Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of The Tibia: A Biological Approach.

Introduction: The treatment of fractures of proximal and distal tibia is challenging, because of the limited soft tissue envelope and poor vascularity. The best treatment remains controversial and it depends on the fracture morphology, displacement and comminution. Treatment options vary from closed reduction and cast to open reduction and internal fixation with plate. Open reduction and internal fixation with plate can result in extensive dissection and tissue devitalization. We conducted a study on management of these fractures by biological osteosynthesis using Minimally Invasive Plate Osteosynthesis (MIPO) technique with preservation of osseous and soft tissue vascularity. Methods: We conducted a prospective study on closed reduction and percutaneous plating in 30 cases (mean age 42.7 years; 22 males and 8 females) of closed fractures of tibia. Among them 24 had proximal tibial fractures and 6 had distal tibial fractures. The mean time from injury to surgery was seven days. Results: The mean operative time was 72.6 minutes ( range: 55-90 minutes). Mean time for radiological union was 17 weeks (range: 14-22 weeks). There was one superficial wound infection which resolved with daily dressings and one week of oral antibiotics. One patient developed a nonunion which required a bone grafting procedure. Conclusions: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in periarticular fractures. Biological fixation of complex fractures gives stable as well as optimal internal fixation and complete recovery of limb function at an early stage with minimal risk of complications.

Adult proximal humerus locking plate for fixation of paediatric subtrochanteric fractures.

PURPOSE: The current study was done to evaluate the outcome of paediatric subtrochanteric fractures managed by adult proximal humerus locking plate (PHLP). METHODS: This prospective study included eight children (three females and five males) with femoral subtrochanteric fractures who met the inclusion criteria and underwent open reduction and internal fixation of the fracture with ipsilateral long adult PHLP. The mean age of the patients at the time of surgery was 13 years (range 10-16 years), and the mean follow-up was 32 months (range 18-48 months). Outcome at final follow-up was assessed using the Harris hip score. RESULTS: At the time of final follow-up, all fractures united at an average of 8.75 weeks (range 6-14 weeks). The average final Harris hip score was 80.25 (range 67-90). The only complain was prominent hardware in the proximal thigh, near the trochanteric ridge, which was present in two of our patients, and one of them opted for implant removal at 10 months. CONCLUSION: Internal fixation of paediatric subtrochanteric fractures using the proximal humeral locking plate of the ipsilateral side appears to be a good treatment option for the age group of 10-16 years, though comparative studies with a larger sample size are required to further support this observation.

Differential Localization of Two Alternatively Spliced GABAA Receptor gamma2-Subunit mRNAs in the Chick Brain.

Two variants of the GABAA receptor gamma2 subunit are known to exist, which differ by the presence (gamma2L) or absence (gamma2S) of eight amino acids in the presumed intracellular loop between the third and fourth membrane-spanning domains. These variants have been shown to be generated by alternative splicing of the gamma2-subunit primary gene transcript in mouse (Kofuji et al., J. Neurochem., 56, 713 - 715, 1991), and in bovine and human (Whiting et al., Proc. Natl. Acad. Sci. USA, 87, 9966 - 9970, 1990) brain. We describe here the cloning, from chick (Gallus domesticus) brain, of cDNAs that encode the gamma2L and gamma2S subunits, and report on the regional and cellular localization of the corresponding mRNAs as revealed by in situ hybridization histochemistry with transcript-specific oligonucleotide probes. While the two transcripts are found to be colocalized throughout the chick neuroaxis, certain nuclei (for example, the nucleus isthmi, pars magnocellularis, the nucleus isthmi, pars parvocellularis, the nucleus solitarius and the paleostriatum primitivum) are found to contain predominantly either the gamma2S- or the gamma2L-subunit mRNA. We conclude that receptors that contain either the gamma2S or the gamma2L subunit occur, and that these probably have functionally different roles in the modulation of neurotransmission in the central nervous system. In addition, our data indicate that certain cells may produce both transcripts. Consequently, these will have either a single receptor subtype that contains both a gamma2S and a gamma2L subunit, or two receptor subtypes, one of which contains a gamma2S subunit and the other a gamma2L subunit.