fractures), time for commencement of
upper limb use (for humeral fractures), complication rates and
the average times of follow up. Any patient who did not have all
of these parameters recorded in their notes were excluded from
the study.
Preoperative radiographs for 30 patients could not be located
Abbreviations
Avg: Average; mL: milliliters; cm: Centimeters; mm:
millimeters; Mins: Minutes; AO: Arbeitsgemeinschaft für
Osteosynthesefragen; M: Male; F: Female; MVA: Motor Vehicle
Accident; NB: Note Well; PWB: Partially Weight Bearing; FWB:
Fully Weight Bearing; OTA: Orthopaedic Trauma Association
Introduction
For acute femoral shaft fractures, the Fixion nail is indicated
for use in fractures at least 5 cm distal to the surgical neck and
5 cm proximal to the distal end of the medullary canal. Three of
the patients in this study however, had subtrochanteric fractures.
The nail is made of stainless steel with a solid cylindrical core
consisting of 4 longitudinal peripheral bars connected radially
by thin membranes. The proximal end has a 1 way valve to
maintain the inflation. A pump is manually filled with normal
saline or sterile water by placing the end of its tubing at the
bottom of the fluid filled container and then turning its T handle
counterclockwise. The pressure gauge is held upright while filling
the pump. Removal of air in the inflating system is then ensured
[1-4] by removing the tubing from the fluid filled container and
holding it upright after which the T handle is turned clockwise to
release a few drops of fluid from the end of the pump. The driver
handle is attached to the pump and again the fluid is released
at the tip of the driver handle. The driver handle assists in the
insertion of the nail and acts as a conduit for the saline or sterile
water. The nail is passed across the fracture site in its reduced
diameter. This allows for easy passage across the fracture site
thereby reducing the surgical time [5]. The hand pump is then
Open Locked Nailing Using an Expandable Nail - An
Alternative Approach
Abstract
Objective: The main objective is to evaluate various outcomes of open intramedullary
nailing using the Fixion expanding nail at our institution.
Method: A retrospective study was performed using the hospital records. The
mechanism of injury, the time between injury and surgery, blood transfusion
requirements, blood loss, surgical times, time taken to weight bear (for the femoral/
tibial fractures), time for commencement of upper limb use (for humeral fractures),
complication rates and the average follow up times were documented. Fifty-seven
long bone fractures in 57 patients were included in this study. Complete results
including preoperative X-Rays were available for 27 patients. In 30 cases, the actual
X-Rays were not located but documentation by the treating surgeons was available.
Results: There were 44 acute femoral fractures, 6 acute tibial fractures, 3 acute
humeral fractures, 2 humeral nonunion, 1 tibial nonunion and 1 pathological femoral
fracture. All patients achieved radiological union and the complication rates were
deemed acceptable.
Conclusion: Open intramedullary nailing using an expanding nail may be used for a
variety of indications involving the humerus, tibia and femur.
Keywords
Expandable; Open; Fixion; Intramedullary; Fractures; Locked nailing
Research Article
Volume 1 Issue 1 - 2014
Cary K Fletcher1*, McDowell D1 and
Naparla C2
1
Department of Orthopaedic, St. Ann’s Bay Hospital,
NERHA, Jamaica
2
Department of Radiology, St. Ann’s Bay Hospital, NERHA,
Jamaica
*Corresponding author: Cary Fletcher, St. Ann’s
Bay Hospital, North East Regional Health Authority, 4
Sunflower Drive, Discovery Bay, St. Ann, Jamaica, Tel:
876-383-1273; E-mail: c.fletch30@yahoo.com
Received: May 24, 2014 | Published: July 03, 2014
2. Open Locked Nailing Using an Expandable Nail - An Alternative Approach
Citation: Fletcher CK, McDowell D, Naparla C (2014) Open Locked Nailing Using an Expandable Nail - An Alternative Approach. MOJ Orthop
Rheumatol 1(1): 00004.
