Traditional Plating Techniques Research Articles

ASSESSMENT OF OUTCOME IN CASES WITH EXTRAARTICULAR DISTAL THIRD TIBIA FIBULA FRACTURES TREATED WITH INTERLOCKING NAILING OF TIBIA WITH CONCOMITANT FIBULAR FIXATION BY ORIF WITH PLATE OR BY CLOSED NAILING

BACKGROUND- The present study aimed to assess and compare the radiological and functional outcome, union time and complications in cases of extraarticular distal third Tibia bula fractures treated with interlocking nailing of Tibia with concomitant Fibular xation either by ORIF with plate or by closed nailing. METHODOLOGY- This was observational prospective study which was carried out at Department of Orthopedics in Unique Super Speciality Centre, Indore (M.P.) for a period of 1 year on adults belonging to age group between 18 to 75 years of either gender. All the cases were randomly allocated in two groups. During surgery, fracture tibia was managed with the help of interlocking intramedullay nail in all the cases in both the groups whereas bular fracture in group A were managed using ORIF with semitubular plate or reconstruction plate and that in group B was managed using CRIF with rush nail/ square nail/ k wire. RESULTS-There was no statistically signicant association between the complications and the groups (p>0.05), showing that the complications is independent of the groups. There was a signicant improvement in the score at 3 months and 6 months (p<0.05) in both the groups; however, no statistically signicant difference in union time between the two groups (p>0.05). Also no statistically signicant association between the outcome and the groups (p>0.05) was observed. CONCLUSION- The choice of xation for adjunctive stabilization of bula has no effect on the fracture tibia union and the ultimate functional outcome. Closed nailing is better where the soft tissue morbidity is high (as in high velocity trauma and open fractures) and where bones are weak (elderly patients). Other immunocompromised states such as diabetes in which there are higher infection rates with traditional plating techniques.

Effects of chlorination and ultraviolet light on environmental tetracycline-resistant bacteria and tet(W) in water

The effectiveness of traditional water disinfection methods against both environmental antibiotic resistant bacteria (ARB) and antibiotic resistant genes (ARGs) is still not well understood. The study objective was to evaluate two common methods for reducing concentrations of not only culturable tetracycline-resistant bacteria but also a resistance tet(W) gene fragment that has been frequently detected in the environment. Disinfection experiments were performed by exposing tetracycline-resistant isolates to various dosages of sodium hypochlorite or ultraviolet irradiation (UV). Concentrations of resistant bacteria and the tet(W) gene fragment were determined at 0 and 24h after disinfection using traditional plating techniques and qPCR, respectively. Both the UV and chlorine disinfection methods were highly effective in initially reducing bacterial concentrations, and the chlorine disinfection method was more effective in preventing regrowth. However, both UV and chlorine disinfection were less consistent at reducing the concentration of the tet(W) gene fragment than for culturable resistant-bacteria at the dosages studied. Results indicated that after disinfection, resistance genes may remain detectable even if culturable resistant-bacteria are not, and that environmental ARBs and ARGs may survive these commonly used methods.

Potential spread of forest soil-borne fungi through earthworm consumption and casting

To test if forest soil-borne fungi concerned with plant health can be selectively dispersed by earthworms, 10 fungal species isolated from 5 forests were presented, at 2 concentrations, to 3 ecologically distinct earthworm species in laboratory trials. Between 5 and 13 days after introduction, casts were collected, where possible, from each earthworm species fed with a different fungus. These casts were analysed, using molecular methods, for the presence of the given fungus and its vitality verified through traditional plating techniques. The research confirmed that earthworms have an important role in dispersal of soil fungi in forests, and that such activity can depend on the taxonomical position of the fungus, ecological category of the earthworm species involved and the fungal concentration. In certain instances there is a suggestion that some fungi may be toxic to some earthworms at the given concentrations, which equated to those within and outside of the rhizosphere.

A Comparison of Plating and Reverse Transcriptase Polymerase Chain Reaction Followed by Microchip Electrophoresis for the Inactivation ofAlicyclobacillus acidoterrestrisUsing Saponin

It was used reverse-transcriptase polymerase chain reaction (RT-PCR) followed by capillary electrophoresis on a microchip to probe the viability of Alicyclobacillus acidoterrestris spores after inactivation with saponin and heat. The method was shown to be suitable for the purpose, and was faster and more sensitive than the traditional plating technique, the standard of the food industry. The limits of quantification and detection were 0.0107 and 0.0039 ng µL-1 of amplified DNA, respectively. The correlation coefficient (r) between traditional plating and our method was 0.9977, which indicates an excellent correspondence between them. Consequently, it was possible to assess, with confidence, the viability of bacteria using the RT-PCR reaction for detection. It was evaluated the potential of this molecular method over traditional microbiology in the inactivation of A. acidoterrestris by saponin as an effective agent, potentiated by heat.

