Effective Method For Stabilization Research Articles

Minimally Invasive Osteosynthesis in Elderly Osteoporotic Proximal Humerus Fractures Using J-Nailing Technique

Abstract Introduction Proximal humerus fractures in the osteoporotic elderly population are increasing and difficult to treat. Treatment in proximal fracture fixation in elderly has changed from absolute stability to relative stability that preserves soft tissue and vascularity, thereby improving clinical outcomes. Aims and Objectives This study aimed to evaluate the clinical outcome of proximal humerus fractures in osteoporotic patients using minimally invasive J-nailing technique. Methods and Materials A prospective observational study was done on 25 patients with proximal humerus fractures belonging to Neer's classification type 2 and 3 operated between May 2018 and June 2020 in the department of orthopaedics in tertiary health care center and treated by multiple intramedullary blunt Kirschner wires (J-nailing technique). The patients were followed up at 2, 6, 12, and 36 weeks. At the end of follow-up, clinical outcome was assessed using Neer's scoring system. Results Treatment of proximal humerus fractures with J-nailing technique in the elderly population has shown promising results both in terms of function and radiology. Mean union time was 13.48 weeks with a standard deviation of 1.19 weeks. We did not find any significant difference in union time between patients with fracture type 2-part and 3-part. However, there was a significant difference in Neer's scoring between patients with fracture types two-part and three-part. Conclusion Proximal humerus fracture fixation using minimally invasive techniques with J-nailing is an effective method of stabilization in elderly osteoporotic population, yielding good mechanical alignment, protecting rotator cuff muscles, preserving blood supply and predictable union rates with good clinical results.

Evaluation of the management of tibial diaphysial fracture AO Type - 42C with locking compression plate by MIPO technique

Introduction: Fracture involving the diaphysis of the tibia especially due to high energy trauma continues to be a challenging problem in Orthopaedic surgery. Treatment of tibial diaphysial fracture has improved with the evaluation of plate and nailing technologies. Recently locking compression plating have been used with minimally invasive plate osteosynthesis (MIPO) technique with indirect reduction and percutaneous plate insertion, which reported excellent results especially in comminuted tibial shaft fractures (AO Type-42C) where IM nail were contraindicated. The purpose of this study is to analyze and discuss the outcome of comminuted tibial shaft fractures (AO Type-42C) treated with MIPO technique. Methods: This prospective (interventional) study included 19 adult male and 06 adult female patients who had high-energy closed tibial shaft fractures with varying degrees of displacement and comminution. All cases were assessed by clinical examinations and radiographs before and after surgery. Post-operative follow-up was done for a mean time of 06 months and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. Results: Most of the fractures 11(44%) united with a mean union time of 19.6±2.53 weeks. ranging from 19-21weeks. Clinical and radiological outcomes according to the ASAMI scoring system showed satisfactory results (excellent and good) in 23 patients, representing 92% of the studied group. There were no persistent limitation of the knee or ankle motions and deep wound infection. Implant failure didn’t occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention. Conclusion: The minimally invasive plate fixation with locking compression plate is an effective method of stabilization for closed comminuted tibial shaft fractures, yielding good bone alignment with minimal soft tissues injury, leading to higher union rates with good functional outcome.

Open reduction of thoraco-lumbar fractures and sagittal balance correction using Schanz screws

IntroductionThe correction of thoracic and lumbar spine fractures with a short instrumentation using Schanz screws, is an effective method for stabilization and sagittal balance restoration. Materials and methodsBidirectional observational study, included patients undergoing arthrodesis with Schanz screws to manage thoracic and lumbar fractures, the general characteristics, type, and location of the fracture, besides the gain in height of the vertebral body and segmental angle were analyzed before and after surgery. Clinical and imaging control was performed postoperatively and 1 month after this. p-value<.05 was statistically significant. ResultsOf 35 patients undergoing arthrodesis, 13 were excluded due to the absence of images and follow-up. There was a higher proportion of men, the main location of the fracture and AO spine classification was in T12 and type A4/B1 respectively, there was no intraoperative complication, no transfusion was required, and a short hospital stay. A mild complication was presented in the follow-up. The average pre and postoperative change was 12 degrees in the Cobb angle and 5.2mm vertebral body height in the fractured vertebra, these changes were statistically significant. ConclusionThoracolumbar and lumbar spine fracture correction with short segment fixation using Schanz screws, is an effective, safe and fast, showing significantly vertebral height gain and segmental angle correction, as a consequence, a correction of the balance and alignment of the spine.

