Open Fractures Research Articles

Fracture related infection in open tibial fractures

Open tibia fractures frequently occur following high-energy trauma. Contamination of the fracture site combined with limited soft tissue coverage and blood supply means that these open fractures are associated with a high rate of complications, including fracture related infection (FRI). FRI is associated with lowered patient outcomes and requires early recognition and appropriate surgical and medical management.The current evidence on FRI after open tibial fractures largely is limited to case series, small retrospective cohort studies and expert opinion. Recent expert consensus has produced guidelines with the aim of standardising care for these patients. This review summarises the current management strategies employed in treating FRI following open tibial fractures and where possible the evidence behind them.

Immediate plate fixation of open tibial plafond fractures does not elevate risk of infection.

To determine if immediate plate fixation of open tibial plafond fractures has a negative effect on soft tissue complications and increases the risk of deep infection. This was a single-institution retrospective cohort study performed at level-1 trauma center. All patients with open OTA/AO 43C plafond fractures treated over 20-year period with follow-up until fracture union or development of deep infection. Ninety-nine of 333 identified patents met the inclusion criteria. The intervention was operative treatment of open tibial plafond fractures. The main outcome measurements were return to operating room for deep infection, nonunion, and below knee amputation. The overall rate of complications was 52%. Gender, body mass index, tobacco use, diabetes, ASA classification, time to OR from injury, wound location, and associated fibula fracture were not associated with deep infection. There was a significant difference in Gustilo-Anderson fracture grade among infected versus non-infected (P = 0.04). There was no significant difference in postoperative infection rates between patients treated with external fixation, external fixation and limited plate fixation, and plate fixation alone during initial surgery (P = 0.64). It is well established that open pilon fractures have a high incidence for postoperative infection and development of complications such as nonunion. As these injuries have poor clinical outcomes, any additional measures to prevent infection and soft tissue complications should be utilized. In appropriately selected cases, both immediate plate fixation and immediate limited plate fixation with external fixation at the time of I&D do not appear to elevate risk of deep infection. Therapeutic Level III.

Unplanned reoperation is common following intramedullary nailing of open femoral shaft fractures: A retrospective review

BackgroundThe objective of this study is to investigate the incidence of unplanned reoperation, nonunion and infection following open femoral shaft fractures treated with an intramedullary nail and correlate these occurrences with patient variables and injury characteristics. MethodsA retrospective review of open femur fractures from a level 1 trauma center between 2012 and 2020 was performed. Ninety-five patients who sustained an open femur fracture, were treated definitively with an intramedullary nail, and had at least 3 months of follow-up were included in the analysis for surgical site infection. Seventy-three of these patients had at least one year of follow-up. After excluding planned bone grafting for segmental defects, 67 patients were included in the analysis of unplanned reoperation. ResultsThe rate of unplanned reoperation was 31.3 %, with 57 % of these operations occurring to address nonunion. The overall nonunion rate was 18 %. In patients who did not require reoperation to obtain union, the median time to union for the cohort was 6 months, with an interquartile range of 3–7.5 months. Post-operative surgical site infection occurred in 11.6 % of patients. ConclusionsIn conclusion, unplanned reoperation following intramedullary nailing of open femur fractures occurs in nearly 1/3rd of patients and the rates of nonunion and surgical site infection may be higher than previously reported in the literature. Reoperation most closely correlates with the OTA Open Fracture Classification System. Patients with open femur fractures should be counseled that reoperation is often required to obtain fracture union, with soft tissue and fracture injury severity predicting complications.

PERCUTANEOUS PINNING VERSUS OPEN REDUCTION K WIRE FIXATION IN GARTLAND TYPE III SUPRACONDYLAR HUMERUS FRACTURE IN CHILDREN