Real-time PCR method for the quantification ofBurkholderia cepaciacomplex attached to lung epithelial cells and inhibition of that attachment

To develop a rapid method to quantify the attachment of the cystic fibrosis pathogen, Burkholderia multivorans, to lung epithelial cells (16HBE14o(-)) using real-time PCR with a view to monitoring potential inhibition of lung cell attachment. Mammalian and bacterial DNA were purified from bacteria attached to lung epithelial cells. The relative amount of bacteria attached was determined by amplification of the recA gene relative to the human GAPDH gene, in the presence of SYBR Green. The method was thoroughly validated and shown to correlate well with traditional plating techniques. Inhibition of bacterial attachment with simple sugars was then evaluated by real-time PCR. Of the sugars examined, pre-incubation of B. multivorans with lactose, mannose and xylitol all decreased bacterial adherence to 16HBE14o(-) cells, while glucose and galactose had no significant effect. Pre-incubation with lactose had the greatest effect, resulting in reduced adhesion to 35% of untreated controls. This method can be used to quickly and effectively screen novel agents with higher affinities for bacterial adhesins. This method will enable the rapid development of novel agents to inhibit colonization by this pathogen from the environment.

Locking Plate Technology – Current Concepts

The management of fractures with traditional plating techniques has undergone a paradigm shift over the past 20 years. For many fractures, anatomic reduction using a dynamic compression plate has been the gold standard. However, minimally invasive approaches combined with biologically friendly internal fixation have become accepted methods of complex fracture treatment. The orthopedic literature has demonstrated advantages when comparing locking plate techniques with traditional compression plating techniques, particularly in fractures about the knee. The advantages of locking plates apply most directly to cases of highly comminuted fractures, unstable metadiaphyseal segments, and osteoporotic fractures. The biomechanical properties of locking plates have distinguished and defined their clinical use compared to traditional plates. A thorough understanding of these properties will assist the orthopedic surgeon in choosing the appropriate construct when faced with a difficult fracture. Compression plating requires absolute stability for bone healing. In contrast, locking plates function as "internal fixators" with multiple anchor points. This type of fixed-angle device converts axial loads across the bone to compressive forces across fracture sites, minimizing gap length and strain. The strain theory demonstrates that anatomic reduction is not required for bone healing, and that tolerable strain (2%-10%) can promote secondary bone healing. Callus formation is further promoted when biologically friendly surgical approaches are combined with locking plate "internal fixators". In contrast, conventional plates function by creating an environment where primary bone healing occurs. This plate provides "absolute rigidity" and requires anatomic reduction fixed in compression. Primary bone healing occurs in this manner. In highly comminuted, segmentally deficient, or porotic bone, bone quality is poor and "absolute rigidity" does not exist. Furthermore, soft-tissue stripping adds a biologic insult to the poor bone quality. These disadvantages may lead to poor outcomes such as nonunion, implant failure, malunion, or even infection. These disadvantages remain theoretical, as no prospective studies clearly demonstrate a difference between plating methods in difficult metadiaphyseal or osteoporotic fractures. However, the overwhelming biomechanical evidence has led to a more biologically friendly approach to these fractures. The indications for use of locking plates are evolving. The literature demonstrates low rates of nonunion and overall complication rates with locking plates in difficult metaphyseal and diaphyseal fractures. Anatomic reduction of the articular surface remains paramount. Hybrid techniques that combine the benefits of compression plate fixation with the biological and biomechanical advantages of locking plates are the most likely end result of current locking plate applications.

Minimally Invasive Locked Plating of Distal Tibia Fractures is Safe and Effective

Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Use of Elastic Stable Intramedullary Nailing for Treating Unstable Forearm Fractures in Children

