Flexible Thermoelectric Films Based on Bi2Te3 Nanowires and Boron Nitride Nanotube Networks with Carbon Doping.

Energy recovery and reuse, industrial waste heat, and thermal energy recovery and conversion in emerging electronic devices are topics of widespread interest. Flexible composite thermoelectric (TE) films have become the key to TE conversion, and many studies and synthesis methods related to them have made great progress. However, little research has been performed on the corresponding composites of typical TE materials with low-dimensional nanotubular materials, particularly modulation of the overall TE properties using doped low-dimensional nanotubular materials. In this work, high-quality bismuth telluride (Bi2Te3) nanowires and boron nitride nanotubes (BNNTs) were prepared using electrolytic deposition and high-temperature catalytic deposition, respectively. Bi2Te3-BNNTs composite films were prepared using a solvent hot pressing method. The Bi2Te3-BNNTs composite film conductivity reached 179.6 S/cm at room temperature (300 K), the corresponding Seebeck coefficient was 171.4 µV/K, and the power factor (PF) was 52.8 nW/mK2. Carbon doping of BNNTs resulted in carbon-boron nitride nanotubes (BCNNTs), and Bi2Te3-BNNTs composite films were prepared. The Bi2Te3-BCNNTs composite films obtained a conductivity of 4629.6 S/cm, at room temperature (300 K), a corresponding Seebeck coefficient of 181.2 µV/K, and a PF of 1520.0 nW/mK2. This study has important reference value for the application of TE conversion. Moreover, the electrical conductivity decreased by no more than 10% after 400 cycles of bending tests, and the electrical conductivity showed signs of recovery after repressing thermally, which undoubtedly proves that Bi2Te3-BCNNTs composite films have good flexibility and thermal stability, and this has contributed to the application and promotion of flexible thermoelectric materials.

Boron Nitride Nanoribbons Grown by Chemical Vapor Deposition for VUV Applications.

The fabrication process of vacuum ultraviolet (VUV) detectors based on traditional semiconductor materials is complex and costly. The new generation of wide-bandgap semiconductor materials greatly reduce the fabrication cost of the entire VUV detector. We use the chemical vapor deposition (CVD) method to grow boron nitride nanoribbons (BNNRs) for VUV detectors. Morphological and compositional characterization of the BNNRs was tested. VUV detector based on BNNRs exhibits strong response to VUV light with wavelengths as short as 185 nm. The photo-dark current ratio (PDCR) of this detector is 272.43, the responsivity is 0.47 nA/W, and the rise time and fall time are 0.3 s and 0.6 s. The response speed is faster than the same type of BN-based VUV detectors. This paper offers more opportunities for high-performance and low-cost VUV detectors made of wide-bandgap semiconductor materials in the future.

Chlorin e6-loaded sonosensitive magnetic nanoliposomes conjugated with the magnetic field for enhancing anti-tumor effect of sonodynamic therapy.

In sonodynamic therapy (SDT), when Chlorin e6 (Ce6) accumulates in tumor tissues, its anti-tumor effect can be achieved by ultrasound activation. To increase the local drug concentration of Ce6 in tumor cells, we had established a novel drug delivery system, Ce6-loaded sonosensitive magnetic nanoliposome (Ce6/SML), which realized the targeting delivery by the external magnetic field. It was worth mentioning that the targeting release of Ce6/SML and the activation on Ce6 could be achieved simultaneously by ultrasound of SDT. In our study, after Ce6 was loaded into the sonosensitive magnetic nanoliposome (SML), the values of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in vitro and in vivo were determined, indicating the activation on Ce6 of ultrasound. The delivery system also displayed the tumor-targeting ability and anti-tumor activity, which associated with the determined tumor growth and expression levels of angiogenin (ANG), vascular endothelial growth factor (VEGF) and tumor necrosis factor-alpha (TNF-α). In conclusion, the Ce6/SML-SDT-Targeted delivery system could effectively enhance the anti-tumor activity of SDT and had a great potential application for the treatment of malignant tumors located in deep tissues.

