Successful Union Research Articles

Work, precarity and militant unionism in an industrial Area in the mid-hills of Nepal

ABSTRACTThis article examines the ways militant (Maoist) unionism has affected labour relations in industries within an industrial area in the mid-hills of Nepal. Much of the ethnography of industrial factories around the globe, I argue, has stressed workers’ growing precarity and the deteriorating conditions of employment. This article, however, outlines a case of a different trajectory, where militant unionists managed to successfully challenge precarious labour conditions in larger factories within the industrial area. Yet, as I also show, such successful union interventions in the relationship between capital and labour remain limited to large factories, and over the past years union activism has been in decline. I give various reasons for the decline in labour activism including the changing political context, the continuous antagonistic relationship between Nepal’s two major unions which is historically rooted in violence, and the shift from radical militant unionism to a more bureaucratic and standardized form of unionism at the central level. In doing so, the article opens a new dialogue between the ethnography of work, labour history, and the social study of radical political groups.

Hook Plate Fixation of Medial Malleolar Fractures: A Comparative Study of Clinical Outcomes

Medial malleolar fractures, occurring in isolation or in bi- or trimalleolar fractures, require surgical fixation if there is any displacement. Several techniques have been described in the literature for open reduction and internal fixation of medial malleolar fractures, but no data exist on the functional outcomes after fixation with a hook plate. The objective of this review study was to compare complication and union rates in patients who underwent hook plate fixation of medial malleolar fractures to those who underwent fixation with 2 lag screws. A total of 31 patients were included in the study. They were all followed for a minimum of 6 months from the day of surgery. There was a 18% to 35% complication rate with this technique; however, there was no statistical difference in the complication rate between medial malleolar fracture fixation with hook plate versus 2 lag screws in our study. All patients in this study went on to have a successful union. Hook plate fixation is an acceptable alternative to medial malleolar fracture fixation, especially in patients at high risk for poor bone healing.

Paediatric Long Bone Fractures Managed with Elastic Intramedullary Nails: A Retrospective Study of 30 Patients.

Elastic intramedullary nailing or titanium elastic nail (TEN) is an alternative method for the treatment of various pediatric long bone fractures. Titanium nails are preferred over plaster cast and stainless steel nails for children older than six years. Our series included 30 paediatric long bone fractures who were managed with TEN. The mean age was 9.3 years and the mean follow-up period was 28 months. A mean time of 10 weeks was recorded for the union of all fractures. The occurrence of superficial infection in three cases healed with antibiotics and minor debridement. Limb length discrepancy was seen in three cases of femur fracture, which was functionally insignificant, but it may be a potential problem needing close follow-up until skeletal maturity is attained. An elastic intramedullary nail or TEN in long bone fractures in children is a safe and minimally invasive technique that achieves stable reduction, especially in long spiral fractures till union. We attained successful union and good results in all our 30 cases with long bone fractures in children. A few complications of hardware prominence were resolved with implant removal. Long-term studies with a comparison to casting techniques in paediatric long bone fractures are required.

Arthroscopy-Assisted Corrective Osteotomy, Reduction, Internal Fixation and Strut Allograft Augmentation for Tibial Plateau Malunion or Nonunion.

