Back Slab Research Articles

A rare case of vastus intermedius tear in a middle-aged gentleman: a case report

Although quadriceps strain is fairly common, reports of isolated vastus intermedius tears are rare. We highlight the case of a middle-aged gentleman who sustained this injury when he slipped while bending down, with a 'pop' sound. Subsequently, he experienced pain, swelling, and reduced knee flexion, but was able to extend his knee fully. A plain radiograph revealed an non-displaced chip avulsion fracture of the patella, which was immobilized with an above-knee back slab. A sonogram revealed a grade 2 tear. During the acute stage, we treated the patient conservatively with progressive rehabilitation and physiotherapy. Six weeks later, the patient reported a good recovery. We admittedly considered platelet-rich plasma as an adjunct to augment the healing process of the avulsed tendon if recovery was unsatisfactory. In conclusion, vastus intermedius strains can be successfully treated conservatively with timely rehabilitation, paying attention to progress along the healing process as demonstrated in this case.

Surgical Treatment of Plantar Fasciitis After failure of Conservative Treatment

Plantar fasciitis is a common problem faced almost daily in our orthopedic clinic, and it is not easy to satisfy patients with a curative treatment in a short period of time; it is characterized by deep pain in the plantar aspect of the heel, particularly on arising from bed, although the pain often subsides after few steps, in some patients the pain will persist for a long period. Aim of the study: To evaluate the result of surgical treatment in cases of plantar fasciitis which are not respond to conservative treatment. Methods: Prospective study was conducted at the Department of Orthopedic Surgery in Al-Kadhemiyah Teaching Hospital from November 2010 to May 2012 to evaluate 50 patients com¬plaining of inferior heel pain. There were 30 females and 20 males; the main presenting symptoms were pain on the inferno-medial aspect of the heel exacerbating by prolongs weight-bearing and in the morning following sleep. The age of the patients is 23-58 years. Bilateral heel pain presented in 10 patients in our series; therefore, the overall number of heels treated in our series was 60 heels. All of the patients were treated first conservatively by rest, anti-inflammatory drugs, and local corticosteroid injection. 13 patients showed no response, so we advised them for surgery; 12 patients out of 13 accepted surgery and were treated by plantar fascial release. Patients with systemic diseases had been excluded from our study. Results: Regarding treatment, 37 patients (74%) respond to conservative treatment, while 13 patients (26%) had no response to conservative treatment. Therefore they were advised to undergo surgery, and 12 of them accepted surgery. Nine patients (75%) undergoing surgery had a good result (pain-free) 17% of patients undergoing surgery in our study showed fair results (pain after heavy exercise), while 8% showed poor results (persistent pain). Per-operative drilling of calcaneum showed to be effective in post-operative heel pain relieve, which may be due to reduced intra-osseous pressure. Regarding complications, 6% showed superficial wound infection, which was treated conservatively by rest and antibiotics for seven days. Post-operative back slab for two weeks is important to decrease post-operative pain and to facilitate soft tissue healing

EXTERNAL PNEUMATIC COMPRESSION FOR PREOPERATIVE MANAGEMENT OF SWELLING FOR ANKLE FRACTURES: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Patients awaiting resolution of swelling and oedema prior to ankle surgery can represent a significant burden on hospital beds. Our study assessed whether external pneumatic intermittent compression (EPIC) can reduce delays to surgery.Our prospective randomised controlled trial (n= 20) compared outcomes of patients treated with EPIC vs control group managed with ice and elevation. Included were patients aged <18 years with isolated closed ankle fractures admitted for management of swelling prior to surgery. Excluded were open fractures, injuries to contralateral leg, diabetes, absent pulses, peripheral vascular disease, inability to consent, no requirement for admission. Eligible patients were randomised to active or control arms. All patients were managed initially with reduction and back slab application. Patients in active arm fitted with EPIC (Hydroven 3000) device over the back slab. Assessment by treating team determined the time at which patient is assessed ready for surgery.Patients in the treatment arm were assessed as ready for surgery sooner, (123 hrs vs 168hrs, T score = 1.925, P 0.035) and had a shorter time to surgery (167 hrs vs 216 hrs, T score = 1.748, P 0.047) Length of stay was reduced bud did not reach statistical significance. (259 hrs vs 269 hrs, T score 0.229, P 0.41)Our results showed a statistically and clinically significant reduction in time that patients were assessed ready for surgery and time to surgery in the treatment cohort. We conclude that although further data is needed to achieve an adequately powered study and assess the safety profile of the EPIC, incorporation of EPIC into routine clinical practice has the potential for significant cost savings.