Copyright:
2014 Fletcher et al.
2/4
at the time of performing this study. For these patients, we relied
on the documentation of a member of the admitting orthopedic
team. From the documentations, the fracture pattern was
mentioned in each case but not classified using the AO system. For
the comminuted fractures, it was mentioned whether or not the
comminution was mild or severe. Based on the description of the
preoperative films and review of the postoperative radiographs
by the authors, a relatively accurate assessment of the fracture
pattern was made. Where the description of the fracture pattern
was deemed inadequate, the case was not considered for the
study. An independent Radiologist examined the X-rays for the
remaining 27 patients. For these patients, the AO classification
was used. Due to the lack of a fracture table and a C-arm, all
procedures were performed open. All patients received a single
dose of intravenous antibiotics just prior to incision. All but 1
patient with lower limb fractures had spinal anesthesia. Hand
reaming was performed to allow for passage of the nail in cases
where the canal was narrower than the diameter of the nail. In
those cases, reaming was done to 1mm greater than the diameter
of the nail. Monitoring of the fracture site during inflation of the
nail was done under direct vision.
Results
From the period August 2008 to August 2013, we performed
open intramedullary nailing on 57 patients with long bone
injuries using the Fixion expandable nail. The breakdown of the
AO classification identified A2, A3, B2, B3, C1, and C3 subtypes
(Table 1). The femoral shaft was the commonest site of injury
for the acute traumatic fractures. Nonunion accounted for 6%
of all injuries (Figure 1). Males outnumbered females to a ratio
of 46:11. The age ranged from 18-90 years, with a mean age of
38 years. Motor vehicle accidents accounted for majority of the
cases (Figure 2). Nineteen patients had concomitant injuries, the
commonest of which was mild head injury. Ninety-eight percent
of all injuries were closed. The time of surgery varied, with the
time between injury and surgery being 2-213 days (average 17.8
days). The patient who waited 213 days for surgery had defaulted
from the outpatient department and subsequently presented
again. Surgery time also varied, with femoral cases accounting
for 102 mins, tibial 120 mins, and humeral 250 mins; this also
accounted for 36, 5, and 4 patients respectively. The mean blood
loss was 120 mL, 250 mL, and 400 mL, for the tibial, humeral,
and femoral fractures respectively. The excluded patients for
the reporting of surgical time were due to the fact that they had
other surgical procedures in the same sitting and the actual
time taken for the Fixion nailing could not be ascertained from
the notes. Preoperatively 8 patients received blood transfusion
at an average of 2.25 units. Postoperatively 6 patients were
transfused at a rate of 2.8 units. Three of the 6 patients who were
transfused preoperatively, was also transfused postoperatively.
The patients were allowed to PWB with crutches when there
was evidence of adequate callus formation. Regardless of the
fracture pattern, immediate weight bearing was not allowed.
Full weight bearing (FWB) was allowed when there was at
least 3 out of 4 healed cortices. For humeral fractures, range of
motion exercises of the adjacent joints were allowed 2 weeks
postoperatively and manual work was permitted after 3 months.
For the femoral fractures, PWB was commenced at an average of
7.8 weeks whereas for the tibial fractures it was commenced at
9.5 weeks. FWB was commenced at an average of 14.2 weeks in
the patients with femoral fractures in comparison to 16 weeks
in the patients with tibial fractures. All of the humeral fractures
HUMERUS 3 pts
A2 1
C1 2
FEMUR 21 pts
A2 6
A3 5
B2 1
B3 7
C3 2
TIBIA 3 pts
A2 1
A3 1
C3 1
Table 1: Breakdown of the AO classification in the patients.
44
6
3
1
2
1femur
tibia
humerus
0 10 20 30 40 50
Traumatic Nonunion Pathological
Figure 1: N=57; Epidemiological distribution of the pathological
fractures, traumatic fractures, and nonunion.
30
17
10
MVA
FALLS
OTHERS
Figure 2: Etiology of the injuries was blunt trauma, with MVA
accounting for majority, followed by falls and others respectively. The
majority of the falls were low energy.