The majority of the pediatric diaphyseal forearm fractures are treated with closed reduction and the application of an above elbow cast for a varying period, depending on the age of the child. Some forearm diaphyseal fractures require osteosynthesis mainly because of the presence of an unacceptable angular deformity, fracture instability, presence of an open injury or failure of conservative management in the form of redisplacement in the cast after manipulation. We present our experience with elastic stable intramedullary nailing (ESIN) for displaced and unstable pediatric diaphyseal fractures. A consecutive series of 21 patients treated with ESIN between 1997 and 2005 have been reviewed retrospectively. There were 14 boys and 7 girls with a median age of 11.8 years. All fixations were protected in an above elbow plaster cast. Patients were followed up for an average of 12.8 months (Range, 12-21.5 months). Clinical and radiologic union was achieved within 13 weeks after the procedure in 19 children. One patient had delayed union of the ulna which finally united at 9 months after operation without any further intervention. Another patient had nonunion of ulna that required autologous bone marrow injection after 1 year before full consolidation occurred. Complications were all modest and transient and eventually all patients achieved a good functional clinical outcome. We think that the technique has many merits over a more traditional plating technique including a minimally invasive technique, a less time consuming procedure and easier metal work removal. We think that cosmesis is perhaps the most important to our patients because the wounds are small and less conspicuous than the traditional Henry approach for plating which leaves a long unsightly volar forearm scar. We think that ESIN is an attractive treatment option for displaced and unstable diaphyseal forearm fractures in children.

Prebiotics and immune responses.

Feeding breast milk of healthy mothers is associated with a lower incidence of infectious and allergic diseases. Although this effect is of multifactorial origin, it is widely accepted that the entire intestinal flora of breastfed infants provides anti-infective properties and is an important stimulating factor for the postnatal development of the immune system. Clearly, the effect of human milk on the postnatal development of the intestinal flora cannot be attributed to a single ingredient. It is generally accepted, however, that human milk oligosaccharides play a key role in this matter (1). The composition of human milk oligosaccharides is very complex. As they are resistant against digestion, they can be detected in the faeces as well as in the urine of breast-fed infants (2). This low or absent digestibility is a prerequisite for prebiotic activities of dietary compounds (3). Apart from their prebiotic effects, there is also evidence that human milk oligosaccharides act as receptor analogues to inhibit the adhesion of pathogens on the epithelial surface (1) and interact directly with immune cells (Eiwegger Th, et al., unpublished data). Due to their complexity, oligosaccharides with structures indentical with human milk oligosaccharides are not available as dietary ingredients. Searching for alternatives, a mixture of neutral galacto-oligosaccharides (GOS) and fructo-oligosaccharides (FOS) have been identified as effective prebiotic ingredients during infancy (5). More recently, also acidic oligosaccharides such as pectin hydrolysate are under investigation (6). In several clinical trials it could be demonstrated that feeding a formula supplemented with a mixture of GOS and long-chain FOS results in an entire intestinal flora similar to that found in breast fed infants (7). Comparable to human milk oligosaccharides, GOS and FOS stay present during the whole gastrointestinal passage and are therefore detectable in the faeces of infants fed a GOS/FOS supplemented formula. With regard to stool characteristics, there was a significant influence of GOS/FOS in preterm as well as term infants: feeding the oligosaccharides-supplemented formula increased the stool frequency and softened the stool consistency in comparison to a standard formula so that stool characteristics could be achieved which were very similar to those of human milk fed infants (5). In a study in term infants the effect of different concentrations of the GOS/FOS mixture was tested in parallel by a traditional plating technique and a modern molecular biologic technique (7). Whereas with the plating technique, only living bacteria can be detected, all bacteria are counted with the molecular biologic technique. The results obtained by the two methods are shown in Figure 1. They clearly indicate that with the use of the GOS/FOS mixture, the number of bifidobacteria increases and the effect is much more pronounced for the living bacteria than for the total number of bacteria. Short-chain fatty acids (SCFA) are an important marker of the bacterial metabolism in the intestine. Invitro experiments focusing on the short SCFA synthesis by the faecal flora could demonstrate that the SCFA synthesis from GOS/FOS mixture was comparable to the synthesis from a quantitatively equivalent neutral human milk oligosaccharides fraction (7). Similar results were obtained in-vivo by measuring the fatty acid pattern in faeces from infants fed a formula supplemented with GOS/FOS: The faecal SCFA pattern was similar to that observed in breast fed infants (8). The results are in line with the observation that during a 28-day feeding period the faecal pH decreased in a group of term infants fed a GOS/FOS supplemented formula similar to breast fed infants, whereas the faecal pH in infants fed a nonsupplemented standard formula increased (5). Increased numbers of bifidobacteria and a decreased faecal pH are contributing to a reduction of clinically relevant pathogens, either expressed in absolute numbers or as percentage of total bacteria. In an animal study using the mouse vaccination model as recommended by international governmental guidelines (6), feeding GOS/FOS significantly stimulated the cellular (i.e., Th1/Th2) immune balance. In an animal model for allergic hypersensitivity using ovalbumin as allergen, dietary GOS/FOS inhibited the allergic inflammation (7). In summary, the data demonstrate that an infant formula supplemented with a mixture of GOS/FOS stimulates the entire intestinal flora and results in the production of physiologically important bacterial metabolites as well as a faecal pH similar to influences of human milk feeding. These effects are accompanied by stool characteristics close to those of breast-fed infants and by a Address correspondence and reprint requests to Prof. Gunther Boehm, Director Infant Nutrition Research Germany, Milupa GmbH & Co, KG Bahnstrasse 14-30, D-61381 Friedrichsdorf; Fax: 0049-6172991862 (e-mail: guenther.bohem@milupa.de). Journal of Pediatric Gastroenterology and Nutrition 39:S772–S773 © June 2004 Lippincott Williams & Wilkins, Philadelphia