A Comparison of Skin Graft Techniques with and without Plaster Back Slab Dressing in Reducing Donor Site Morbidity in Radial Forearm Free Flap Surgery - A Retrospective Study.

The radial forearm free flap (RFFF) is a commonly used free flap for the reconstruction of orofacial defects because of its versatility and reliability. The donor site is closed with either split or full-thickness skin graft, and one of the common donor site morbidities is skin graft failure. Various techniques to minimise skin graft failure were reported, and we compared the skin graft techniques with and without plaster back slab dressing in the radial forearm donor site. This is a retrospective study of 75 patients who had RFFF for reconstruction of oral cavity cancer at two different tertiary teaching hospitals in the United Kingdom between April 2015 and March 2020. Thirty-nine patients from Hospital one had volar back slap, bolster dressing and crepe bandage. In contrast, 36 patients from Hospital two had only pressure dressing without a back slab. The mean age of the study population was 60.65 (P = 0.274). In both groups, two patients had donor site complications. However, there was no significant difference in the donor site skin graft complications with a P = 0.662. There was no evidence in the literature to support an ideal bandage for skin graft at the RFFF donor site. Our comparison of two techniques of skin graft dressings with and without back slap did not show any difference in the skin graft take, and the volar back slab did not add any additional benefits. The simple use of foam as a bolster dressing without a back slab is ideal for the radial forearm free flap donor site.

Users’ satisfaction and experiences in using assistive devices distributed by a rehabilitation centre in Bangladesh: a cross-sectional study

Purpose This study aimed to understand Bangladeshi users’ satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals’ wellbeing. Method We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data. Results We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh. Conclusion These findings indicate that the provision of assistive devices requires accommodating individuals’ needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities. IMPLICATIONS FOR REHABILITATION It is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities. There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation. Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities. Future research could (i) include user’s satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.

Comparison of outcome following knee immobilization versus no immobilization in the immediate post operative period following arthroscopic anterior cruciate ligament reconstruction

Background: Post operative bracing following ACL reconstruction has been traditionally used in post operative period to reduce pain limit knee range of motion to protect against valgus and varus stress. There is a lack of consensus in published literature regarding knee immobilization. The aim of this study is to compare the functional outcome and pain control in patients using knee immobilizer with those not using them in immediate post operative period.Methods: A total of 60 patients admitted with ACL tear who were admitted from January 2020 to August 2021 were enrolled in this study and randomised into two groups, given knee immobilizer or no immobilizer following arthroscopic ACL reconstruction. Patients were assessed for pain, knee range of motion and functional outcome with 6-month follow-up.Results: VAS score for pain was significantly lower for knee brace users (p=0.24) on post-op day2 but there was no significant difference on subsequent measurements. Also, the IKDC Score, arc of motion of knee joint and complication rate did not show significant difference between the two groups.Conclusions: Based on this study, the use of a knee brace for improving short term outcome following ACL reconstruction is not justified and adds to the cost of treatment. A short cylindrical back slab for 2-3days can serve the same purpose of controlling pain and soft tissue protection.

Management of Giant Cell Tumor of Talus With Extended Intralesional Curettage and Reconstruction Using Polymethylmethacrylate Cement.

An 18-year-old man presented with complaints of pain and swelling around the left ankle region. Local examination revealed diffuse, hard, mildly tender swelling with ill-defined margins over the medial aspect of the left ankle joint just below the medial malleolus. Radiographic and computed tomographic assessment revealed osteolytic lesion with moderately defined margins. Provisional diagnosis of Campanacci grade 2 giant cell tumor was made, which was later confirmed on histopathology. Extended intralesional curettage and reconstruction with polymethylmethacrylate cement was done under spinal anesthesia. Full weight bearing was allowed at 4 weeks when the below knee back slab was removed. Radiographic assessment was done every 3 months during the first year of follow-up and then every 6 months. No evidence of recurrence of tumor, collapse of talus, or avascular necrosis was found during follow-up. Managing such rare form of bone tumors with extended intralesional curettage and bone cement is an appropriate treatment and gives good functional results.Level of Evidence: Level V.