This study was carried out to explore the percutaneous pinning versus open reduction K wire fixation in Gartland Type III supracondylar humerus fractures in children. This randomized control trial was conducted at the Department of Orthopaedic and Trauma DHQ Hospital Timergara Lower Dir KPK Pakistan hospital from September 2022 to November 2023. Eighty-four patients participated in this study, which was distributed into two groups. The open reduction and percutaneous pinning groups contained 42 patients each. Both groups were assessed for enhancement in function and radio-logically for fracture union. Children of both genders with Gartland type III supracondylar fractures between the ages of 2 and 12 years were included. In contrast, all children with open fractures, multiple fractures, and systemic diseases like infections such as pneumonia and individuals with cancer were excluded. In the group receiving percutaneous pinning, 33 (78.5%) children had excellent functional outcomes, 7 (16.6%) showed good functional outcomes, and 2 (4.7%) showed fair functional outcomes. In the open reduction group, there were 27 (64.3%) children with excellent functional results, 10 (23.8%) with good functional outcomes, 3 (7.1%) with fair outcomes, and 2 (4.7%) with poor functional consequences (p > 0.05). When treating children with Gartland type III supracondylar fractures of the humerus, percutaneous pinning is the safest and most successful method than open reduction with K wire fixation. Its apparent operative scars and other consequences are modest.

Upper Extremity Fractures in the Emergency Department: A Database Analysis of National Trends in the United States.

Upper extremity (UE) fractures are a common reason for emergency department (ED) visits, but recent data on their epidemiology are lacking. This study aimed to describe the incidence, demographics, patient characteristics, and associated health care factors of UE fractures, hypothesizing that they would remain prevalent in the ED setting. Using the Nationwide ED Sample database, patients presenting to the ED with UE fractures in 2016 were identified, and population estimates were used to calculate incidence rates. Data on insurance status, trauma designation, cost, and teaching status were analyzed. The study identified 2 118 568 patients with UE fractures, representing 1.5% of all ED visits in 2016. Men accounted for 54.2% of UE fractures, with phalangeal fractures being most common. Distal radius and/or ulna fractures were most common in women (30.4%). The greatest proportion of UE fractures (23.2%) occurred in patients aged 5 to 14 years (1195.5 per 100 000). Nontrauma centers were the most common treating institutions (50.4%), followed by level I (19.5%), II (15.3%), and III (12.8%) centers. The greatest proportion of fractures (38.3%) occurred in the southern United States. Emergency department cost of treatment was almost 2-fold in patients with open UE fractures compared with closed. This study provides important epidemiological information on UE fractures in 2016. The incidence rate of UE fractures in the ED has remained high, with most occurring in the distal radius, phalanges, and clavicle. In addition, UE fractures were most common in younger patients, men, and those in the southern United States during the summer. These findings can be useful for health care providers and policymakers when evaluating and treating patients with UE fractures.

Clinical validation of the “Straight-Leg-Evaluation-Trauma-Test” (SILENT) as a rapid assessment tool for injuries of the lower extremity in trauma bay patients

PurposeClinical assessment of the major trauma patient follows international validated guidelines without standardized trauma-specific assessment of the lower extremities for injuries. This study aimed to validate a novel clinical test for lower extremity evaluation during trauma resuscitation phase.MethodsThis diagnostic, prognostic observational cohort study was performed on trauma patient treated at one level I trauma center between Mar 2022 and Mar 2023. The Straight-Leg-Evaluation-Trauma (SILENT) test follows three steps during the primary survey: inspection for obvious fractures (e.g., open fracture), active elevation of the leg, and cautious elevation of the lower extremity from the heel. SILENT was considered positive when obvious fracture was present and painful or pathological mobility was observed. The SILENT test was compared with standardized radiographs (CT scan or X-ray) as the reference test for fractures. Statistical analysis included sensitivity, specificity, and receiver operating characteristic testing.Results403 trauma bay patients were included, mean age 51.6 (SD 21.2) years with 83 fractures of the lower extremity and 27 pelvic/acetabular fractures. Overall sensitivity was 75% (95%CI 64 to 84%), and overall specificity was 99% (95%CI 97 to 100%). Highest sensitivity was for detection of tibia fractures (93%, 95%CI 77 to 99%). Sensitivity of SILENT was higher in the unconscious patient (96%, 95%CI 78 to 100%) with a near 100% specificity. AUC was highest for tibia fractures (0.96, 95%CI 0.92 to 1.0) followed by femur fractures (0.92, 95%CI 0.84 to 0.99).ConclusionThe SILENT test is a clinical applicable and feasible rule-out test for relevant injuries of the lower extremity. A negative SILENT test of the femur or the tibia might reduce the requirement of additional radiological imaging. Further large-scale prospective studies might be required to corroborate the beneficial effects of the SILENT test.