Purpose: The purpose of this study was to present the results of arthroscopy-assisted corrective osteotomy (AACO), reduction, internal fixation, and strut allograft augmentation for tibial plateau malunion or nonunion. Methods: Fifty-eight patients, mean age 49 ± 11.9 years old, with tibial plateau malunion (n = 44) or nonunion (n = 14), were included in this study. There were 19 Schatzker type II fractures (32.7%), 2 type III fractures (3.4%), 7 type IV fractures (12%), 20 type V fractures (34.5%), and 10 type VI fractures (17.2%). The mean follow-up period was 46.2 ± 17.6 months. Clinical and radiologic outcomes were scored by the Rasmussen system. Articular depression was measured from computed tomography. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up. Results: Mean clinical score improved from 15.4 ± 3.9 (pre-revision) to 23.2 ± 4.5 (post-revision). Mean radiologic score improved from 7.7 ± 2.5 (pre-revision) to 12.0 ± 3.9 (post-revision). Fifty-six fractures achieved successful union. The average union time was 19.6 ± 7.5 weeks. Post-revision, 81% had good or excellent clinical results and 62% had good or excellent radiological results. Secondary osteoarthritis (OA) was noted in 91% of all injured knees, where 25.8% were mild OA, 25.8 % were moderate OA, and 38% were severe OA. There were 6 cases of deep infection (10.3%) and 1 case of wound edge necrosis (1.7%). Five cases were converted to total knee replacement after the index surgery with an average period of 13.5 months (range 8–24 months). Conclusions: Arthroscopy-assisted corrective osteotomy, reduction, internal fixation, and strut allograft augmentation can restore tibial plateau malunion/nonunion with well-documented radiographic healing and good clinical outcomes.

Risk factors of non-union in intramedullary stabilized diaphyseal long bone fractures: identifying the role of fracture stabilization strategies and concomitant injuries

PurposeConcomitant chest injury is known to negatively affect bone metabolism and fracture healing, whereas traumatic brain injury (TBI) appears to have positive effects on bone metabolism. Osteogenesis can also be influenced by the timing of fracture stabilization. We aimed to identify how chest injuries, TBI and fracture stabilization strategy influences the incidence of non-union.MethodsPatients with long bone fractures of the lower extremities who had been treated between 2004 and 2014 were retrospectively analysed. Non-union was defined as fracture healing not occurring in the expected time period and in which neither progression of healing nor successful union is expected without intervention. Diverse clinical and radiological parameters were statistically analysed using the Statistical Package for the Social Sciences (SPSS).ResultsThe total number of operations before consolidation was an independent predictor (odds ratio [OR] = 6.416, p < 0.001) for the development of non-union in patients with long bone fractures. More specifically, patients treated according to the damage control orthopaedics (DCO) principle had a significantly higher risk of developing a non-union than patients treated according to the early total care (ETC) principle (OR = 7.878, p = 0.005). Concomitant chest injury and TBI could not be identified as influencing factors for non-union development.ConclusionOur results indicate that the number of operations performed in patients with long bone fractures should be kept as low as possible and that the indication for and the timing of DCO treatment should be meticulously noted to minimize the risk of non-union development.

Outcomes and Review of Periprosthetic Tibial Fractures.

Periprosthetic fractures around total knee arthroplasties (TKA) are well documented in the literature. Fractures of the tibial side occur least frequently and often pose reconstructive challenges to the treating surgeon. As use of arthroplasty continues to rise, periprosthetic fractures of the tibia will likely become more prevalent. Periprosthetic fracture management is based on recommendations (Mayo classification) made 20 years ago. With newer design technology, the adjuvant use of locking plates in the presence of implant stable periprosthetic tibial fractures (Felix types IIA and IIIA) is unknown. The authors retrospectively reviewed 19 patients who sustained periprosthetic Felix type IIA or IIIA fractures that were treated with operative stabilization using plate and screw constructs. Union rate, time to union, incidence of need for revision on an acute or delayed basis, and restoration of ambulation were investigated. Fourteen patients were followed for the entire course of treatment. Preoperative range of motion was unable to be obtained due to the nature of the injuries. After primary surgical stabilization, 78.6% of the patients obtained successful union of their fracture at a mean of 25 months, but no arthroplasty component revision was necessary in any patient. Three (21.4%) patients required revision surgery, resulting in an overall union rate of 92.9%. Mean time to union in this cohort was 8.4±3.4 months, and the overall complication rate was 28.6%. Treatment of periprosthetic (TKA) tibial fractures carries a relatively high risk of complications and nonunion after primary stabilization, and patients should be counseled accordingly. [Orthopedics. 2020;43(3):182-186.].

Determining the optimal osteotomy distance with the fibula free flap in mandibular reconstruction.