INTERNAL FIXATION OF TYPE I CAPITELLUM FRACTURE WITH HEADLESS SCREWS: A CASE REPORT

Background: Capitellum fractures are relatively rare. Distal humeral fractures that include capitellum and trochlea constitute approximately 6% of all distal humeral fractures and 1% of all elbow fractures. Despite the rarity of these injuries, an increasing number of clinical series have emerged, enhancing our understanding of these fractures.Case Report: A 26-year-old woman came to the emergency department with complaints of swelling and localized pain on the lateral side of her left elbow 2 hours after she fell off her motorcycle. Routine imaging such as plain radiographs and computed tomography scanning confirmed the fracture. She underwent open reduction and internal fixation surgery, stabilization of articular fragments with headless screws, and was fixated by a back slab and arm sling. The patient was also encouraged to do early elbow mobilization to avoid contractures and joint stiffness, routine follow-up every two weeks for a ROM evaluation. Preoperative Mayo Elbow-Performance Index score (MEPI) was 15, and postoperative 100.Discussion: The aim of capitellum fracture treatment is anatomical reconstruction and fixation to reduce the risk of non-union. In this case, we performed open reduction, secured two headless screws, which allow rigid fixation at the fracture site, provide fracture site compression through variable thread pitch design, and remained not removed later. These screws are suitable for use in anteroposterior and posteroanterior directions.Conclusion: The patient at two months follow-up has shown significant improvement. Accurate reduction, stable fracture fixation, and early postoperative mobilization were reported to provide good results with a MEPI score of 100.

Radiological and Functional Outcome of Distal Radius Fracture treated conservatively vs Percutaneous K-wire fixation

Aim: To compare the radiological and functional result of conservatively treated distant radius fractures (manipulation under anesthesia and plaster of paris) versus percutaneous K- wire fixation Study design: Retrospective Duration and place of study: Department of Orthopedic Surgery, The Indus Hospital, Raiwind campus Lahore from July 2018 to August 2020. Methods: The sample size of 100 patients aged between 18-60 years, closed, isolated distal radius fracture were included, and patients with diabetes mellitus, ischemic heart disease, pathological fractures, chronic renal disease, head injury, chronic liver disease, whose Glasgow coma scale was <14, malignancy were excluded. Patients were randomized as A & B by lottery method. They managed with conservative treatment ( manipulation under anesthesia (MUA) and plaster of paris (POP) cast) and K- wire fixation in groups A & B, respectively. Side of the fractured bone, infection, radiological union, and function outcome were recorded. Results: Amongst the total 100 patients in group-A, 32(63.8%) were males, and 18(36.2%) were females, and 35 (70.2%) were males, and 15 (29.8%) were females in Group-B. in group A patients mean age was 38.86.19 years, while patients mean age of the group B was 39.57.36 years. With the conservative method, 45(95.7%), the union rate was while with the K- wire fixation method, the union rate was 48(96%). In group-A, 35(70%) had excellent, 10 (20%) good, 03 (6%) had an average, and 2(4%) poor and in group-B, 40(80%) had excellent, 04 (08%) good, 04(08%) had an average, and 02 (4%) poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, fixation of a distal radius fracture with K-wires has a better outcome than conservative treatment (MUA and POP cast) with a low infection rate and better union and result. Keywords: closed fracture, distal radius, back slab, K-wires

Sliding rotational osteotomy for cases of dorsally angulated distal radius malunion: A technical note

The aim of this study was to present a novel pre-planned distal radius sliding rotational osteotomy that can address all deformities in dorsally angulated distal radius malunion through a volar approach using a locking plate. Four consecutive adult women with symptomatic dorsally angulated distal radius malunion were surgically treated with sliding rotational osteotomy. All the patients underwent preoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores, a series of radiography, and a course of physiotherapy. The osteotomy was planned on 2 orthogonal radiographs, and the surgery was performed through a volar approach. A back slab was applied post-operatively for two weeks and changed to a removable splint for further four weeks. Gentle active movements out of splint were permitted at two weeks, and formal physiotherapy at six weeks post-operatively. Radiographs were taken immediately post-operatively, at three months, and with DASH scores at a mean final follow-up of 18 months. On radiographic evaluation, all the deformities were corrected within an acceptable range. The mean increase in radial inclination was 6.5 degrees. The mean gain in radial height was 2.95 mm. The mean improvement in ulnar variance was 4.25 mm. The mean change from dorsal to volar angulation was 23 degrees, and the mean improvement in the DASH score was 45.25 at a mean final follow-up of 16 months. All osteotomies achieved bony union within 3 months postoperatively. None of the patients required metalwork removal, and no complications were observed. Sliding rotational osteotomy appears to be a safe technique to correct deformity and improve function in patients with dorsally angulated, shortened, and radially deviated distal radius malunion.