3. Open Locked Nailing Using an Expandable Nail - An Alternative Approach
Citation: Fletcher CK, McDowell D, Naparla C (2014) Open Locked Nailing Using an Expandable Nail - An Alternative Approach. MOJ Orthop
Rheumatol 1(1): 00004.
Copyright:
2014 Fletcher et al.
3/4
in this study demonstrated advanced callus at an average of
12.3 weeks. The mean follow up time for all patients was 44.6
months (6-70 months). There were no cases in which the nail was
damaged, no cases of iatrogenic fractures, or disorders of union.
The medical records of the 57 patients in the study clearly stated
that all of the fractures healed with no evidence of malrotation,
angulation or shortening. All of the nails expanded. There were
2 superficial infections and 1 deep infection. Both superficial
infections resolved with intravenous antibiotics. The patient who
had a deep infection returned to the operating theatre and had
nail removal, reaming and Gentamicin bead placement. After
removal of the beads, his biochemical markers normalized and he
did clinically well thereafter. One patient who had bilateral tibial
shaft fractures developed a pulmonary embolus postoperatively.
He was successfully treated with Warfarin. We had 1 case of radial
nerve palsy. On revision the nerve was found to be entrapped
under a circlage wire. This patient to date had full recovery of
radial nerve function post wire removal. All the other patients
treated with circlage wiring had femoral fractures (Table 2).
Nine patients requested nail removal after having persistent limb
discomfort for at least 3 months postoperatively (5 femurs, 3
tibiae and 1 humerus). Five of these patients subsequently had
nail removal because a definite cause was identified i.e. a proud
implant. All 5 patients eventually had less pain post procedure.
Discussion
Musculoskeletal injury secondary to trauma continues to be
a major cause of morbidity and mortality in developing countries
[7]. Motor vehicle accidents continue to be the leading cause of
trauma [7,8]. The institute where this study was conducted is
located near one of the country’s major highways. Thus, motor
vehicle accidents always account for a sizable percentage of the
admissions. Intramedullary nailing has unquestionably been
the treatment of choice for long bone fractures which require
surgical care [1,9,10]. Excellent union rates in combination
with low complication rates and excellent return to function
has historically made this procedure one of the most successful
Orthopaedic surgical procedures [10]. The ease of insertion and
the elimination of the need to pass distal interlocking screws
reduce the operation time of the Fixion nail [5]. Passage of distal
interlocking screws remains a potentially challenging, time
consuming step when using a device which relies on interlocking
screws [11]. Occasionally force has been used to pass the nail
which will then increase the risk of nail damage [5]. We believe
that an anatomic or near anatomic open reduction significantly
reduced the force required to pass the nail across the fracture
site and hence there were no cases of nail fracture in our series.
Blomquist et al. [12] in his biomechanical study suggested that
the expandable nail ought to only be used for stable fracture
patterns (greater than 50% contact between major fragments)
as its stability is related to the intrinsic nature of the fracture
pattern. It has been argued that shortening is a potential
problem if the expandable nail is used in AO type C fractures
because of reduced cortical contact [1]. In our study, AO type
C fractures were also successfully treated with the expandable
nail, possibly due to the comminuted fragments being circlaged.
We theorized that circlaging the fragments may have allowed
for adequate cortical contact. Zoccali et al. [13] stated that for
stable fractures, the expandable nail performed well in a head
to head comparison with the gold standard interlocked nail.
There was no difference in terms of rotational stability and the
expandable nail was found to have a higher bending stiffness.
Zoccali et al. [13] also recommended its use only for types A2, A3,
B2 and B3. Interestingly, although he performed his procedures
closed, the healing times averaged 6 months. He theorized that
the high contact pressures produced by expansion of the nail on
the endosteum retards healing. Zoccali et al. [13] considered A1
and B3 contraindications for treatment; however 7 cases of B3
femoral fractures were successfully treated in our study. Ben-
Galim et al. [1] performed a randomized prospective level 2 study
in 53 patients with 53 tibial fractures with either an expandable
nail or an interlocking nail. The AO/OTA classification in these
patients ranged from A1 TO B3. Ben-Galim et al. [1] concluded
that for A1 TO B3 fractures the expandable nail was superior to
the interlocking nail. He found a 39% reduction in overall surgical
and hospital cost in the patients treated with the expandable nail.