Medial Compartment Decompression by Proximal Fibular Osteotomy: A Biomechanical Cadaver Study.

Medial compartment knee osteoarthritis is a painful and debilitating disease. A proximal fibular osteotomy is a novel, simple surgical technique that may reduce pain and improve function for patients with osteoarthritis. The purpose of this biomechanical cadaver study was to determine what effect proximal fibular osteotomy had on knee joint and ankle pressures and tibia strain. Ten matched pairs of cadaver legs were tested in compression to 1.1 times body weight comparing intact and with proximal fibular osteotomy at 0°, 15°, and 30° of flexion. Sensors were inserted into the knee and ankle joint to measure pressure, force, and contact area. Strain was measured with a strain gage on the anterior medial tibia. In the medial compartment, the peak force, contact area, and pressure all decreased from intact to after fibular osteotomy, with significant differences at 15° of flexion (P<.05). There were no significant differences in the lateral compartment for any measures. In the ankle joint, the peak force and pressure decreased from intact to after fibular osteotomy at all 3 flexion angles. There were no significant changes in strain in the tibia. Proximal fibular osteotomy decreases the pressure in the medial compartment of the knee, which may reduce knee pain and improve function in patients with medial compartment knee osteoarthritis. [Orthopedics. 2018; 41(4):e496-e501.].

Age-, gender- and Arbeitsgemeinschaft für Osteosynthesefragen type-specific clinical characters of adult tibial plateau fractures in eighty three hospitals in China.

OBJECTIVE: The purpose of this study was to verify the age-, gender- and Arbeitsgemeinschaft für Osteosynthesefragen (AO) type-specific clinical characters of adult tibial plateau fractures in 83 hospitals in China and to investigate whether altitude has potential relationships with adult tibial plateau fractures. METHODS: A retrospective investigation was performed on consecutive patients with tibial plateau fractures treated in 83 hospitals in China between January 2010 and December 2011, data including age, gender and imaging were collected retrospectively through the PACS system and case reports checking system, imaging were classified into six types under fully qualified estimation based on AO classification. To further investigate imparities among different altitudes in China, all data were classified into four groups according to the centre altitudes of each city, G1 = plains group (<500 m), G2 = hills group (500-1000 m), G3 = mountain areas group (1000-2000 m), and G4 = plateau group (>2000 m). Comparison of gender distribution, age distribution and AO type were done. RESULTS: A total of 6,227 adult tibial plateau fractures were included. Men in the age range of 40-44 years were the most affected patients, and the overall high-risk injury type was 44-B. In four groups, the same peak age showed, namely, 40-44 years in males and 55-59 years in females. Age distribution showed no statistically significant difference in four groups (P > 0.05), while sex distribution and AO type indicated statistically significant differences (P < 0.05). Note an inversion of sex ratio among people over 60 years. CONCLUSION: Our study showed that men in the 40-44 year age range are the most affected patients, and different sex distribution as well as injury type of adult tibial plateau fractures differed with various altitudes in China.

Diagnostic accuracy of various modalities relative to open bone biopsy for detection of long bone posttraumatic osteomyelitis.