Removal of bromate from drinking water using a heterogeneous photocatalytic mili-reactor: impact of the reactor material and water matrix.

The main goal of this study was to evaluate the removal of bromate from drinking water using a heterogeneous photocatalytic mili-photoreactor, based on NETmix technology. The NETmix mili-reactor consists of a network of channels and chambers imprinted in a back slab made of acrylic (AS) or stainless steel (SSS) sealed, through mechanical compression and o-rings, with an UVA-transparent front borosilicate glass slab (BGS). A plate of UVA-LEDs was placed above the BGS window. TiO2-P25 thin films were immobilized on the BGS (back-side illumination, BSI) or SSS (front-side illumination, FSI) by using a spray deposition method. The photoreduction rate of a 200 μg L-1 (1.56 μM) BrO3- solution was assessed taking into account the following: (i) catalyst film thickness, (ii) catalyst coated surface and illumination mechanism (BSI or FSI), (iii) solution pH, (iv) type and dose of sacrificial agent (SA), (v) reactor material, and (vi) water matrix. In acidic conditions (pH 3.0) and in the absence of light/catalyst/SA, 28% and 36% of BrO3- was reduced into Br- only by contacting with AS and SSS during 2-h, respectively. This effect prevailed during BSI experiments, but not for FSI ones since back SSS was coated with the photocatalyst. The results obtained have demonstrated that (i) the molar rate of disappearance of bromates was similar to the molar rate of formation of bromides; (ii) higher BrO3- reduction efficiencies were reached in the presence of an SA using the FSI at pH 3.0; (iii) formic acid ([BrO3-]:[CH2O2] molar ratio of 1:3) presented higher performance than humic acids (HA = 1 mg C L-1) as SA; (iv) high amounts of HA impaired the BrO3- photoreduction reaction; (v) SSS coated catalyst surface revealed to be stable for at least 4 consecutive cycles, keeping its photonic efficiency. Under the best operating conditions (FSI, 18 mL of 2% wt. TiO2-P25 suspension, pH 3.0), the use of freshwater matrices led to (i) equal or higher reaction rates, when compared with a synthetic water in the absence of SA, and (ii) lower reaction rates, when compared with a synthetic water containing formic acid with a [BrO3-]:[CH2O2] molar ratio of 1:3. Notwithstanding, heterogeneous TiO2 photocatalysis, using the NETmix mili-reactor can be used to promote the reduction of BrO3- into Br-, attaining concentrations below 10 μg L-1 (guideline value) after 2-h reaction. Graphical Abstract .

Intensification of heterogeneous TiO2 photocatalysis using the NETmix mili-photoreactor under microscale illumination for oxytetracycline oxidation

This study focuses on the intensification of heterogeneous TiO2 photocatalysis for the removal of a contaminant of emerging concern (CEC), oxytetracycline (OTC), as a polishing step of urban wastewaters, using an innovative NETmix mili-photoreactor under UVA-LEDs illumination. The effect of catalyst coated surface per reactor volume and the illumination mechanism, back-side (BSI) or front-side (FSI) irradiation, on OTC oxidation were evaluated. For that, a thin film of photocatalyst was uniformly deposited on the front borosilicate slab (BS) (BSI mechanism; 333 m2catalyst m−3reactor) or on the network of channels and chambers imprinted in the back stainless-steel slab (SSS) (FSI mechanism; 989 m2catalyst m−3reactor) using a spray system. OTC removal was also assessed as a function of TiO2 film thickness immobilized on both slabs. The photocatalyst reactivity in combination with photoreactor was significantly enhanced (3.4 times) from 0.64 to 2.19 mmolOTC m−3illuminated reactor volume s−1, when considering the BSI and FSI mechanisms, respectively. In addition, the influence of UVA-LEDs intensity on OTC oxidation rate was investigated. UVA-LEDs plates were placed on the top of the NETmix borosilicate window. Moreover, the effect of water matrix was assessed using a secondary effluent from an urban wastewater treatment plant fortified with OTC. OTC oxidation rate was only inhibited in about 1.3 times in the presence of the real matrix, showing the ability of the NETmix to overcome matrix effects due to its unique characteristics. Catalyst film stability over four consecutive reaction cycles was evaluated using synthetic and real matrices fortified with OTC.