The mean surgical duration was 52.9 minutes in the expandable
nail group and 104 minutes in the interlocking group.
To our knowledge, there is no other report in the literature
describing open locked nailing using the Fixion nail. Similar to
our institution, Sekimpi et al. [7] performed open intramedullary
locked nailing because their facility did not have fluoroscopy or
Table 2: The cases that had circlage wiring was 7 (N=7). The mechanisms of injuries were MVA, falls, and others; where MVA accounted for 3 and falls
and others accounted for 2 each. X-ray findings ranged from mild to significant comminution. The presence of other injuries was 2; 1 each for MVA and
others. Only 3 of the cases needed blood transfusion, and the transfusion was administered before, after or both combined. The average time for surgery
from the time of injury ranged from 5.7 to 16. The average blood loss was 933 ml to 1350 ml. The average surgical times ranged from 95 minutes to
156.7 minutes. The average days spent on the ward post surgery ranged from 6.5 to 8 days. The time taken to PWB ranged from 8 to 12.5 weeks and
FWB ranged from 13 to 15.5 weeks.
Mechanism
of Injury
X-Ray
Findings
Other
Injuries
Blood
Transfusion
Amount (ml)
Average Time to
Surgery
(days)
Blood
Loss
(ml)
Surgery
Time
(min)
Days to
Discharge
PWB
(wks)
FWB
(wks)
MVA Significant comminution Head 3 Units preop
4 Units postop
5.7 933 156.7 7 12.5 15.3
Falls Significant
Comminution
Nil 2 units preop
4 units postop
7 1350 111.5 8 8 13
Others Mild to significant
Comminution
Head 2 units postop 16 1050 95 6.5 9 15.5
4. Open Locked Nailing Using an Expandable Nail - An Alternative Approach
Citation: Fletcher CK, McDowell D, Naparla C (2014) Open Locked Nailing Using an Expandable Nail - An Alternative Approach. MOJ Orthop
Rheumatol 1(1): 00004.
Copyright:
2014 Fletcher et al.
4/4
a fracture table. Similarly they also did not have power reamers.
They reported 2 infections (1 superficial, 1 deep), 2 delayed
unions, 4 cases of malalignment and zero cases of nonunion and
nail breakage. Our operative times did not significantly differ
from Kapoor et al. [2] who performed a closed reduction in 27
out of 32 cases, and our healing times in our lower limb fractures
were interestingly superior. The blood loss and surgical time
for femoral fracture fixation were actually superior to Lepore’s
study [6] in which he performed his procedures closed. Kapoor
et al. [2] only reported on AO type A and B fractures. Mallik et
al. [3] reported on a high complication rate of 7 complications
in 7 patients with acute humeral fractures including 2 nonunion,
2 intraoperative device failures, 2 radial nerve palsies and 1
instance of shoulder pain from proximal nail migration. In Mallik
et al. [3] study, callus appeared at an average of 8.25 weeks and
union was at an average of 16.5 weeks. Our study had evidence
of advanced callus at 12.3 weeks. Beazley et al. [14] having
performed a Medline search reviewed 2 quazi-randomised
studies and 8 case series analyzing the fixation of tibial fracture
with the expandable nail. The average reoperation rate was
10.2%, fracture propagation occurred in 2%, the average surgical
time was 55 minutes, and the fractures united at an average of
12.2 weeks.