Effects of microwave treatment on the stability and antioxidant capacity of a functional wheat bran.

A functional wheat bran (FWB) was obtained from wheat grains that were rich in wheat aleurone. The effects of the microwave (MW) power (2.5, 5.0, 7.5, and 10.0 kW) and treatment time (15, 30, 60, 90, and 120 s) on the moisture and free fatty acid (FFA) content, lipase activity, and antioxidant activity of the FWB were investigated. The purpose of this study is to stabilize the FWB against lipid oxidation and rancidity and as much as possible to retain its antioxidant activities. MW treatment significantly decreased the FFA content, moisture content, and lipase activity of the FWB. Moreover, MW treatment significantly increased the total phenolic content (TPC) and antioxidant activity of the FWB without drastically altering its color. MW treatment at 7.5 kW and 120 s was found to be optimal for stabilizing the FWB and increasing its antioxidant activity. The stabilized FWB was proven to be far more stable than the control FWB during storage. Thus, MW treatment is an effective stabilization method for the storage and utilization of FWB. Additional research is needed for the exact mechanism of the decrease of FFA content and increase of antioxidant activity of FWB induced by MW treatment.

Analysis of loess landslide mechanism and numerical simulation stabilization on the Loess Plateau in Central China

Loess landslides have complicated deformation mechanisms. Accurately describing the internal failure deformation of loess landslides and establishing a theoretical method of landslide instability evaluation for the prevention of subsequent landslides have become important topics in western development project construction in China. This paper presents a case study of the Zhonglou Mountain landslide in Shaanxi Province, China. Based on field investigation results, a two-dimensional stability analysis model was constructed using the finite element method. Taking the deformation characteristics of the landslide as the research basis, the distribution laws of the displacement, stress, and shear strain of this landslide were identified with the strength reduction finite element numerical simulation method. Additionally, the safety factor was evaluated under normal and storm conditions. The numerical simulation results show that the horizontal tensile stress of the landslide was mainly distributed in the middle and upper parts of the landslide under normal conditions, while the vertical tensile stress was distributed near the sliding surface. Under heavy rainfall, the sliding force increased, and the anti-sliding force and anti-sliding section decreased; the location of the maximum shear strain shifted down from the middle and upper parts of the landslide body to the area with a shear crack, and the plastic shear strain area expanded along nearly the entire the sliding surface, leading to the occurrence of a landslide. Thus, the use of anti-slide piles to stabilize the landslide was proposed and tested. Monitoring points were arranged along the sliding surface to evaluate the displacement, stress, and strain responses. The on-site observation results agreed with the modeling results. The use of anti-slide piles was demonstrated to be an effective stabilization method for the Zhonglou Mountain landslide.

Reducción abierta de fracturas toracolumbares y corrección del balance sagital usando tornillos Schanz

IntroductionThe correction of thoracic and lumbar spine fractures with a short instrumentation using Schanz screws, is an effective method for stabilization and sagittal balance restoration. Materials and methodsBidirectional observational study, included patients undergoing arthrodesis with Schanz screws to manage thoracic and lumbar fractures, the general characteristics, type, and location of the fracture, besides the gain in height of the vertebral body and segmental angle were analyzed. before and after surgery. Clinical and imaging control was performed postoperatively and 1 month after this. p-value < .05 was statistically significant. ResultsOf 35 patients undergoing arthrodesis, 13 were excluded due to the absence of images and follow-up. There was a higher proportion of men, the main location of the fracture and AO spine classification was in T12 and type A4/B1 respectively, there was no intraoperative complication, no transfusion was required, and a short hospital stay. A mild complication was presented in the follow-up. The average pre and postoperative change was 12 degrees in the Cobb angle and 5.2 mm vertebral body height in the fractured vertebra, these changes were statistically significant. ConclusionThoracolumbar and lumbar spine fracture correction with short segment fixation using Schanz screws, is an effective, safe and fast, showing significantly vertebral height gain and segmental angle correction, as a consequence, a correction of the balance and alignment of the spine.