Effect of catalyst coated surface, illumination mechanism and light source in heterogeneous TiO2 photocatalysis using a mili-photoreactor for n-decane oxidation at gas phase

This work evaluates the effect of the catalyst coated surface per reactor volume, illumination mechanism (back side (BSI) or front side (FSI) illumination) and light source on heterogeneous TiO2 photocatalysis using a mili-photoreactor, for the oxidation of a volatile organic compound in a gas stream. A thin film of TiO2-P25 was uniformly deposited on the front borosilicate window of the mili-photoreactor (BSI mechanism) or on the network of channels and chambers imprinted in the back stainless steel slab (FSI mechanism) using a spray system. BSI and FSI mechanisms were assessed using two different UVA LED systems (9 LEDs – LED9 and 18 LEDs – LED18), UVA lamps and simulated solar light as radiation sources. Under BSI and solar light the maximum reaction rate (rdec) obtained was 1.0 µmol min−1, whereas a 1.7-fold increase was attained using BSI-LED9. Although under FSI mechanism the catalyst coated surface per reactor volume is three times higher than under BSI, the maximum rdec for FSI showed only a 1.4 and 1.1-fold increase using simulated solar light and LED9, respectively, when compared with BSI. In order to provide a better light distribution over the catalyst coated surface, a new LED plate with 18 LEDs was designed and tested. Under FSI or BSI mechanisms and using the LED18 system, a ∼3.6 fold increase on the maximum rdec was observed when compared to the LED9 system. However, even for the LED18 system, similar maximum reaction rates are observed for BSI and FSI mechanisms. This means, that regardless of the light source configuration used, ∼60% of the catalyst coated surface is not illuminated.

Sleeve fracture of the patella: a case report

Sleeve fractures form an integral part of the patellar fractures seen in children, which in their own entity are rare injuries. Diagnosis is usually missed early due to lack of awareness, and X-ray features are tricky if one is not aware of or familiar with the anatomy of an immature patella. This propagates neglect and outcomes are undesirable for the patient. We present a case of a 12-year-old boy who presented to our facility with a sleeve fracture that was initially missed in the outpatient clinic. Open reduction and repair with nonabsorbable sutures was done and the construct protected with a back slab. Early diagnosis and surgical management are critical to favorable outcomes in these injuries.Keywords: Patella, Sleeve fracture, Pediatrics

Intensifying heterogeneous TiO2 photocatalysis for bromate reduction using the NETmix photoreactor

This work focuses on the intensification of BrO3− (200 μg L−1) reduction by TiO2-assisted heterogeneous photocatalysis, using the NETmix mili-photoreactor illuminated by UVA light-emitting diodes (UVA-LEDs). The mili-photoreactor was assembled in two configurations: i) catalyst deposition on the channels and chambers of a back stainless steel slab (SSS) and ii) catalyst deposition on the front borosilicate glass slab (BGS), allowing the study of front-side (FSI) and back-side (BSI) illumination mechanisms, respectively. The BrO3− reduction rate in aqueous solution was assessed as a function of: i) pH; ii) dissolved oxygen (DO); iii) addition of formic acid (CH2O2) as a sacrificial agent (SA); iv) photocatalyst film thickness; v) illumination mechanism; vi) irradiation intensity; vii) temperature; and viii) water matrix. Higher BrO3− reduction rates were observed using the FSI mechanism and lower pH values. Nitrogen injection (to eliminate DO) did not significantly improve the reaction rate and the addition of CH2O2 had a negative effect at pH 6.5. Neither temperature nor irradiance increase showed a considerable improvement on the reduction rate. Moreover, TiO2 film remains stable for at least 13 consecutive reactions without significant catalyst leaching. The chemically pre-treated fresh water (FW) matrix negatively affected the reaction rate when compared with the synthetic water (SW), under the best operational conditions (SSS: pH = 5.5, 287 mg of TiO2, 25 °C, SA absence, [DO] = 232–263 μM). This was associated with the presence of both inorganic and organic matter at much higher concentrations than BrO3−. Notwithstanding, heterogeneous TiO2 photocatalysis, using the NETmix mili-photoreactor, was successfully applied to fresh water, achieving [BrO3−] < 10 μg L−1 (guideline value) after 2-hour reaction.