Fibula free tissue transfer is a common and reliable method for mandibular reconstruction. Functional outcomes from this procedure are dependent on the successful union of the osseous segments postoperatively. This study was conducted to define the maximum gap-size criteria for osseous union to occur at osteotomy sites in fibula free flap reconstruction of the mandible. Retrospective chart review. Tertiary care academic center. A retrospective chart review of computed tomography and medical records was conducted on patients who underwent fibula free flap surgery and had imaging of the mandible at <3months and >6months after surgery. Distances between osteotomies were measured and evaluated for interval healing. Secondary data included subject age, sex, smoking status, diabetes, number of osteotomies, complications, and adjuvant therapy. Thirty-eight osteotomy sites were analyzed from thirteen subjects and a total of 190 measurements were made. The mean gap size at the first scan that demonstrated union by the second scan interval was 1.31mm and mean gap size demonstrating non-union was 2.55mm (p<0.01). Complication rate, number of osetotomies, adjuvant therapy, or medical co-morbidities did not significantly affect rates of union. In this study, osseous union was achieved with a mean osteotomy gap size of 1.31mm. The data suggests that distances between ossesous segments >2.55mm have a higher risk of non-union. We believe the information from this study will help augment current and future techniques in the field of mandible reconstruction.

A Catalytic Asymmetric Ene Reaction for Direct Preparation of α-Hydroxy 1,4-Diketones as Intermediates in Natural Product Synthesis

Asymmetric access to α-hydroxy-1,4-diketones has been achieved by direct ene coupling of silyl enol ethers with glyoxal electrophiles, mediated by a chiral N,N′-dioxide–nickel(II) complex catalyst. Successful union of a polyketide silyl enol ether with an α-quaternary glyoxal, generated by dioxirane oxidation of an α-diazo ketone, models a proposed C5–C6 disconnection of the polyketide and spirocyclic imine domains of the marine natural product, portimine.

Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update.

Tibial tubercle fractures in adolescents are uncommon injuries which typically occur in 12-16year-old males involved in athletic activities. We hereby present our experience in the surgical treatment of such lesion. By reviewing all the tibial tuberosity fractures treated surgically at our institution between January 2012 and January 2016, we were able to identify 12 patients (14 fractures), of which 11 males and 1 female, whose average age at the time of the trauma was of 14.05. According to the Ogden classification, we identified two Type IIA fractures, one Type IIB fracture, one Type IIIB fracture, four Type IIIC fractures, four Type IVA fractures, one Type IVB fracture and one Type IVC fracture. All patients underwent surgical treatment-9 fractures ORIF (64.3%), 5 CRIF (35.7%)-and postsurgical immobilization in plaster cast for 15days, with a non-weight bearing period of approximately 4.7weeks. They all had a complete ROM recovery and returned to preinjury activities within 4.1months on average. The successful union of the fracture was observed in all patients, and no cases of meniscal lesions, compartment syndrome, infections, lower limb length discrepancy or axial deviations emerged at the minimum follow-up of 24months. After an average period of 11months and 2weeks (range 6.1-16.3), all patients underwent surgical implant removal. Our experience matches the outcomes described in the literature, therefore confirming the safety and effectiveness of this treatment.

Autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults：a Meta analysis

To systematically evaluate the clinical effects of autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults and provide reference for this fracture. According to the methods of systematic review of Cochrane, the randomized controlled trials which compared autologous bone grafting with bone morphogenetic protein treatment for nonunion of long bone fractures in adults were searched in PuMed, Embase, Cochrane library, CNKI , Wangfang data and CBM from the databases were established to March 2019. Information was screened and extracted according to the inclusion and exclusion criteria by two researchers respectively, and the qualities of the included studies were assessed by the modified Jadad quality scale. The rate of infection, successful union, second operation, hospital stays and intraoperative blood loss were compared by RevMan 5.3 software from Cochrane Collaboration for Meta-analysis. Seven randomized controlled trials with a total of 652 patients were included, 410 in the autologous bone grafting group and 242 in the bone morphogenetic protein group. Meta analysis showed there were no statistically significant differences regarding infection［RR=1.32, 95%CI (0.90, 1.93) , P=0.16］, successful union［RR=0.95, 95%CI (0.84, 1.08) , P=0.43］, second operation［RR=1.16, 95%CI (0.43, 3.12) , P=0.76］, hospital stays［MD=0.69, 95%CI (-0.38, 1.75) , P=0.21］between the two groups. But compared with the bone morphogenetic protein treatment, autologous bone grafting significantly increased the intraoperative blood loss［MD=223.00, 95%CI (32.72, 413.28) , P=0.02］. Since bone morphogenetic proteins can attain as the same fracture healing rate as autologous bone grafting and can significantly reduce the intraoperative blood loss, bone morphogenetic proteins may be a better choice for nonunion of long bone fractures in adults.