Comparison of clinical, radiological, and functional outcome of closed fracture of distal third tibia treated with nailing and plate osteosynthesis

Aim: This is a prospective study of 30 patients with distal tibia fracture (Closed extra-articular distalthird tibia fractures - 4 to 11cm from tibial plafond) who underwent surgical fixation were included inthis study after excluding compound, pathological and pediatric fractures. Materials and Methods:15 underwent closed intramedullary interlocking nail and 15 were treated with plate osteosynthesis(MIPO). Results: The age distribution ranged from 23 to 68 years with the mean age of 39.4 years.The mode of injury in all patients was due to vehicle accidents. All 30 patients were classifiedaccording to AO classification of which 15 belonged to A1, 14 belonged to A2, and 1 belonged to A3.The time of fixation from injury varied from 6 hours to 18 days. Conclusion: Plate osteosynthesisby minimally invasive technique and Intramedullary interlocking nailing is an equally effectivemethod of stabilization for distal tibia fracture when considering the union rates and final functionaloutcome. However, malunion, nonunion and secondary procedures were more frequent afterintramedullary interlocking nail. In MIPO platting Infection followed by an exposed plate occurs in 2patients. Randomized prospective evaluation of distal tibia fractures may clarify the efficacy of plateversus nail treatment and optimize patient care.

Soil Stabilization by using fly ash and Ferric Chloride

The soil is stabilized with fly ash and ferric chloride mixtures in this research paper. The Serviceability of the pavement is very tractable to the soil sub-grade properties. For that reason, a weaker sub-grade can be improved by using the most effective stabilization method. Based on the literature review, stabilization with fly ash activated sub grade has been found to be an effective option for improvement of soil properties. Stabilization of the soil is mostly done in soft soils such as organic soil, clayey peat, silt. Some of the wastes used are fly ash, marble dust, foundry sand, rice ash and so on. These materials not only provide an alternative to the use of conventional materials but also help control environmental pollution. In many places, the waste is dumped into the open air, which can be very problematic for the people in the area and the workers working in these areas. Using these waste materials not only reduces pollution but also reduces human credibility on natural resources, leading to a more sustainable process of construction. It was found from the literature that the optimum dose of fly ash and ferric chloride revealed essential enhancement in strength and durability characteristics and declination in the swelling and plasticity properties of the soil. Based on that result, it is suggested that a mixture of fly ash and ferric chloride should be take into consideration a workable option for the stabilization of broad subgrades.

Characterization and comparison of predominant aroma compounds in microwave-treated wheat germ and evaluation of microwave radiation on stability

The present study was performed to evaluate the effects of microwave (MW) output power and treatment time on moisture content, lipase and lipoxygenase activities as well as colour changes of wheat germ (WG). In addition, the key aroma compounds in different MW-power-treated WG, which is of importance to the flavour of WG products, were also investigated. The obtained results showed that MW treatment maintained the inherent colour of WG and significantly reduced the moisture content (maximum reduction of 95%) and the activities of lipase and lipoxygenase (maximum reduction of 65% and 99%, respectively). In terms of aroma compounds, with the increase of the MW output power, the content of esters, alkanes, alcohols and acids decreased, while the content of heterocyclic compounds, nitrogen-containing compounds, aldehydes and ketones increased, providing more compounds with roasted flavour and less volatiles with grass-like flavour. Therefore, MW treatment was an effective stabilization method for WG utilization.