BACKGROUND: Long bone posttraumatic osteomyelitis (PTOM) is a relatively common complication following surgical fixation of open fractures. There is a lacking consensus on ideal strategies for diagnostic evaluation of long bone PTOM. While open bone biopsy and culture is considered the 'gold diagnostic standard,' its cost and invasiveness are often prohibitive and have prompted the search for alternate diagnostic methods. OBJECTIVE: To evaluate the sensitivity and specificity of various diagnostic modalities relative to open bone biopsy and culture for the detection of long bone PTOM. DESIGN: Retrospective cohort study; Level of Evidence, III. SETTING: Urban Level I trauma center and safety-net institution. PATIENTS/PARTICIPANTS: A consecutive cohort of 159 adult patients presenting with long bone PTOM at our Level I trauma center between January 1, 2004, and December 31, 2013, were retrospectively identified. All included patients fulfilled diagnostic criteria for PTOM (as defined by the Center for Disease Control and Prevention) that involved a long bone (femur, fibula, tibia, humerus, radius, and ulna). Patients with diabetic foot infection, septic arthritis, osteomyelitis of the spine/pelvis/hand, or insufficient medical records were excluded. MAIN OUTCOME MEASUREMENTS: Sensitivity and specificity of deep wound culture, soft tissue histopathologic examination, and elevated levels of acute phase reactants [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and leukocyte count (WBC)] were determined using findings of open bone biopsy and culture as a reference standard. RESULTS: The most common pathogen isolated on open bone culture was staphylococci, contributing to 89 (57%) of 159 cases of long bone PTOM (p < 0.001). Relative to open bone biopsy and culture as the gold diagnostic standard, soft tissue histopathology demonstrated a sensitivity of 69.8% [95% confidence interval (CI) 53.7-82.3%] and specificity of 38.9% (95% CI 18.3-63.9%) for the detection of long bone PTOM. Deep wound culture exhibited a lower sensitivity of 66.0% (95% CI 56.1-74.8%) and specificity of 28.1% (95% CI 12.9-49.5%), a difference that was statistically significant (p = 0.021). Among inflammatory markers, elevated levels of CRP and ESR were equally sensitive for the detection of PTOM compared to open bone biopsy and culture, while WBC was significantly less sensitive (sensitivity 33.2%; 95% CI 25.3-43.7; p < 0.001). CONCLUSION: Soft tissue histopathologic examination and deep wound culture are relatively poor substitutes for the diagnosis of long bone PTOM compared to open bone biopsy and culture. The accurate identification of causative pathogens underlying long bone PTOM is critical for diagnosis and choice of antibiotic treatment. Future studies investigating the use of higher-resolution diagnostic methods are merited.

Factors associated with adverse postoperative outcomes in patients with long bone post-traumatic osteomyelitis.

AIMS: To evaluate short-term clinical and functional outcomes following operative treatment of long bone post-traumatic osteomyelitis (PTOM). METHODS: We retrospectively analyzed a consecutive cohort of 142 adult patients undergoing operative treatment of long bone PTOM at our Level I trauma center over a 10-year study period. In addition to subjective patient evaluations, surveyed postoperative outcomes included incidence of residual infection, fracture malunion or nonunion, and requirement for limb amputation. All included patients had a minimum follow-up of 12 months postoperatively. RESULTS: Patients suffering an adverse postoperative outcome tended to have a higher incidence of polymicrobial infection (25.4 vs. 11.4%, p = 0.042) and requirement for skin grafting (58.1 vs. 37.9%, p = 0.024) and free-flap procedures (43.6 vs. 19.5%, p = 0.003) compared to those achieving complete healing. Sequential administration of parenteral and oral antibiotic therapies was associated with a reduced incidence of adverse postoperative outcome (p = 0.047). DISCUSSION: Patients with long bone PTOM and extensive soft tissue defects often fail to develop complete remission of their symptoms by 12 months postoperatively. Sequential administration of parenteral and oral antibiotics may help to limit infection recurrence. Further research is required to inform optimal treatment strategy.

Arthroscopic Juvenile Allograft Cartilage Implantation for Cartilage Lesions of the Hip.

Cartilage lesions in the hip are of high prevalence. Most of these lesions are treated with microfracture. Microfracture has relatively good subjective outcomes for smaller lesions; however, it is limited by the ability to reproduce hyaline cartilage, especially in older patients. For larger chondral defects, we present a technique using juvenile allograft cartilage implantation implanted arthroscopically to treat cartilage lesions in the hip. The purpose of this technical note is to describe the arthroscopic technique for treating chondral lesions in the hip with allograft juvenile cartilage.

Prevention of inaccurate targeting of proximal screws during reconstruction femoral nailing.

