Lower Union Rate Research Articles

Surgical treatment of open fractures of the talus

To evaluate the long-term outcomes of surgical treatment of open fracture of talus. Sixteen patients with displaced open fractures of the talus, including 3 cases of type 1, 8 of type 2, 2 of type 3A, 2 of type 3B, and 1 of type 3C according to the Gustilo-Anderson classification system, 15 males and 1 female, aged 37.5 (21 - 48), were treated with open reduction and stable internal fixation within 6 - 8 hours after injury, and followed up for 3.2 years (3 - 6 years). There were 7 cases of pure displaced talar neck or body fracture and 9 cases of fractures associated with an ipsilateral pilon, ankle, and calcaneus totally that included 2 cases of type 2, 3 of type 3, and 1 of type 4 according to the Hawkins classification system modified by Canale. The union rate was 81% (13/16) with the average union time of 4.5 months. Three cases failed to heal and developed osteomyelitis, of which 2 were treated with late talectomy because of septic nonunion. One case underwent amputation below-the-knee because of instability and pain. Osteonecrosis developed after seven of the nineteen closed fractures, whereas posttraumatic arthritis developed after all nineteen. Osteonecrosis developed in 11 (68%), and posttraumatic arthritis developed in 13 of the 16 cases (85%). The average American Orthopaedic Foot and Ankle Society score of these patients was 43.7 points. Open fractures of the talus has a low union rate, a higher osteonecrosis rate, and substantially higher reoperation and infection rates. Posttraumatic arthritis is a more common complication than osteonecrosis following operative treatment. Open reduction and internal fixation are recommended for the treatment of open fractures of talus.

Complications of circular plate fixation for four-corner arthrodesis

Four corner arthrodesis is an accepted salvage operation for scapholunate advanced collapse and scaphoid non-union advanced collapse. Circular plates were introduced in 1999 and promoted as a rapid and more stable method for this procedure. A retrospective chart review was performed on all patients who were treated with the Spider Limited Wrist Fusion Plate (Kinetikos Medical Inc., San Diego, CA). Sixteen patients were identified and followed clinically and with X-rays for an average of 16 (range 5-38) months. Nine out of the 16 patients (56%) had complications, including non-union (25%), delayed union (6%), dorsal impingement (25%), radial styloid impingement (6%) and broken screws (13%). The purpose of this study was to compare our complication rate using circular plates with published outcomes using traditional methods of fixation: this study identified a significantly higher complication rate and lower union rate using circular plate fixation for four-corner arthrodesis compared with previously published techniques.

Working poverty in southern California: towards an operational measure

As a result of welfare-to-work, discussions on working poverty have sprouted among urban scholars and policy makers. Yet, there is little consensus on how to define working poverty, limiting both knowledge of such populations and ability to inform policy. Using 1998–2000 CPS data for southern California, we compare twelve definitions of work and poverty in an attempt to provide a better understanding of who the working poor are and suggest an operational measure of working poverty that is both empirically simple and realistic. Results indicate that working poor families represent a diverse group of people, which varies significantly depending upon the definitions used. However, as expected, we find a dominance of families with young children and fewer adult workers, most of whom are Latino, work in service or laborer occupations, have lower educational attainment and very low unionization rates, and earn hourly wages close to the legal minimum.

Exit, Voice and Loyalty Reactions to Job Insecurity in Sweden: Do Unionized and Non‐unionized Employees Differ?

Although job insecurity has received growing recognition in connection with the transformation of working life, little is known about how unionization affects its consequences. Data from Swedish health care employees indicate that job insecurity is related primarily to coping strategies in the exit and voice domains. Union members were less inclined to make use of the exit and voice options compared with their non‐unionized co‐workers, and more typically expressed loyalty to the organization. The collective support derived from union membership may make individual voice expressions less important, a finding that has to be replicated in countries with lower unionization rates.

Transacromial approach to obtain fusion of unstable os acromiale

The purpose of this study was to identify possible causes for the low union rate for surgically stabilized os acromiale. Between February 1990 and November 1995, fusion of an os acromiale was attempted in 15 shoulders in 12 patients at our institution. All patients were men. The mean age was 54 years (range 37 to 63 years). All shoulders had an os mesoacromiale considered too large for simple resection. An associated lesion of the rotator cuff ranging from partial-to full-thickness tear was present in all patients. Eleven had an unfused acromial epiphysis in both shoulders. Two different surgical approaches were used. Seven shoulders were approached through an anterior deltoid-off approach, thus potentially devascularizing the os acromiale. Eight shoulders were approached transacromially, preserving the deltoid origin and hence the terminal branches of the thoracoacromial artery. The technique of internal fixation (tension band wiring) was the same for both groups. The mean follow-up was 44 months (range 13 to 72 months). Union, as demonstrated by axial radiographic views, occurred in 3 out of 7 cases with a devascularized os acromiale and in 7 out of 8 shoulders with a perfused os acromiale (P = .017), respectively. Patients with a united os acromiale had a significantly better functional outcome as measured by the Constant score (P = .0169). In conclusion, aiming at a stable fusion of a sizable and hypermobile os acromiale is probably desirable because it enhances the overall functional result. Obtaining consolidation was possible when the vascularity of the acromial epiphysis was respected.