Anteroinferior plating of midshaft clavicular nonunions.

Many different techniques have been reported for the treatment of clavicular nonunions. Those techniques involving screws and plate generally position the plate on the superior (subcutaneous) surface of the clavicle. To decrease the risk of screw pull-out and prominence of the instrumentation, we currently perform anteroinferior plating using a 3.5-millimeter pelvic reconstruction plate with a lag screw and bone graft. A consecutive group of twelve patients with midshaft clavicular nonunions was treated with this technique. All nonunions united after an average of 3.6 months (range 2 to 8 months). All patients regained full function and mobility of the shoulder. The technique as described in this article illustrates a successful modification of the traditional plating technique of midshaft clavicular nonunions. We conclude that anteroinferior plating is a reliable and safe technique that leads to high rates of bony union in midshaft clavicular nonunions.

Perfect order plating: principle and applications

▼The raw quality of data is one of the first and most desirable requirements of Good Laboratory Practice (GLP) and Good Statistics Practice (GSP). In quantitative microbiology, this implies that cell and colony counts should follow the ‘ideal’ Poisson distribution (Ref. 1). Since the classical works by Student (Ref. 2) and Fisher et al. (Ref. 3), it has been known that under ‘ideal conditions’, microbial cell counts taken using a haemocytometer or colony counts on parallel plates will vary in accordance with Poisson distribution. When these conditions are fulfilled, the mean count is a direct measure of the density of the bacterial population, and such an estimate is the most accurate. ‘Any significant departure from the theoretical [Poisson] distribution is a sign that the mean may be wholly unreliable’ (Ref. 3). Modern studies show that the plate counts from, for example, the Ames Salmonella assay (Ref. 4–6) or the microbiological quality control of food and drug products (Ref. 7) too often (∼50% of experimental data sets) exhibit significant extra-Poisson variability, also called ‘over-dispersion’. This phenomenon remains a serious problem in quantitative microbiology. Biometricians try to solve it by inventing sophisticated statistical models and corresponding tests for this phenomenon. However, introducing additional parameters into such models complicates the analysis and reduces its efficacy and reliability (Ref. 5–8 and references therein). The problem is so serious that, in a recent publication (Ref. 7), German microbiologists and biometricians suggested the introduction of non-Poisson statistical models into national GLP standards for microbiological (epidemiological) control of the safety and quality of foods and drugs. One of the main reasons for all this might be the low precision of traditional plating techniques. Traditionally, two plating procedures are the most common.

Comparison of conductimetric and traditional plating techniques for detecting yeasts in fruit juices

Frozen fruit juice concentrates containing an average microbial population of log10 1.54 cfu ml‐1 were examined by traditional plating techniques and direct and indirect conductimetry. The initial populations in diluted (1:4) concentrates increased to an average of log10 3.82 cfu ml‐1 during incubation at 25°C for 24 h. Incubation before plating and subjecting to conductimetric tests also facilitated the resuscitation of cells that may have been freeze‐injured. Yeasts were recovered in equal numbers on acidified (pH 3.5) potato dextrose agar and dichloran rose bengal chloramphenicol agar (pH 5.6). Yeasts and bacteria were recovered on orange serum agar. Detection times determined by indirect conductimetry correlated fairly well (r= ‐0.73) with populations (cfu ml‐1) detected on traditional plating media. Populations in diluted concentrates which were not incubated before examination were detected conductimetrically in an average of 48.9 h, whereas detection times for diluted concentrates incubated for 24 h at 25°C before testing were reduced to an average of 14.1 h. Examination by conventional (direct) conductimetry required an additional 10–20 h to reach changes in conductance of 5 μS h‐1.