Fratura in uterus de metacarpo em neonato bovino

Long bone fractures are common in juvenile cattle, however, cases of fractures occurring in the intrauterine environment during pregnancy are rare. The objective of this report is to present a case of an open consolidated fracture of the metacarpal that occurred in uterus, in a newborn calf, in which the surgical approach used was successful. A 48-hour-old female bovine was treated at the Veterinary Hospital of Paranaense University, who presented a complete, open and poorly consolidated transverse diaphyseal fracture in uterus during the gestational period on clinical and radiographic examination. As a therapeutic approach, open reduction was chosen, with ostectomy followed by stabilization with type IA external skeletal fixator. Four 4mm transcortical pins were positioned proximally and distally to the newly formed fracture line, followed by two more pins in the proximal phalanges region, seeking to stabilize the metacarpophalangeal joint, since flexural deformity of that joint was observed after the realignment of the longitudinal axis of the metacarpal, even after the section of the superficial and deep digital flexor tendons and suspensory ligament. The ESF was removed after 32 days, when radiographic signs of neoproliferation and bone consolidation were observed. In a last evaluation 15 months after the surgical correction, a complete and satisfactory recovery was observed regarding the development and well-being of the animal.

Effects of carbon/glass nonwoven interleaving veils and their areal density on opening and shearing mode interlaminar fracture toughness of glass epoxy composites

The study explores the impact of Carbon and Glass nonwoven interleaving veils with varying areal density on delamination resistance in unidirectional (UD) Glass epoxy composites under Opening (Mode-I) and Shearing (Mode-II) mode loadings. Commercially available non-woven Carbon and Glass interleaves with areal densities of 15, 20, 25, and 30 g/m2 were used to manufacture the interleaved Glass epoxy laminates. Double Cantilever Beam (DCB) and End Notch Flexural (ENF) specimens were used to determine the mode-I and mode-II fracture energies. The results reveal that, during mode-I initiation, interleaved laminates exhibit a lower interlaminar fracture toughness (IFT) except for the Carbon fiber interleaved laminates of areal density 30 g/m2. However, during propagation, all veils interleaved laminates presented significant improvement in IFT ranging from 5 to 25 % accompanied by substantial fiber bridging. In case of mode-II test, the laminates with Carbon and Glass veils exhibit enhanced IFT (60–182 %) with increasing areal density compared with the non-interleaved Glass laminates. Optical and scanning electron micrographs (SEM) provide evidence of fracture mechanisms involved in the interleaved and non-interleaved composite laminates.

Harnessing Healing Power: A Comprehensive Review on Platelet-Rich Plasma in Compound Fracture Care.

This comprehensive review explores the applications of platelet-rich plasma (PRP) in the context of compound fracture care, providing a thorough examination of its biological mechanisms, preparation techniques, and clinical implications. The analysis highlights PRP's potential in accelerating bone healing, enhancing soft tissue repair, reducing inflammation and infection risks, and managing pain during fracture recovery. The review underscores the importance of ethical and regulatory considerations in integrating PRP into orthopaedic practice, emphasising informed consent, transparent patient communication, and ongoing monitoring of ethical concerns. Looking ahead, the implications for the future of compound fracture care suggest a transformative shift with the potential for personalised medicine approaches and emerging technologies. However, the conclusion calls for a balanced perspective, acknowledging the promising applications of PRP while emphasising the need for responsible and ethical use. The collaborative efforts of healthcare professionals, researchers, and regulatory bodies are crucial in navigating this evolving landscape and harnessing the healing power of PRP to redefine orthopaedic care for individuals with compound fractures.

Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures

Unstable ankle fractures are routinely managed operatively. However, because of soft tissue and implant-related complications, recent literature has reported on the nonoperative management of well-reduced medial malleolus fractures after fibular stabilization, but with limited evidence supporting the routine application. To assess the superiority of internal fixation of well-reduced (displacement ≤2 mm) medial malleolus fractures compared with nonfixation after fibular stabilization. This superiority, pragmatic, parallel, prospective randomized clinical trial was conducted from October 1, 2017, to August 31, 2021. A total of 154 adult participants (≥16 years) with a closed, unstable bimalleolar or trimalleolar ankle fracture requiring surgery at an academic major trauma center in the UK were assessed. Exclusion criteria included injuries with no medial-sided fracture, open fractures, neurovascular injury, and the inability to comply with follow-up. Data analysis was performed in July 2022 and confirmed in September 2023. Once the lateral (and where appropriate, posterior) malleolus had been fixed and satisfactory intraoperative reduction of the medial malleolus fracture was confirmed by the operating surgeon, participants were randomly allocated to fixation (n = 78) or nonfixation (n = 76) of the medial malleolus. Olerud-Molander Ankle Score (OMAS) 1 year after randomization (range, 0-100 points, with 0 indicating worst possible outcome and 100 indicating best possible outcome). Among 154 randomized participants (mean [SD] age, 56.5 [16.7] years; 119 [77%] female), 144 (94%) completed the trial. At 1 year, the median OMAS was 80.0 (IQR, 60.0-90.0) in the fixation group compared with 72.5 (IQR, 55.0-90.0) in the nonfixation group (P = .17). Complication rates were comparable. Significantly more patients in the nonfixation group developed a radiographic nonunion (20% vs 0%; P < .001), with 8 of 13 clinically asymptomatic; 1 patient required surgical reintervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome. In this randomized clinical trial comparing internal fixation of well-reduced medial malleolus fractures with nonfixation, after fibular stabilization, fixation was not superior according to the primary outcome. However, 1 in 5 patients developed a radiographic nonunion after nonfixation, and although the reintervention rate to manage this was low, the future implications are unknown. These results support selective nonfixation of anatomically reduced medial malleolar fractures after fibular stabilization. ClinicalTrials.gov Identifier: NCT03362229.

Unexpected Positive Cultures in Hip and Knee Periprosthetic Fractures

BackgroundThe purpose of this study was to determine the prevalence of unexpected positive cultures noted at the time of revision surgery for periprosthetic fracture (PPF) after total hip or knee arthroplasty. Moreover, we evaluated whether this finding should be considered clinically significant and what type of treatment, if any, was required. MethodsThis was a single-center retrospective review of 270 patients undergoing surgery for PPFs from December 2010 to December 2021. Exclusion criteria included: open fractures; history of infection at fractured joint; non-operatively treated patients; and intraoperative fractures. The primary end point was the prevalence of unexpected positive cultures noted at the time of revision surgery. This was defined as one or more positive cultures in a PPF that the surgeon had preoperatively classified as aseptic according to the 2018 International Consensus Meeting. Data collection included patient demographics, medical histories, preoperative investigations, postoperative microbiology, and treatment. ResultsDuring the study period, 159 patients were admitted with PPFs of the hip and 61 with PPFs of the knee. The mean age was 70 years (range, 32 to 93 years). Unexpected positive cultures were diagnosed postoperatively in 15 patients (6.8%; 10 hips, 5 knees). The most prevalent organism was Staphylococcus epidermidis (35.0%). Of those 15 patients, 6 required a surgical revision for infection. None of the patient-related risk factors were found to be associated with an increased risk of unexpected positive cultures. The comparison between infected and noninfected patients showed a significant association between preoperative C-reactive protein >10 mg/mL (P = .04), loose implant (P = .07), and infection. ConclusionsThe prevalence of unexpected positive cultures was 6.8% in our study cohort. Although surgical treatment may be required, the majority of patients seem to require no treatment. Larger series are required to investigate the clinical importance of this rare finding. Level of EvidenceIII.

Evaluation of Novel Preformed Particle Gel System for Conformance Control in Mature Oil Reservoirs.

To address challenges associated with excessive water production in mature oil reservoirs, this study introduces a carboxymethyl cellulose (CMC)-based material as a novel preformed particle gel (PPG) designed to plug excessive water pathways and redistribute the subsequent injected water toward unswept zones. Through microwave-assisted grafting copolymerization of CMC with acrylamide (AM), we successfully generated multi-sized dry particles within the range of 250-800 µm. Comprehensive analyses, including Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM), have confirmed the chemical composition and morphology of the resulting carboxymethyl cellulose-grafted crosslinked polyacrylamide (CMC/PAMBA). Swelling kinetics and rheology tests were conducted to confirm the ability of this novel PPG system to perform at different reservoir conditions. The results of core flooding experiments showed that the CMC/PAMBA PPG is capable of plugging open fractures with a water breakthrough pressure gradient of up to 144 psi/ft. This preformed particle gel (PPG) system was designed specifically for application in Middle East reservoirs, which are distinguished by high salinity and elevated temperature levels. This PPG system is able to swell up to 10 times its original size in seawater and maintain a strength of about 1300 Pa at a temperature of 80 °C. Further optimization is conceivable to enhance injection efficiency and achieve superior plugging outcomes.