PURPOSE: The purpose of this study was to identify the underlying cause by simulating the forces involved in a controlled laboratory setting, and then to illustrate some intraoperative tips on how to detect this malalignment and suggest solutions prevent this intraoperative complication. METHODS: The Expert Asian Femoral Nail (A2FN) and Proximal Femoral Nail Antirotation (PFNA) reconstruction nail systems were evaluated to compare the characteristics of each nailing system and their reactions to soft tissue tension at the time of proximal reconstruction screw placement. Soft tissue tension was simulated by placing a fulcrum under the distal drill sleeve and exerting a load on the targeting device via the addition of weights. The occurrence and degree of guide malalignment were determined while gradually increasing the weight. RESULTS: When soft tissue tension was simulated on the drill/guide sleeve of the A2FN, the drill sleeve deviated from the proximal screw hole proportionally to the weight applied and the K-wire guide passed outside of the nail at a weight of 7 kg. However, the drill sleeve of the PFNA was aligned exactly to the center of nail axis and the K-wire passed cleanly through the proximal locking hole regardless of weight applied. CONCLUSIONS: Inaccurate guidance of the screw-targeting device can be caused by soft tissue tension. Thus, the authors recommend that careful attention be placed on minimizing soft tissue tension during proximal screw placement while using the targeting device of the A2FN system.

Does the OTA Open Fracture Classification Predict the Need for Limb Amputation? A Retrospective Observational Cohort Study on 512 Patients.

BACKGROUND: Few studies have examined the utility of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) compared to the traditional Gustilo-Anderson classification for prediction of treatment outcomes in patients with open fractures. QUESTIONS/OBJECTIVES:: (1) How do the Gustilo-Anderson classification and OTA-OFC systems compare in accuracy of predicting limb amputation, infection, and need for soft tissue coverage? (2) Is there an OTA-OFC summative threshold score that may guide the discussion and decision-making with regard to limb salvage or amputation? DESIGN: Retrospective observational cohort study; Level IV evidence. SETTING: Level I trauma center and urban safety-net institution. PATIENTS/PARTICIPANTS: Consecutive adult patients with open long bone fractures who underwent operative treatment between January 1, 2007 and December 31, 2012. MAIN OUTCOME AND MEASUREMENTS: Postoperative complications of infection, early limb amputation, and requirement for soft-tissue procedures. RESULTS: The study cohort comprised 512 patients with mean age 49.6 ± 14.9 years. Nineteen patients (3.7%) underwent amputation. The Gustilo-Anderson classification demonstrated no correlations with any of the primary outcome measures, while OTA-OFC summative scores significantly varied between all outcome comparison groups. The skin injury component of the OTA-OFC was an independent predictor of limb amputation (OR, 5.44; 95% CI, 2.37-12.47), and an OTA-OFC summative score of ≥10 best correlated with need for amputation (P < 0.001). Sensitivity and specificity of the reported model were 79% and 94%, respectively. CONCLUSIONS: Our results should be interpreted with caution due to the retrospective nature of our study. Based on our data, the OTA-OFC is superior to the Gustilo-Anderson classification system for prediction of postoperative complications and treatment outcomes in patients with open long bone fractures. A summative threshold score of 10 seems to identify increased odds of successful limb salvage.

Fluoroscopic Views for a More Accurate Placement of Iliosacral Screws: An Experimental Study.

OBJECTIVES: Misperception on the fluoroscopic image showing a well-placed iliosacral (IS) screw can occur, when the screw is in reality misplaced. The purpose of this study was to demonstrate and highlight examples of misperception and suggest alternative inlet and outlet views to confirm adequate IS screw placement. METHODS: We used 9 different pelvic plastic models. In 8 of those models, IS screws were purposely misplaced: exiting anterior at the midportion of the S1 body, exiting at the lateral aspect of the anterior S1 body, abutting posterior to S1 body, exiting posterior to the S1 body, exiting superior to the far-side of the sacral ala, exiting superior to the S1 body, exiting partially in the S1 foramen, exiting completely in the S1 foramen. One model was used as control with correct screw placement. Different outlet and inlet views were tested to accurately detect important anatomic landmarks and avoid fake phenomenon (FP) using 3 different angles. RESULTS: Misperception occurred in 3 models: (1) penetration at the midportion of the anterior border of S1, (2) penetration of the superior sacrum ala, and (3) partial penetration of S1 foramen. In the first situation, misperception could be avoided when the "anterior inlet view" was obtained. In the other 2 situations, misperception could be avoided using specific outlet views herein described. CONCLUSIONS: Our findings highlight that misperception can occur using standard inlet and outlet views. We suggest using 2 variations of the inlet views and 3 variations of the outlet views to avoid misperception in clinical practice.