Do Foreign-Owned and U.S.-Owned Establishments Exhibit the Same Location Pattern in U.S. Manufacturing Industries?

There are arguments to support and contradict the proposition that foreign-owned and U.S.-owned establishments exhibit similar location patterns within the United States. This paper addresses these conflicting views by comparing the location of all manufacturing establishments in the United States held by the U.S. and by foreign firms. The empirical evidence indicates that the location patterns of foreign-owned and U.S.-owned establishments differ. Moreover, the most influential factor in explaining the location pattern difference is that foreign-owned establishments, compared to U.S.-owned establishments, favor coastal states. I also find evidence to suggest that foreign firms favor states with low unionization rates, low wage rates, and right to work legislation. These results are consistent with arguments that foreign establishments differ from their domestic counterparts and value location attributes differently.

O DECLÍNIO DAS TAXAS DE SINDICALIZAÇÃO: A DÉCADA DE 80

O artigo faz parte de um estudo mais amplo sobre a situação do sindicalismo nos países da OCED. O objeto principal é o processo de "dessindicalização", considerado o sintoma mais visível da crise do sindicalismo. O estudo limita-se a descrever a evolução das taxas de sindicalização, comparando a situação existente nos países assinalados. De modo geral, a década de 70 foi bastante positiva para a maior parte dos movimentos sindicais. Já na década seguinte, começou a haver declínio da proporção e do número de trabalhadores sindicalizados na maioria dos países. De modo geral, três situações sindicais foram distinguidas: (a) países de sindicalismo forte, com taxas de sindicalização nacional acima de 50%, onde as perdas sindicais na década de 80 foram relativamente pequenas ou inexistentes, como os países nórdicos; (b) países de média sindicalização (mais de 30% e menos de 50% de trabalhadores sindicalizados), como a Grã-Bretanha, a Itália e a Alemanha, onde as perdas foram relativamente grandes, mas onde os sindicatos conservam certa força; (c) países de baixa sindicalização (menos de 30%), como o Japão, Estados Unidos, França, Holanda etc. O sindicalismo dos EUA e da França estão entre os mais atingidos, tendo a dessindicalização se iniciado há mais tempo. Em todos os países, os sindicatos de trabalhadores do setor privado foram mais atingidos que o sindicalismo do setor público.

The impact of part-time employment on union density

Because part-time employees are less likely to be unionized than full-timers, increases in part-time employment may lower unionization rates. However, the size of the reduction, after controlling for other factors, has not been estimated. My results obtained from a probit analysis indicate that part-time status has a small, but significant, negative effect on the probability that a worker is a union member. Not surprisingly, as the working hours of part-time employees decrease, the negative effect increases. The results of this analysis also show that the negative effect of part-time variables had decreased between 1973 and 1989.

The Effect of Infection and Lag Screw Fixation on the Union of Membranous Bone Grafts in a Rabbit Model

Infection complicating craniofacial procedures contributes significantly to patient morbidity and health care costs. The role of fixation materials in this setting remains unclear. As foreign material, does fixation hardware increase patients' susceptibility to developing postoperative infection? Furthermore, once infection is established, should fixation hardware be removed? To answer these questions, we performed an onlay membranous bone grafting procedure to the mandible in 94 New Zealand White rabbits, applied lag-screw fixation in half the animals, and inoculated the wounds with different bacterial doses. We quantified the differential rates of infection and rates of graft union in the presence of infection. The infection rates for the rigidly fixated group were not significantly different from the rates for the nonfixated group for a range of bacterial inoculum doses. There was no significant difference in the rates of resolution of infection and sepsis between the two groups. Gross and histologic assessments revealed a significantly lower union rate for infected grafts when compared with uninfected grafts. Furthermore, grafts rigidly fixated with a lag screw showed a higher rate of union when compared with nonfixated grafts in the presence of infection. In the absence of infection, the union rates for fixated and nonfixated groups did not differ significantly. While fixation hardware has been cited as a risk factor for postoperative infection, we were unable to show that lag-screw fixation contributes to this risk. Although infection impaired the union of membranous bone grafts to the recipient mandible, fixation of the grafts with a lag screw significantly decreased this deleterious effect of infection.(ABSTRACT TRUNCATED AT 250 WORDS)