Extra-Periosteal Plate Fixation of Ankle Fractures

AbstractBackground: Open reduction and internal fixation with plate and screws is the standard operative treatment for displaced or unstable malleolar fractures, as it allows for a stable mechanical environment for healing. However, extensive surgical dissection can lead to devitalization of the fracture fragments and their soft tissue attachments, resulting in delayed union, non-union, and infection. Hence, a balance is necessary between anatomic reduction and soft tissue devitalization.Aim of Study: Was to evaluate the results of extra-periosteal plate fixation in ankle fractures.Patients and Methods: This study was done on 21 patients with closed ankle fractures who were admitted to Department of Orthopaedics, Tanta University Hospitals. The distribution of patients was according to age, sex, side, mode of trauma, lauge hansen classification type of fracture, medical history, smoking, time lag and associated injuries. Fixation was done by extra-periosteal plating technique. Clinical evaluation was according to Baird and Jackson scoring system. Results: There were significant statistical correlation between the time of union and mode of trauma, associated injuries, associated medical condition and Time lag.Conclusion: Extra-periosteal plating of ankle fractures is an effective method of stabilization that leads to predictable union of the fibular fracture. The results of this procedure are at least as good as those of other techniques of open reduction and internal fixation of the ankle.

Electrophoretic deposition of electroless nickel coated YSZ core-shell nanoparticles on a nickel based superalloy

In this work, yttria-stabilized zirconia (YSZ) nanoparticles were covered by a thin Ni layer with approximately 10 nm thickness by electroless deposition method to reduce sintering temperature of the ceramic coating which was applied on a Ni based superalloy via electrophoretic deposition (EPD). Suspensions containing the processed Ni-YSZ core-shell nanoparticles in acetone and isopropyl alcohol solvents were stabilized by addition of 0.4 wt% iodine and 1.5 wt% polyethylenimine, respectively, to find more effective stabilization method for EPD. It was seen that the presence of the Ni layer on YSZ nanoparticles improved performance and sticking factor of EPD and uniform coatings were obtained in both suspensions. The Ni-YSZ green coating which was produced by EPD at voltage of 35 V and deposition time of 30 min in acetone with thickness of 41 μm was sintered in 1100 °C and finally a uniform NiO-YSZ coating was formed on the metallic surface.

Thermal stability and propane combustion activity of RhxCe1−xO2−y nanoparticles deposited on functionalized alumina

A new, effective method for stabilization of RhxCe1−xO2−y nanoparticles synthesized by the reverse microemulsion method by their deposition on functionalized alumina has been successfully applied for systems in a wide range of Rh contents (x ≤ 0.15).

SUPRACONDYLAR FRACTURE

Objective: Management of supracondylar femur fracture is complex. Theobjective of this study was to assess the functional outcome of our patients managed withdynamic condylar screw fixation. Methods: This descriptive case series was carried out in thedepartment of Orthopedic Surgery, Dow University of Health Sciences / Civil Hospital Karachifrom 6th October, 2012 to 5th April, 2013.All the patients with Type A supracondylar fractures offemur diagnosed clinically and radiologically presenting within two weeks of injury wereincluded. Patients with systemic injuries were excluded. Final functional outcome were assessedby Schatzker and Lambert Criteria. Results: A total of 97 patients were included in this study. Theaverage age of the patients was 38.36±9.45 years (years + SD) and average duration of fracturewas 6.10 days. Male to female ratio was 2.03: 1. Two third of patients (67.01%) were injured byroad traffic accident, 28.87% suffered fall from height and 4.12% had slips. Acceptable outcome(Excellent and Good) at three months was observed in 86.6% (84/97) patients while unfavorableoutcome (Moderate and poor) were observed in 13.4% (13/97) cases. Outcome was better inpatients below 50 years of age (p=0.0005). Conclusions: Dynamic condylar screw appeared tobe an easy, less technically demanding and effective method for stabilization of supracondylarfemur fractures. Younger age group (age &lt;50yrs) had better functional outcome.

Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: tumor and deformity: 250. Safety and efficacy of fenestrated pedicle screws with cement augmentation for spinal metastases: early experience with 292 screws

BACKGROUND CONTEXT Pedicle screw fixation can be a major challenge in patients with spinal metastases. The osteopenic nature of the vertebrae along with factors like previous radiation, immunosuppression, and marrow replacement by cancer affect the bone quality for fixation. Complications related to cement augmentation are known. We share our initial experience with the fenestrated screws. PURPOSE To demonstrate the efficacy and safety of this new screw technology in challenged fixation environements, specifically vertebral column metastases. STUDY DESIGN/SETTING Retropsective analysis from a prospective spine oncology database at a major cancer center. PATIENT SAMPLE We identified 38 consecutive patients who underwent posterior thoracic, lumbar, or sacral decompression and stabilization for pathologic fracture or cord compression (T1-sacrum) related to metastatic cancer over a 1 year period. OUTCOME MEASURES Preoperative SINS (spine instability neoplastic score), ASIA grade, cancer histology, radiation history, ECOG, and patient demographics were recorded and analyzed in a multivariable regression analysis. Postoperative CT was performed in all cases. CT was reviewed and cement extravasation was recorded at each level of pedicle screw placement in (1) the epidural space, (2) neural foramen, (3) paravertebral space, (4) lung, and (5) nearby vasculature including the segmental vessels and aorta. Complications and instrumentation or implant failure were recorded. Patient reported outcomes measures were recorded prospectively including EQ-5D, PROMIS-pain, PROMIS-disability, PROMIS-depression, Spine Oncology Study Group Questionnaire. METHODS IRB approval was obtained and a retrospective analysis was performed on a prospective spine oncology outcomes database. Fenestrated screws became available at our institution in November 2016. We identified 38 consecutive patients who underwent posterior thoracic, lumbar, or sacral decompression and stabilization for pathologic fracture or cord compression (T1-sacrum). In each case, postoperative CT imaging was performed within 24 hours of surgery. The investigators independently reviewed the studies evaluating for the extent of cement fill and extravasation. Chart review was performed for analysis of implant or construct failure and complications. RESULTS Thirty eight patients were identified and a total of 292 fenestrated screws were placed with an mean 7.21 screws implanted percase. The most common construct was two levels above and two levels below the site of worst vertebral fracture or cord compression. Cement extravasated into the (1) epidural space at six levels (2.97%), (2) neural foramen at three levels (1.49%), (3) paravertebral space at 37 levels (18.3%), (4) lung – 0, (5) nearby vasculature at 15 levels (7.42%). There was no cement spread to the aorta or vena cava. No patients developed a symptomatic radiculopathy from foraminal extent. No patient required reexploration, cement removal, or hardware revision. Follow-up ranged from 1 month to 15 months with no significant change invertebral body height at the instrumented levels by CT and x-ray. CONCLUSIONS Fenestrated screws with cement provide a safe and effective method for stabilization in the cancer patient.

Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures: Surgical Management and Early Outcome.

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or (and) sacral decompression. EQ-5d score was applied to evaluate the patients' quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years (range: 15-55 years) at the time of injury. There were 6 females and 9 males. The mean followup time was 22.7 months (range: 9 47 months) and mean full weight-bearing time was 9.9 weeks (range: 8-14 weeks). Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle (mean 27.87°, and range: 8°-90°) of the sacrum was smaller than that pre-operation (mean 35.67; range: 15-90) with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score (VAS) was reduced from preoperative 7.07 (range: 5-9) to postoperetive 1.93 (range: 1-3). All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work foil time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

The selection of surgical approach in the surgery of multiple rib fractures and flail chest