Transarticular plating for acute posterior sternoclavicular joint dislocations: a valid treatment option?

BACKGROUND: Restoration of the sternoclavicular joint after posterior dislocation is important for upper limb function. The proximity of neuro-vascular mediastinal structures makes open reduction and internal fixation (ORIF) a high-risk procedure. The ideal treatment strategy is still debated. Our aim is to review the treatment of acute posterior sternoclavicular joint dislocation with a locking compression plate. MATERIALS AND METHODS: We present our experience of transarticular plating using a locking compression plate for the treatment of three consecutive patients with posterior sternoclavicular dislocation (SCD). Our primary outcome measure was objective functional outcome using DASH (disability of the arm, shoulder and hand) and PROMIS (patient-reported outcomes measurement information system) questionnaires. All patients had a minimum follow-up of six months, and serial radiographs were reviewed to evaluate maintenance of reduction. RESULTS: All three patients presented a posterior SCD with instability refractory to closed reduction. In all three patients, we opted for surgical management using open reduction and fixation with a locking compression plate and allowed early mobilization at two weeks postoperatively. No complications were encountered during follow-up. Good functional outcomes were evidenced by DASH scores of 7.5, 20 and 30, and PROMIS scores were 53.8, 53.8 and 38.1 in each patient, respectively. CONCLUSION: Our experience of transarticular plating using a locking compression plate for posterior SCD is positive, as it allows early mobilization and resulted in good functional outcomes.

Medial Compartment Decompression by Fibular Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Pilot Study.

Compared with high tibial osteotomy and total knee arthroplasty, the authors found a simpler surgical procedure, partial fibular osteotomy, could effectively relieve knee pain and also correct the varus deformity for patients with medial compartment knee osteoarthritis (OA). From January 1996 to April 2012, a total of 156 patients with medial compartment OA were treated by proximal fibular osteotomy in the authors' hospital. A 2-cm-long section of fibula was resected 6 to 10 cm below the fibular head. A total of 110 patients with follow-up of more than 2 years were included in the study, including 34 males and 76 females with an average age of 59.2 years. Anteroposterior and lateral weight-bearing radiographs, the femorotibial angle (FTA) and lateral joint space, and the American Knee Society Score (KSS) and the visual analog scale (VAS) score of the knee joint were evaluated preoperatively and at final follow-up, respectively. At final follow-up, mean FTA and lateral joint space were 179.4°±1.8° and 6.9±0.7 mm, respectively, which were significantly smaller than those measured preoperatively (182.7°±2.0° and 12.2±1.1 mm, respectively; both P<.001). Mean KSS at final follow-up was 92.3±31.7, significantly higher than the mean preoperative score of 45.0±21.3 (P<.001). Mean VAS score and interquartile range were 2.0 and 2.0, significantly lower than the preoperative data (7 and 1.0, respectively; P<.001). The authors found that proximal fibular osteotomy can significantly improve both the radiographic appearance and function of the affected knee joint and also achieve long-term pain relief. This procedure may be an alternative treatment option for medial compartment OA.

Optimizing Stability in Femoral Neck Fracture Fixation.

Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants.

Acetabular fractures in elderly patients: a comparative study of low-energy versus high-energy injuries.