Pascarella et al. [15] in their review of 19 patients with
certain AO type A and B patterns, allowed PWB at an average
of 7 days and FWB at an average of 40 days despite achieving
consolidation at an average of 5 months for the femur and 4
months in the tibia. This suggests that when appropriate fracture
patterns are treated with this implant early weight bearing may
be advocated. In any open procedure, the concern will always be
an increased infection risk as well as increased risk of a disorder
of union due to an exposed fracture site and the loss of a confined
fracture haematoma respectively. Time to union in this study was
similar to those historically reported to close nailing. The single
deep infection also correlates favorably with data reported on
closed locked nailing. It is our opinion that in hospitals which lack
a c-arm, fracture table and power reamers, open locked nailing
with the Fixion nail is a viable option.
Conclusion
We found that open intramedullary nailing had acceptable
operative times, healing times, excellent union rates and
acceptable complication rates.
Acknowledgement
Thank you to Dr. Bianca Edwards who was integral in the data
collection process.
References
1. Ben-Galim P, Rosenblatt Y, Parnes N, Dekel S, Steinberg EL (2007)
Intramedullary fixation of tibial shaft fractures using an expandable
nail. Clin Orthop Relat Res 455: 234-240.
2. Kapoor SK, Kataria H, Boruah T, Patra SR, Chaudhry A, et al. (2009)
Expandable self-locking nail in the management of closed diaphyseal
fractures of femur and tibia. Indian J Orthop 43(3): 264-270.
3. Mallik E, Hazarika S, Assad S, Scott M (2008) The Fixion nailing system
for stabilising diaphyseal fractures of the humerus : A two-year
clinical experience. Acta Orthop Belg 74(3): 308-316.
4. Lepore S, Capuano S, Romano G (2001) Preliminary clinical and
radiographic results with the Fixion Intramedullary Nail: An inflatable
self-locking system for long bone fractures. Folia Traumatologica
Lovaniensia 3: 80-85.
5. Panidis G, Sayegh F, Beletsiotis A, Hatziemmanuil D, Antosidis K, et al.
(2003) The use of an innovative inflatable self locking intramedullary
nail in treating and stabilizing long bone fractures. Technique-
preliminary results. Osteo Trauma Care 11: S108-S112.
6. Lepore L, Lepore S, Maffulli N (2003) Intramedullary nailing of the
femur with an inflatable self-locking nail: comparison with locked
nailing. J Orthop Sci 8(6): 796-801.
7. Sekimpi P, Okike K, Zirkle L, Jawa A (2011) Femoral fracture fixation
in developing countries: an evaluation of the Surgical Implant
Generation Network (SIGN) intramedullary nail. J Bone Joint Surg Am
93(19): 1811-1818.
8. Mock C, Cherian MN (2008) The global burden of musculoskeletal
injuries: challenges and solutions. Clin Orthop Relat Res 466(10):
2306-2316.
9. Bong MR, Kummer FJ, Koval KJ, Egol KA (2007) Intramedullary Nailing
of the Lower Extremity: Biomechanics and Biology. J Am Acad Orthop
Surg 15(2): 97-106.
10. Brumback RJ, Virkus WW (2000) Intramedullary nailing of the femur:
reamed versus nonreamed. J Am Acad Orthop Surg 8(2): 83-90.
11. Winquist RA (1993) Locked femoral nailing. J Am Acad Orthop Surg
1(2): 95-105.
12. Blomquist J, Lundberg OJ, Gjerdet NR, Molster A (2008) Are inflatable
nails an alternative to interlocked nails in tibial fractures? Clin Orthop
Relat Res 466(5): 1225-1231.
13. Zoccali C, Francesco AD, Ranalletta A, Flamini S (2008) Clinical and
radiological midterm results from using the Fixion expandable
intramedullary nail in transverse and short oblique fractures of femur
and tibia. J Orthop Traumatol 9(3): 123-128.
14. Beazley J, Mauffrey C, Seligson D (2011) Treatment of acute tibial shaft
fractures with an expandable nailing system: A systematic review of
the literature. Injury 42(Suppl 4): S11-S16.
15. Pascarella R, Nasta G, Nicolini M, Bertoldi E, Maresca A, et al. (2002)
The Fixion nail in the lower limb. Preliminary results. Chir Organi Mov
87(3): 169-174.