Clinical and radiographic outcomes of negative pressure wound therapy combined with polymethylmethacrylate sealant for wound management of Gustilo type III open tibia fractures.

This study aimed to introduce a new wound management method combining negative pressure wound therapy and polymethylmethacrylate sealant for Gustilo type III open tibia fractures and to evaluate its clinical outcomes. Among 186 patients who visited our institution for the treatment of open tibia fractures between January 2016 and December 2019, 20 male patients who sustained Gustilo type III open tibia fractures and were compelled to undergo delayed flap coverage using negative pressure wound therapy combined with polymethylmethacrylate sealant due to initial critical condition were enrolled in this study. We retrospectively investigated patients' demographics, interval between the injury and flap coverage, number of negative pressure wound therapy changes, flap survival, bone union time, and infection-induced complications. The mean interval from injury until flap coverage was 27.8 (range, 8-63) days. Most soft-tissue defects were reconstructed using free flaps (14/20, 70%); the anterolateral thigh flap was the most frequently used flap (12/20, 60%) in this study. Among 20 flaps trans- ferred, 16 flaps (80%) survived uneventfully, 1 flap (5%) developed partial necrosis, and 3 flaps (15%) failed. The mean follow-up period was 22.7 (range, 12- 43) months. A total of 17 patients (85%) achieved tibia fracture union. The mean bone union time was 31 (range, 12-81) weeks. With regard to infection-induced complications, 3 patients (15%) developed osteomyelitis and no patient showed superficial surgical site infection. Combination therapy using negative pressure wound therapy and polymethylmethacrylate sealant serves as a useful and reliable therapeutic strategy for wound management of Gustilo type III open tibia fractures, especially when delayed soft-tissue recon- struction is unavoidable. Corresponding author: Yoo Joon Sur yoojoon@catholic.ac.kr Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Level IV, Therapeutic Study.

Clinical Application and Evaluation of Specialised Ring Fixators for the Management of Upper and Lower Limb Bone Fractures in Dogs

Present study was conducted on nine-clinical cases of humerus (n=4), femur (n=3) and radius-ulna (n=2) fractures in dogs of either sex, weighing 5.5 to 18 kg. Both closed (n=6) and open (n=3) fractures were treated in this study. The fracture was reduced and stabilized by transfixation using modified ring fixators. Semicircular (n=4) and hybrid fixators (n=5) were used for upper limb and lower limb bones respectively. The main component of fixator i.e. aluminium rings were designed locally at Bikaner using 4-mm aluminium sheets and fabricated accordingly. Full rings were used for distal radial (n=2) and distal femoral (n=1) fractures whereas semicircular rings were made through cutting the full ring during surgery for specific humeral (n=4) and femoral (n=2) fractures. Specialised wire fixation bolt (iron based; weighing 5.5g) was also designed locally at Bikaner for transcortical pin and ring articulation. Humeral and distal femoral fractures are challenging while bone plating of distal radial fracture demands further surgeries therefore external fixators were modified and applied in present study. Operated limbs were evaluated clinically with serial postoperative radiographs at regular intervals. Fixator-assembly evaluation and functional recovery of operated limbs were considered as objectives of this study.

Application of Nice knot technique in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures

To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. The wound area was 21.0-180.0 cm 2 (mean, 57.82 cm 2) before operation, and it was 1.2-27.0 cm 2 (mean, 6.57 cm 2) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.