PURPOSE: The goal of this study is to compare the characteristics, clinical course, and mortality rates of acetabular fractures in the elderly population with respect to two types of injury. METHODS: We reviewed 183 consecutive patients with acetabular fractures aged 60 years old and older. One hundred eighty-three patients (129 men and 54 women) were included in the study with an average age of 70.2 years. There were 186 fractures, which included three cases of bilateral fractures. Patients were divided into two groups: low-energy injuries (group I), 56, and high-energy injuries (group II), 130. Patient characteristics and fracture pattern, as well as in-hospital mortality rates were compared between the low-energy and high-energy groups. RESULTS: Patient demographics and comorbidities were significantly different between the groups. In group I, the average age was 74.9 years, versus 68.2 years in group II (p < 0.001). The percent of females in each group was 39.3 % and 24.6 %, respectively (p = 0.043), and the average body mass index (BMI) was 25.6 and 28.4, respectively (p = 0.001). The Charlson comorbidity index was higher in group I (1.98 vs 0.95 in group II, p < 0.001). However, the American Society of Anesthesiologists physical status (ASA) was similar between groups (2.56 vs 2.53, respectively, p = 0.808). The proportion of surgical treatment was 44.6 % in group I and 61.6 % in group II (p = 0.019). Group II had a longer hospital stay (10.4 days vs 14.5 days, p = 0.025), but in-hospital death was not significantly different (5.3 % vs 7.9 %, respectively, p = 0.567). CONCLUSION: Patients with acetabular fractures resulting from low-energy injuries were older and had lower BMI with more comorbidities. This study may highlight characteristics of fragility fractures of the acetabulum.

An observational case series of HIV-positive patients treated with open reduction internal fixation for a closed lower extremity fracture.

OBJECTIVES: The purpose of this study was to investigate the influence of immune deficiency status of HIV-positive patients on postoperative complication such as surgical site infection and nonunions. DESIGN: Retrospective observational cohort study: Level III. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Consecutive adult HIV-positive patients with closed fractures who underwent operative treatment between January 1, 2001 and December 31, 2012. MAIN OUTCOME AND MEASUREMENTS: postoperative complication including infection and fracture nonunion. RESULTS: A total of 42 HIV-positive patients with closed fractures who underwent surgical fracture fixation were identified during the 12-year study time window. Of these, 18 patients were excluded due to incomplete medical records (n = 16) or open fractures (n = 2). The remaining 24 patients with closed fracture treated surgically (19 males and 5 females; mean age 45.1 ± 10.5 years; age range 20-67 years) were included in the study. Within a 6-month period from the time of injury, 16 patients had a CD4+ cell count >200 and five patients had a CD4+ cell count <200 (CD4+ cell count was not available in three patients). Twenty-two patients (91.6 %) were on antiretroviral therapy at the time of injury. Only one patient, with associated end-stage renal failure and diabetes mellitus, developed a postoperative infection (4.2 %). All patients achieved fracture union within 180 days postoperatively, without the need for surgical revisions. CONCLUSIONS: Our study suggests that HIV infection does not seem to correlate with a higher risk for the development of postoperative complication related to surgical site infection and fracture nonunions after operative fixation of closed fractures.

[Development of ultrasonic power meter].

This article describes the design and development of an ultrasonic power meter which is consist of an electronic balance, a practice target, an acoustic enclosures and a blocking. The electronic balance mounted on the blocking is linked with the practice target by connecting rod. By adjusting the blocking makes the practice target suspended above ultrasound probe, and then the ultrasonic power can be measured. After initial tests, the ultrasonic power meter performanced with good stability and high precision.

Custom-made antibiotic cement nails: a comparative study of different fabrication techniques.