Strategies to reduce mass and photons transfer limitations in heterogeneous photocatalytic processes: Hexavalent chromium reduction studies

The current work presents different approaches to overcome mass and photon transfer limitations in heterogeneous photocatalytic processes applied to the reduction of hexavalent chromium to its trivalent form in the presence of a sacrificial agent. Two reactor designs were tested, a monolithic tubular photoreactor (MTP) and a micro-meso-structured photoreactor (NETmix), both presenting a high catalyst surface area per reaction liquid volume. In order to reduce photon transfer limitations, the tubular photoreactor was packed with transparent cellulose acetate monolithic structures (CAM) coated with the catalyst by a dip-coating method. For the NETmix reactor, a thin film of photocatalyst was uniformly deposited on the front glass slab (GS) or on the network of channels and chambers imprinted in the back stainless steel slab (SSS) using a spray system. The reaction rate for the NETmix photoreactor was evaluated for two illumination sources, solar light or UVA-LEDs, using the NETmix with the front glass slab or/and back stainless steel slab coated with TiO2-P25. The reusability of the photocatalytic films on the NETmix walls was also evaluated for three consecutive cycles using fresh Cr(VI) solutions. The catalyst reactivity in combination with the NETmix-SSS photoreactor is almost 70 times superior to one obtained with the MTP.

Enhanced Treatment

Category: Ankle, Trauma Introduction/Purpose: Ankle fracture fixation has commonly been undertaken with an inpatient process due to swelling and surgery may not always be conducted on the next available operating list. In the UK there has been a move over the last 5 years to manage many trauma cases semi-electively and within the day case departments, to give patients more choice in their treatment. We conducted a study looking at the impact of a home therapy ankle pathway combined with day case- surgery on the length of stay and safety of patients with ankle fractures requiring surgical fixation conducted by group consultant trauma surgeons and their teams. Methods: Patients were assessed in two periods from Jan 2015 to Dec 2016; all patients were placed in a plaster of paris back slab in casualty with the ankle reduced, limb care advice given – elevation, cooling and DVT thromboprophylaxis. A group of patients were assessed for home therapy and day case surgery and were then discharged home on crutches after a slot was determined on a rapid access trauma list typically six days later. Patients who were not suitable for home therapy were excluded from review. We compared two cohorts of patients with weber B fractures whom choose surgical fixation, which would have been suitable for both day case and in-patient care over a 12-month period. We performed a prospective audit of the cases undertaken and analysis of the number of cases, complications and the cost benefits Results: 143-patients identified; 21 patients identified for home-therapy &amp; day-case, and 32 patients for inpatient management. Within home-care &amp; day case group: 1-tri-malleolar-fracture, 11-bi-malleolar fractures and 9-uni-malleolar and within inpatient group there were a similar mixture of fracture patterns. Time-to-surgery for inpatient management was 2.38 (1-16d) days; length of stay was 4.94 days (2-31d). Home-care &amp; day-case time to surgery was 5.8 days (2-7). No patient admitted following surgery. All patients followed to pre-morbid ambulation levels. One DVT confirmed in the inpatient group no-wound-complications or failures of fixation reported. A mean 1.5 hrs operating time was required (59.3 min tourniquet time); day-case-surgery is £228 per patient cheaper than in- patient surgery. Cost efficiency based on 4.94 bed-day-improvement is 158 bed-days a cost-saving of £1,235 per patient. Conclusion: We believe home-care and day-case ankle fracture surgery is both valid and cost effective in optimizing the management of the appropriate ankle fractures without any significant rise in co-morbidity. For the patient there is little difference in waiting times and a pre planned surgical episode can give them flexibility to plan their treatment. The total potential saving per patient to the health care provider could be approx. £1,486 per patient. Furthermore, in our healthcare system it reduces demand for inpatient beds, provides significant cost savings for the provider and improves patient satisfaction due to choice and reduction wasted bed days

How to apply a cast for forearm fractures.