Free vascularised medial femoral condyle periosteal flaps in recalcitrant long bone non-union: a systematic review.

In adults, treatment of recalcitrant long bone non-union is extremely challenging, with poorly vascularised and atrophic defects unresponsive to standard non-vascularised bone graft treatment. Recent studies have documented the use of free vascularised periosteal flaps to achieve union in refractory long bone fracture non-union, yet its use is not well established. This systematic review aims to assess the evidence for free vascularised periosteal flaps in recalcitrant long bone non-union. The MEDLINE®/PubMed® and Embase databases were searched for the Medical Subject Heading (MeSH) terms periosteal flap/vascularised flap/long bone/non-union/non united fracture in accordance with the PRISMA guidelines. Bibliographies were scrutinised for additional articles. Pooled data from 14 studies met the inclusions criteria, comprising 137 cases of non-union, with 117 relating to long bone non-union. Pooled data indicated an overall 99% (116/117) successful union rate. All studies were of mid- to low-level evidence (Level III, IV and V). Only one study directly compared vascularised periosteal flaps to non-vascularised bone grafts, showing union rates of 100% versus 80% and faster time to union (2 versus 5.5months). Free vascularised periosteal flaps are promising with pooled data showing a 99% success rate in achieving union in refractory long bone non-union. This compares favourably with standard orthopaedic care consisting of revision fixation and non-vascularised bone graft union rates of approximately 80%. However, study design flaws should be addressed by validated outcome measures plus adequate blinding, and further comparative studies with greater patient numbers are required.

A successful union in an era of decline: interrogating the growth of the Service Employees International Union, 1980-1995

ABSTRACT Between 1980 and 1995, while John Sweeney was president, the membership of the Service Employees International Union rose from around 600,000 to over 1.1 million. It continued to increase after 1995, making the SEIU the largest and fastest-growing union in the country. This growth was remarkable because it occurred at a terrible time for unions, one where the overwhelming emphasis – in both the media and academic scholarship – was on labor’s decline. While scholars have noted the SEIU’s growth, there has been little sustained analysis of how it was achieved. Existing accounts also posit growth largely as a reflection of the union’s organizing prowess. Drawing on the SEIU’s papers and interviews, this article argues that the union’s growth under Sweeney did reflect its commitment to organizing. At the same time, the article makes a fresh contribution by showing that the SEIU also grew because of lesser-known factors, including the affiliation of independent unions and legislative advances in public sector rights. The SEIU also benefited from operating in a growing sector of the economy, where low-paid workers needed unions. These conclusions are developed through analysis of “flagship” drives at Beverly Nursing homes, Blue Cross/Blue Shield, and the high-profile “Justice for Janitors” campaign.

Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and halfyears follow-up.