Quantitative characterization of fractures and holes in core rolling scan images based on the MFAPNet deep learning model

The exploration and comprehensive assessment of fractured-vuggy reservoir information have perennially constituted focal points and challenges within the domain of oil and gas reservoir evaluation. The verification of geological phenomena, identification of various fracture and hole types, and the quantitative characterization thereof currently present pressing challenges. This study meticulously examines the deep carbonate reservoirs within the Dengying Formation in the Penglai gas region of the Sichuan Basin. The Core Rolling Scan images reveal five discernible features: unfilled holes, filled holes, filled fractures, open fractures, and algae. The analysis pinpoints three primary challenges in semantic segmentation recognition: the amalgamation of feature scales, class imbalance, and the scarcity of datasets with substantial sample sizes. To address these challenges, this paper introduces a Multi-Scale Feature Aggregation Pyramid Network model (MFAPNet), achieving a pixel accuracy of 68.04% in recognizing the aforementioned five types. Lastly, the model is employed in calculating core porosity, exposing a scaling relationship between wellbore image porosity and core porosity ranging from 1.5 to 3 times. To a certain extent, it reveals the correlation between the wellbore image logging data and the actual formation of the Dengying Formation in the Penglai Gas Field of the Sichuan Basin, and also provides a basis for the subsequent logging evaluation of the formation. The partial code and CHA355 dataset are publicly available at https://github.com/zyng886/MFAPNet.

Ulnar Nerve Reconstruction With a Basilic Vein Tributary Graft: A Practical and Easily Replicable Technique With Favourable Outcomes

A young gentleman presented with a closed fracture of the left radius and an open fracture of the left ulna complicated with segmental loss of the ulnar nerve measuring 1.5cm. After thorough debridement and stabilization of the bone injuries, the ulnar nerve gap was bridged with an autologous venous graft harvested off a tributary of the basilic vein that served as a nerve conduit. At 18 months post-surgery, sensori-motor function of the patient’s left ulnar nerve was nearly fully restored, indicative of successful reconstitution of the ulnar nerve using a basilic vein tributary vein graft.

Antibiotic Impregnated Cement Coated Intramedullary Nailing in the Management of Infected Fractures and Chronic Osteomyelitis of Long Bones

Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI Criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.

Specification and formation process of enriched portions in Au veins in an epithermal deposit via clustering and geostatistical approaches

Even though epithermal vein-type deposits are the main sources of Au and Ag worldwide, accurate three-dimensional modeling of vein structures and the extraction of high-grade zones are still difficult because of geologic structure heterogeneities and the scarcity of available data, mostly obtained via drilling. Accordingly, by selecting a low-sulfidation epithermal Au–Ag deposit in the Philippine archipelago, we develop an efficient and reliable workflow for determining the spatial distribution of Au-rich veins in detail and the transport of hydrothermal fluids. The studied deposit is mostly hosted in open fractures and breccias with a relatively large tonnage of low Au+Ag grades and/or a small tonnage of high Au+Ag grades. The whole-rock geochemical data (1877 core samples) and lithological data (56 drilling sites) are processed using hierarchical clustering analysis (HCA) and two geostatistical simulations: turning bands simulation for the Au grade distribution and interpretation of mineralization process and truncated Gaussian simulation for the spatial distribution of clusters with similar Au–Ag grade features as classified by HCA. The general correlation between the Au and Ag grades, with a linear correlation coefficient of ≈ 0.69, is based on the HCA application, and the clusters were likely formed by three-stage mineralization processes. A plausible three-dimensional geologic model is then constructed, delineating in detail hydrothermally mineralized and altered zones with Au enrichment and vein system structures in the study area.

Refractory Osteomyelitis in a Military Service Member Resolved With Adjunctive Hyperbaric Oxygen Therapy.

Refractory osteomyelitis is typically defined as a chronic infection that persists or recurs despite definitive surgical management and antibiotic therapy. Cases often involve complex wounds or fractures and can be challenging to treat, resulting in multiple courses of broad-spectrum antibiotic therapy and numerous surgeries over periods of months to years. Adjuncts to improve resolution of these complicated infections are sorely needed. Here, we describe the case of a 47-year-old active duty military member who sustained an open right ankle fracture during a skydiving accident that was subsequently complicated by refractory osteomyelitis. The patient failed more than three courses of combined medical and surgical management over a 9-month period before undergoing adjunctive hyperbaric oxygen therapy (HBOT), ultimately resulting in resolution of the infection. Adjunctive HBOT for treatment of conditions such as refractory osteomyelitis may be an underutilized resource in part because of a general paucity of high-quality data in the literature supporting its use, as well as a relative lack of availability of this resource. Nonetheless, the overall accumulating body of evidence indicates that the use of adjunctive HBOT in select patients with refractory osteomyelitis is safe and effective and further research may be warranted given its relevance and potential impact to military populations.