The forearm bones (radius and ulna) are the two most commonly broken bones in the body.1 Immediate management of these injuries includes applying a plaster cast—called a back slab—to the dorsal aspect of the forearm. These casts are a simple and effective way of providing temporary stabilisation of the fracture and pain relief. All medical students and junior doctors should know how to apply a dorsal back slab.2 It is usually applied in the emergency department or orthopaedic theatre, but it might also be required during expeditions or in remote settings on elective placement. The back slab bridges the gap in treatment until definite fracture fixation takes place—that is, an operation is planned within a few days or a full circumferential cast is applied once swelling has settled. In both cases, a fracture of a forearm bone will take about six weeks to heal. It is important that a back slab does not encircle the limb to allow for some expansion secondary to swelling, and it should be easy to remove. A back slab can be applied with or without manipulation of the fracture, and it can play an important part in managing a fracture conservatively. However, application of the back slab is not without its risks. Circulatory or nerve impairment can occur if a back slab is applied too tightly, and pressure ulcers can develop if padding at bony prominences is not applied appropriately.23 Practice is all that is required to become proficient in applying a cast, and the fracture clinic or emergency department plaster room can be a source of training and support. The principles learnt from casting the forearm can be applied to other parts of the body. The British Orthopaedic Association’s patient liaison group states that they expect that anyone who requires …

Intensification of heterogeneous TiO2 photocatalysis using an innovative micro–meso-structured-reactor for Cr(VI) reduction under simulated solar light

Process intensification of heterogeneous TiO2 photocatalysis using a new type of static mixer micro–meso-structured-reactor, based on the NETmix reactor, was evaluated to promote the hexavalent chromium reduction to its trivalent state, in the presence of sacrificial agents. The photocatalytic micro–meso-structured reactor comprises a back acrylic slab where chambers and channels are imprinted and a frontal borosilicate slab with especially high UV transparency, irradiated by simulated solar light. An UV transparent cellulose acetate (CA) sheet coated with TiO2-P25 by a simple spray method was assembled between the two slabs of the photoreactor. The reactor geometry provides an efficient exposure of TiO2-P25 CA sheets to radiation, with an illuminated surface per unit of volume inside the reactor of 470m2m−3 and 1.36g TiO2 per liter of liquid inside the reactor. Beyond that, it provides a good degree of mixing using a laminar flow, maximizing heterogeneous and homogeneous Cr(VI) reduction reactions. Firstly, different organic species were tested as hole scavengers in order to avoid the Cr(III) re-oxidation. The effect of the degree of mixing inside the photoreactor, according to the Reynolds number, on the Cr(VI) photocatalytic reduction was then evaluated. Following, operating conditions such as TiO2 mass, tartaric acid concentration, pH value, temperature and initial Cr(VI) concentration were analyzed. Results indicate high reduction rates (1mmolCr(VI)m−3illuminated volumes−1) and a photonic efficiency of 3.96% for Re=830, 30mg TiO2 and a Cr(VI):tartaric acid molar ratio of 1:90 at pH 3.0 and 25°C. Finally, the CA sheets coated with thin films of TiO2-P25 showed to be suitable for continuous Cr(VI) reduction, without losing efficiency during 3 consecutive photocatalytic cycles.

Isolated Subtalar Arthrodesis.

An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults. Perform a comprehensive clinical and radiographic assessment. Position the patient supine on the operating table with a bump under the ipsilateral hip, to internally rotate the involved leg. Mark a longitudinal incision from just inferior to the tip of the lateral malleolus and extending toward the base of the 4th metatarsal. Expose the subtalar joint by reflecting the extensor digitorum brevis and protecting the peroneal tendons. Meticulously prepare the subtalar joint using osteotomes and curets down to healthy bleeding subchondral bone. Reduce the subtalar joint into 5° of valgus and fix it with cannulated screws. Meticulously close the wound in layers and place the lower leg in a well-padded plaster back slab with the ankle in a neutral position. The operatively treated leg is kept immobilized and non-weight-bearing for the first 6 weeks. Numerous retrospective articles have reported high fusion rates and good functional outcomes after isolated subtalar arthrodesis, for all indications.