Nonunion of femur fractures is a devastating disabling complication which is rare in children. The purpose of this study was to report the outcomes of treating infected femur nonunions in children by the Ilizarov fixator in one stage. The study included 13 patients with unilateral infected nonunion of the femur with an average age of 9.1years. The nonunion duration averaged 10.69months. Ten cases were draining nonunions, and three patients had quiescent sinuses. Associated problems include shortening in all cases (mean 3.5cm), joint stiffness (9 cases), and angular deformity (7 cases). The quiescent cases were treated by bloodless monofocal compression-distraction. Four draining cases were treated by debridement and compression with relengthening through nonunion site. The remaining six cases were treated by bifocal technique. The mean follow-up duration was 60.15months. External fixation period averaged 5.3months. Successful union was achieved in all patients. Recurrences of infection occurred in two cases including one with refracture and another one with late pathological fracture. Other complications included pin tract infections, one delayed union, two residual angular deformities, and 6cm residual shortening in one patient. ASAMI bone results were excellent (8 patients), good (3 patients), fair (one patient), and poor (one patient). The functional results were excellent (9 cases), good (3cases), and fair (one case). The Ilizarov method provided a viable treatment option for treating paediatric infected femur nonunions in single stage of management with infection control in most cases and satisfactory outcomes.

Metabolite profiling during graft union formation reveals the reprogramming of primary metabolism and the induction of stilbene synthesis at the graft interface in grapevine

BackgroundGrafting with rootstocks is essential for the culture of many perennial fruit crops and is increasing being used in the production of annual fruits and vegetables. Our previous work based on microarrays showed that transcripts encoding enzymes of both primary and secondary metabolism were differentially expressed during graft union formation in both homo-grafts (a genotype grafted with itself) and hetero-grafts (two different genotypes grafted together). The aim of this study was to profile primary and secondary metabolites, and quantify the activity of phenylalanine ammonia lyase (PAL) and neutral invertase (NI) in the scion and rootstock tissues and the graft interface of homo and hetero-grafts of grapevine 1 month after grafting. Table-top grafting was done on over-wintering stems (canes) of grapevine and the graft interface tissues (containing some woody stem tissues and callus) were compared to the surrounding rootstock and scion tissues. The objective was to identify compounds involved in graft union formation and hetero-grafting responses.ResultsA total of 54 compounds from primary and secondary metabolism (19 amino acids, five primary and 30 secondary compounds metabolites) and the activity of two enzymes were measured. The graft interface was associated with an increase in the accumulation of the branched-chain amino acids, basic amino acids, certain stilbene compounds and higher PAL and NI activity in comparison to the surrounding woody stem tissues. Some amino acids and stilbenes were identified as being accumulated differently between the graft interfaces of the scion/rootstock combinations in a manner which was unrelated to their concentrations in the surrounding woody stem tissues.ConclusionsThis study revealed the modification of primary metabolism to support callus cell formation and the stimulation of stilbene synthesis at the graft interface, and how these processes are modified by hetero-grafting. Knowledge of the metabolites and/or enzymes required for successful graft union formation offer us the potential to identify markers that could be used by nurseries and researchers for selection and breeding purposes.

Antibiotic Hydroxyapatite Impregnated Bulk Autograft for Traumatic Large Bone Void. Technique &amp; Case Report

Background: Mid-foot open fractures are rare, and usually presents with high energy trauma. Staged approach for the management of open midfoot fractures was described by few authors. Case presentation: Up to authors best knowledge, this is the first article describing the management of mid-foot open fracture that presented 6 weeks spost injury and had absent medial cuneiform at presentation, with multi-fragmentary fracture of middle and lateral cuneiform associated with fracture of proximal second, third and fourth metatarsals. Management and Outcomes: Management involved conjoint ortho-plastics care, External fixation, with iliac crest graft covered with Gentamicin Eluting Injectable Bone Graft Substitute (Cerament-G) to replace missing medial cuneiform, free Superficial Circumflex Iliac Artery Perforator (SCIP) Flap. This surgical approach resulted in successful union of iliac crest graft restoring the medial cuneiform alignment, with no evidence of infection.

Femoral Neck Shortening After Hip Fracture Fixation Is Associated With Inferior Hip Function: Results From the FAITH Trial.