INTRODUCTION: The management of intramedullary long bone infections remains a challenge. Placement of antibiotic cement nails is a useful adjuvant to the antibiotic treatment of osteomyelitis. However, fabrication of antibiotic cement nails can be arduous. The purpose of this article is to introduce an easy and reproducible technique for the fabrication of antibiotics cement nails. MATERIALS AND METHODS: We compared the time required to peel the chest tube off the 6 antibiotic cement nail using 2 different cement-cooling techniques and the addition of mineral oil in the chest tube. Additionally, we evaluated the optimal time to cut the chest tube (before and after cement hardening), consistency of nail's diameter, and the roughness of its surface. Cooling and peeling times were measured and failure was defined as a working time (from cement mixing to have a usable antibiotic cement nail) that exceeded 1 h. RESULTS: When the antibiotic cement nail was left to cool by convection (i.e. air-cooling), we failed to peel the plastic off the cement nail. When the chest tube was cut after conductive cooling (i.e. cold water-cooled), the cooling time was 10 min and the peeling time was 30 min without the use of mineral oil; the addition of mineral oil reduced peeling time to 7.5 min. Following peeling, residual adherent plastic pieces were found along the entire surface of the nail when no mineral oil was used. This was rarely seen when mineral oil was utilized to coat the inner layer of the chest tube. CONCLUSION: Conductively cooling of the cement nail (in cold water) and pre-lubricating the chest tube with mineral oil are 2 tricks that render fabrication of antibiotic nail more efficient, reliable, and practical.

Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients' bone health.

Osteoporosis has been recognised as a public health concern for at least three decades but it has been relatively recent that the push has been for orthopaedic surgeons to take a more active role in the diagnosis and treatment of patients with decreased bone mineral density (BMD). Most often these patients are encountered after they have suffered a fracture making secondary prevention the area where orthopaedists may exert the greatest influence on patient care. The purpose of this article is to provide a succinct framework for the diagnosis and treatment of patients with decreased BMD. Patients are deemed to have decreased BMD if they have suffered a fragility fracture, a fracture caused by a low-energy traumatic event. These patients are often encountered in the emergency department and admitted for further treatment of their fractures or recommended for follow-up in the clinic. Regardless of treatment course these are opportunities for the orthopaedic surgeon to intervene in the osteoporotic disease process and positively affect a patient's bone health. This article compiles the available literature on osteoporosis and presents it succinctly with the incorporation of both a diagnosis algorithm and treatment profile table. With the use of these two tools, orthopaedic surgeons everywhere should be able to take a more active role in their patients' bone health.

The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable?

BACKGROUND: Acetabular fractures are rare injuries in heterogeneous patient groups, making it difficult to develop adequately powered prospective single-center clinical trials in the USA or Europe. Chinese trauma centers treat a high volume of these injuries, and if the patient population and injury patterns are comparable to those in the USA, this might support development of multicenter studies in Level I trauma centers in the two countries. QUESTIONS/PURPOSES: We determined whether the following parameters were similar between operative acetabular fractures treated at Chinese and US trauma centers: (1) epidemiology of injured patients, (2) mechanism of injuries and fracture types, and (3) hospital stay parameters, including symptomatic postoperative deep vein thrombosis (DVT) rate. METHODS: We extracted data from trauma databases for patients admitted with acetabular fractures managed surgically from 2005 to 2012 for one Chinese center and from 2008 to 2012 for one US center. Sex, age, mechanism of injury, fracture classification, Injury Severity Score (ISS), time from injury to surgery, length of hospital stay, and symptomatic DVT rate were analyzed. We included 661 Chinese patients (539 men, 122 women) and 212 US patients (163 men, 49 women). RESULTS: Mean age at time of injury was different between China and the USA, at 40 years with a unimodal distribution and 44 years with a bimodal distribution (p<0.001), respectively. Incidence of surgically treated acetabular fractures has been increasing in China but decreasing in the USA. Mean ISSs were comparable. Although the distribution of mechanisms of injury was different (p=0.004), high-energy injuries (motor vehicle accidents, falls>10 feet) still accounted for most fractures in both centers. Fracture classifications (per Letournel) were comparable, with posterior wall fractures most common. Mean time from injury to surgery and mean hospital stay were longer in China than in the USA (9 versus 3 days [p<0.001] and 26 versus 11 days [p<0.001], respectively). Symptomatic DVT rates were comparable. CONCLUSIONS: Although we identified differences between the two centers, we also noted important similarities. Multicenter clinical studies involving these locations should be performed with caution and focus on similar end points, taking into account the populations' baseline differences. Because of the potential for such differences, this kind of validation study should be performed before embarking on resource-intensive multicenter trials. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.