Актуальность В хирургии тяжелых повреждений груди достижение стабилизации грудной клетки является одним из ключевых факторов, обеспечивающих положительный исход лечения. Оперативная фиксация переломов является надежным и эффективным способом стабилизации, однако множество технологий обусловливают необходимость уточнения, оценки и совершенствования подходов, в том числе и в вопросе выбора оперативного доступа.Цель исследования Выбор оптимального доступа для выполнения остеосинтеза ребер у пострадавших с тяжелой закрытой травмой грудной клетки.Материал и методы В статье описан опыт хирургического лечения 75 пациентов с множественными и флотирующими переломами ребер. Всем пациентам проведен остеосинтез ребер с помощью системы фиксации «Matrix Rib». Были выделены 2 группы пациентов: I группа – 36 пациентов, у которых доступ осуществляли посредством разреза мягких тканей по ходу межреберий; II группа – 39 пациентов, у которых были применены альтернативные и усовершенствованные варианты хирургического доступа. В работе использованы новые технические приспособления, способствующие усовершенствованию хирургической техники остеосинтеза ребер: сетка для маркировки операционного поля, троакар, двухканальный торакопорт для однопортовой торакоскопии.Результаты и их обсуждение Дана оценка различным видам доступов, приведены их количественные и качественные характеристики. Статистически значимого влияния вида оперативного доступа на показатели морбидности и летальности не выявлено. У пациентов II группы достигнуто уменьшение длины хирургического разреза доступа, сокращение длительности операции, отсутствие необходимости в дополнительных доступах.Выводы Наилучшие условия для выполнения остеосинтеза ребер создает хирургический доступ, осуществляемый в проекции линий переломов предполагаемых для восстановления ребер. Применение специальных приспособлений позволяет выполнять оперативную фиксацию отломков ребер через миниинвазивные доступы, а также проводить торакоскопию для устранения внутриплевральных повреждений.

Transoral Decompression and Posterior Stabilization in Fixed Anterior Pathology of the Craniocervical Junction

Introduction Management of the anterior compressive pathology of the craniovertebral junction (CVJ) is complex and demanding. We review our experience with the transoral surgical decompression of fixed anterior CVJ lesions, with particular attention to the decision making and to the indication for a consecutive stabilization. Patients and Methods Retrospective study (2000–2013) of 47 consecutive patients (14 males and 13 females). Mean age was 59.2 years (range, 32–82 years). Encountered lesions were rheumatoid arthritis with pannus (29, 9 of which with associated cranial settling), ankylosing spondylitis (four), tumors (seven: six extradural chordomas/chondrosarcomas and one metastasis), odontoid fractures with hypoporosis, and rotational instability (seven). Patients presented with a variety of following symptoms: high cervical pain (82%), varying degrees of quadriparesis (64%), lower cranial nerve deficits (23%), and central cord syndrome with neurogenic bladder (14%). All patients underwent one-stage transoral decompression and consecutive posterior atlantoaxial or occipitocervical stabilization. Clinical evaluation was made pre- and postoperatively using the Ranawat score. Follow-up period ranged between 6 and 48 months (average, 22 months). Results According to the Ranawat score, we had 21 grade I patients, in 20 of which pain was eradicated, 10 grade II patients, 8 of which passed to grade I, 11 grade IIIA patients, of which 6 passed to grade I and 5 to grade II, and 5 grade IIIB patients of which 4 passed to grade IIIA. In seven patients, the transarticular screws crossed the anterior cortex of the atlas, without clinical manifestations. In five patients, complete reduction of the C1–C2 rotation was not possible, because of the chronic nature of the defect. Surgical morbidity occurred in five cases (three dural tears and two occipital wound infections). There were two perioperative deaths ([a] dural rupture, pneumoencephaly, meningitis, and massive pulmonary embolism, [b] pulmonary infection, and cardiorespiratory arrest). Conclusion Successful and stable decompression of the CVJ requires extensive preoperative evaluation, appropriate tailoring, and adequate expertise. The transarticular C1–C2 fixation is a safe and effective stabilization method when the atlanto-occipital joints remain competent. Complications appear mostly in patients with rotational deformity of the C1–C2 complex. Patients with clinical and radiological findings of myelopathy improve less even if surgery is successful.

Minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft fractures

Background The most notable change in the treatment of fractures has been the shift from the mechanical aspects of internal fixation with absolute stability and primary bone union as the goal to the biological aspects of internal fixation with relative stability and healing with callus as the preferred method, with a huge focus on preservation of the blood supply of bone and soft tissue to ensure the continued vitality of the individual fragments to improve fracture healing. Percutaneous plate fixation minimizes soft tissue compromise with decreased incidence of wound breakdown and deep infection. It also preserves the vascularity of the bone fragments, and thus reduces the time for union, decreases the need for bone grafting even in comminuted fractures, and also decreases the incidence of nonunion, which requires a second major open intervention. Aim The aim of this study was to evaluate the outcome of minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft (upper and middle thirds) fractures in adults using conventional nonlocked plates through the medial approach. Patients and methods This prospective study included 16 adult male patients who had high-energy closed tibial shaft fractures (upper and middle thirds) with varying degrees of displacement and comminution. All patients were evaluated clinically and radiologically before and after surgery, followed up for a mean time of 14 months postoperatively, and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. All patients were treated using conventional nonlocked plates inserted percutaneously on the medial surface of the tibia. Results All the fractures united with a mean union time of 16.2 weeks, ranging from 13 to 36 weeks. Clinical and radiological outcomes according to the ASAMI scoring system in this study showed excellent results in 14 patients, representing 87.5% of the studied group, and good results in two patients, representing 12.5% of the studied group. No neurovascular complications, no persistent limitation of the knee or ankle motions, no deep wound infection, and no implant failure occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention. Conclusion The minimally invasive percutaneous plate fixation technique is an effective method of stabilization for closed tibial shaft fractures, yielding good bone alignment and protecting soft tissues, leading to higher union rates with good functional outcome. The use of conventional nonlocked plates applied through the medial approach decreases the surgical time and the risk of postoperative compartmental syndrome.

Enhanced Stability and Knockdown Efficiency of Poly(ethylene glycol)-b-polyphosphoramidate/siRNA Micellar Nanoparticles by Co-condensation with Sodium Triphosphate

Polyelectrolyte complex nanoparticles are a promising vehicle for siRNA delivery but suffer from low stability under physiological conditions. An effective stabilization method is essential for the success of polycationic nanoparticle-mediated siRNA delivery. In this study, sodium triphosphate (TPP), an ionic crosslinking agent, is used to stabilize siRNA-containing nanoparticles by co-condensation. siRNA and TPP were co-encapsulated into a block copolymer, poly(ethylene glycol)-b-polyphosphoramidate (PEG-b-PPA), to form ternary nanoparticles. Physicochemical characterization was performed by dynamic light scattering and gel electrophoresis. Gene silencing efficiency in cell lines was assessed by dual luciferase assay system. The PEG-b-PPA/siRNA/TPP ternary nanoparticles exhibited high uniformity with smaller size (80-100 nm) compared with PEG-b-PPA/siRNA nanoparticles and showed increased stability in physiological ionic strength and serum-containing medium, due to the stabilization effect from ionic crosslinks between negatively charged TPP and cationic PPA segment. Transfection and gene silencing efficiency of the TPP-crosslinked nanoparticles were markedly improved over PEG-b-PPA/siRNA complexes in serum-containing medium. No significant difference in cell viability was observed between nanoparticles prepared with and without TPP co-condensation. These results demonstrated the effectiveness of TPP co-condensation in compacting polycation/siRNA nanoparticles, improving nanoparticle stability and enhancing the transfection and knockdown efficiency in serum-containing medium.

Prosthetic reconstruction for tumors of the distal tibia. Report of two cases

Prosthetic reconstruction in two patients with malignant bone tumors of the distal tibia was conducted. The diagnoses were metastatic bone tumor in one patient and low grade central osteosarcoma in another. The mean duration of follow-up was 5.5 years (3 and 8 years). Reconstruction was achieved using custom-made prosthesis (JMM, Japan Medical Materials), which replaced the distal tibia. In the patient with metastasis, local recurrence occurred 8 months after the primary surgery and the recurrent tumor was resected. Both patients were free from neoplastic disease at the latest follow-up. The average functional scores according to the system of the Musculoskeletal Tumor Society were 25 and 23. Custom-made prostheses allow an early return to functional weight-bearing without major complications. This technique provides a safe and effective method of stabilization for properly selected malignant tumors of the distal tibia.