To describe the distribution of femoral neck shortening after internal fixation and to determine whether shortening is associated with inferior hip function at 24 months after a hip fracture in patients 50 years of age or older. Retrospective cohort study. A secondary analysis of data from 81 clinical centers included in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial. Three hundred fifty patients, 50 years of age or older, who had an isolated femoral neck fracture and underwent timely operative fixation of the fracture. Femoral neck shortening was measured as a categorical variable and classified into one of the following groups, as determined by the Central Adjudication Committee: no shortening, mild shortening (≤5 mm), moderate shortening (6-10 mm), or severe shortening (>10 mm). The primary outcome for the current analysis was hip function, as measured by the Western Ontario & McMaster Universities Osteoarthritis Index questionnaire, at 24 months after injury. Two-thirds of patients had no or mild shortening (≤5 mm), whereas one-third of patients had moderate or severe shortening (>5 mm). After adjusting for surgical treatment, a greater amount of femoral neck shortening was found to be associated with poorer hip function (P < 0.01). We found that increasing femoral neck shortening was associated with inferior hip function. Although internal fixation often results in successful union, patients who heal in a shortened position report poorer functional outcomes. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Radiographic Outcomes and Complications of Medial Column Correction in Adult Acquired Flatfoot Deformity Using A Titanium Wedge

Category:Hindfoot, Midfoot/Forefoot, FlatfootIntroduction/Purpose:Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. There are multiple options to plantarflex the medial column of the foot, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform.Methods:Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 years (Range: 12-70). The average follow-up time for patients was 8.1 months (6-17 months). All patients underwent a six-month non-operative treatment course prior to operative intervention. The average time from the initial visit with the primary surgeon (JFD, ARK) to the day of surgical intervention was 211 days (29-1296 days). The choice to use a titanium wedge, versus an alternative method of correction of the medial column, was at the discretion of the primary surgeon (JFD, ARK).Results:A dorsal opening wedge medial cuneiform osteotomy was performed in all patients. All radiographic parameters showed statistically significant correction from preoperative to postoperative. All cases had multiple concomitant procedures performed to address the flatfoot deformity, so it is difficult to isolate the effect of the medial cuneiform osteotomy.30/31 cases went on to successful union of the osteotomy within the study follow-up period. There were no instances of hardware pain requiring implant removal. There was 1 case of plantar gapping at the osteotomy site and implant loosening that required revision to a larger titanium wedge which healed uneventfully. No implants had supplemental fixation or additional bone graft placement at the osteotomy site.Conclusion:To our knowledge, this represents the first reported series on the use of structural titanium wedges with an opening wedge osteotomy of the medial cuneiform. There is limited data regarding the use of metal wedges for flatfoot correction. Nearly every patient in our series underwent concomitant procedures as part of the flatfoot reconstruction. This makes it difficult to isolate the effect of the deformity correction provided solely by the medial column correction. Our study suggests that metal wedges are both safe and effective for use in medial column correction, and future studies comparing titanium wedges to traditional techniques are needed.

Miniopen vs Lateral Approach for Ankle Arthrodesis, Which Approach is Superior in Joint Preparation: A Cadaver Study

Category:Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/BiologicsIntroduction/Purpose:Ankle arthrodesis is a gold standard for end-stage ankle arthritis after conservative managements fail. It may be done through direct anterior, lateral, arthroscopic or mini open approaches. Joint preparation, apposition of joint surfaces and stable fixation are very important for successful outcomes. Ankle arthrodesis maybe associated with infection, chronic pain and nonunion - of these, nonunion is the most common complication reported. Achieving union is of utmost importance while minimizing complications associated with the procedure.Regardless of approach or fixation method, preparation of articular surface is of paramount importance for successful union and may be limited by the approach used. Our study aims to evaluate the difference between direct lateral and dual mini-open approaches (extended arthroscopic portals) in terms of joint preparation.Methods:We used 10 below knee fresh-frozen cadaver legs for this cadaveric study. Ankle joints of five specimens were prepared through the lateral approach, while the remaining five ankles were prepared using dual mini incisions. After the completion of preparation, all ankles were dissected to open, photographic images of tibial plafond and talar articular were taken. Surface areas of each articular facet and unprepared cartilage of the talus, distal tibia, and distal fibula were measured and analyzed using ImageJ software.Results:Significantly greater amount of total surface area was prepared among specimens using mini-open approach compared to those with trans-fibular approach. The percentage of total articulating surface area prepared (including talus and tibia/fibula), talus, tibia and fibula in trans-fibular approach were 76.9%, 77.7% and 75% respectively. The percentages were 90.9%, 92.9%, and 88.6% in mini-open approach.While the medial gutter was well prepared with mini incision technique (unprepared surface 44 .64% vs 91.08%), lateral gutter was well prepared in trans-fibular technique (88.82vs 82.04 square cm).There is no difference in the amount of unprepared surface of talar dome between the two approaches. When excluding the medial gutter, there was no significant difference between trans-fibular and mini open techniques (83.94 vs 90.85, p=0.1412).Conclusion:Joint preparation using the mini-open approach (extended arthroscopic portal) is equally as efficacious as the transfibular approach for preparation of the tibiotalar joint. When including preparation of the medial gutter, the mini-open approach provides superior joint preparation. This may be advantageous with decreased rate of nonunion and less complications. But many surgeons fuse only tibiotalar surface, considering that, both approaches yield equal amount of joint preparation. But it needs to be confirmed with clinical studies.

Applications of the Vascularized Medial Femoral Condyle for Nonunion with Associated Bone Loss of the Foot: A Case Series

Category:Hindfoot, Midfoot/ForefootIntroduction/Purpose:Persistent nonunions with large bone defects continue to represent a challenging problem for foot and ankle surgeons. Vascularized corticocancellous grafts have been well described for various applications and represent a comprehensive solution to these difficult nonunion cases. We describe four cases of nonunions with concomitant large bony defects treated with a vascularized medial femoral condyle (VMFC).Methods:We retrospectively identified four cases of VMFC flaps used for foot nonunions with large bone defects. Surgical indications included talonavicular nonunion with associated avascular necrosis of the navicular, talonavicular-cuneiform nonunion, navicular-cuneiform nonunion, and first metatarsophalangeal nonunion. All cases had large associated segmental bone defects. The average age at the time of surgery was 62-years-old. The average follow up was 2.6 years (1.5-5.0). One patient had a remote history of tobacco use. Another patient quit smoking pre-operatively and had normal nicotine metabolite levels at the time of surgery. There was one Type II diabetic.Results:Two patients underwent staged reconstruction with placement of an antibiotic cement spacer, but intra-operative cultures were negative. No patient had a previous infection. The average graft dimensions were 3 x 2.25 x 1.5 cm. After obtaining adequate compression, all grafts were secured with bridge locking plates. The average time to weight bearing was 14.5 weeks. All patients had knee pain post-operatively that resolved with time. Two patients required reoperation. In one patient, the VMFC graft did not adequately fill the defect requiring supplement allograft. The VMFC-allograft interface went on to nonunion requiring tricortical iliac crest bone grafting. Another patient developed a split-thickness skin graft (STSG) infection requiring debridement and repeat STSG. There were no VMFC graft failures, and all patients went on to successful union.Conclusion:Vascularized medial femoral condyle autografts are a technically demanding solution to difficult nonunion cases with significant associated bone loss of the foot.

Functional Outcomes After Muscle-Sparing Fixation of Flail Chest Injuries.

To present outcomes in a multicenter review of a large number of flail chest patients. Retrospective case series. One urban Level I and 1 urban Level II trauma center. Fifty-two adult patients who underwent treatment of their flail chest injury with locking plate and screw constructs through muscle-sparing approaches, followed for a minimum of 1 year postoperatively. All patients went on to successful union, with complication rates in line with recent published norms. Periscapular strength returned to greater than 90% of the noninjured side by 3 months postoperatively and to within a mean of 95% of the noninjured side by 6 months postoperatively. Glenohumeral range of motion similarly improved over this same interval. Use of anatomically designed modern locking plate and screw fixation constructs with muscle-sparing approaches results in efficient return to function and restoration of shoulder function and strength as compared with the noninjured shoulder. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.