Fibular hemimelia: reconstruction of difficult cases with tibial lengthening and ankle arthrodesis.

PURPOSE: Management of fibular hemimelia includes either prosthetic care with or without a suitable amputation or tibial lengthening. Many studies have documented the success of both procedures. Most parents of these children refuse an amputation or have no access to good prosthetic care. The author presents a limb-salvage procedure with tibial lengthening and ankle stabilization. METHODS: Twelve children of fibular hemimelia with 14 extremities had been subjected to limb lengthening after lateral leg release. To correct the valgus procurvatum, double oblique diaphyseal osteotomy (DODO) of the tibia was performed in 11 extremities. The age of the patients ranged from two to 15 years with the median of five years. All were male. The proposed procedure included three stages of loosening, lengthening, and stabilization with ankle arthrodesis at a later stage. RESULTS: All patients returned for follow-up for the first four years and had been walking on their sensate feet. With DODO followed by fixator/traction could straighten and lengthen the tibia simultaneously and correct the valgus procurvatum. Ankle stabilization provided stability and a plantigrade foot. A follow-up of six to 30 years with a median of ten years has been reported. CONCLUSION: A new procedure of loosening, lengthening, and stabilization of the leg with ankle arthrodesis has been proposed. A follow-up of 30 years with a median of ten years of the said procedure has been reported. The procedure provides a long-lasting plantigrade and painless foot that has sensation and proprioception. An amputation at any level has not been recommended.

Anti-dengue therapeutic potential of Tinospora cordifolia and its bioactives.

ETHNOPHARMACOLOGICAL RELEVANCE: Dengue is one of the most prevalent mosquito-borne viral infections. Moreover, due to the absence of appropriate curative and preventive measures against it, the mortality rate is increasing alarmingly. However, remarkable docking and clinical advances have been achieved with plant-based natural and conventional therapeutics. Tinospora cordifolia is one of the highly explored panaceas at the local level for its effective anti-dengue formulations. AIM OF THE STUDY: The present article aims for critical assessment of the data available on the anti-dengue therapeutic use of T. cordifolia. Efforts have also been made on the clinical and in-silico anti-dengue efficacy of this plant. The phytochemistry and the antiviral machinery of the plant are also emphasized. MATERIALS AND METHODS: The present article is the outcome of the literature survey on the anti-dengue effect of T. cordifolia. A literature survey was conducted from 2011 to 2024 using different databases with appropriate keywords. RESULTS: The present study confirms the anti-dengue potential of T. cordifolia. The plant can suppress the initiation of 'cytokine storm', vascular leakage and inhibition of various structural and NS proteins to exert its anti-dengue potential. Berberine and magnoflorine phytocompounds were highly explored for their anti-dengue potential. CONCLUSIONS: The present study concluded that T. cordifolia serves as an effective therapeutic agent for treating dengue. Further in-silico and clinical studies are needed so that stable, safe and efficacious anti-dengue drug can be developed. Besides, a precise antiviral mechanism of T. cordifolia against DENV infection is still needed.

Unravelling the novel genetic diversity and marker-trait associations of corn leaf aphid resistance in wheat using microsatellite markers.

The study was conducted to identify novel simple sequence repeat (SSR) markers associated with resistance to corn aphid (CLA), Rhopalosiphum maidis L. in 48 selected bread wheat (Triticum aestivum L.) and wild wheat (Aegilops spp. & T. dicoccoides) genotypes during two consecutive cropping seasons (2018-19 and 2019-20). A total of 51 polymorphic markers containing 143 alleles were used for the analysis. The frequency of the major allele ranged from 0.552 (Xgwm113) to 0.938 (Xcfd45, Xgwm194 and Xgwm526), with a mean of 0.731. Gene diversity ranged from 0.116 (Xgwm526) to 0.489 (Xgwm113), with a mean of 0.354. The polymorphic information content (PIC) value for the SSR markers ranged from 0.107 (Xgwm526) to 0.370 (Xgwm113) with a mean of 0.282. The results of the STRUCTURE analysis revealed the presence of four main subgroups in the populations. Analysis of molecular variance (AMOVA) showed that the between-group difference was around 37 per cent of the total variation contributed to the diversity by the whole germplasm, while 63 per cent of the variation was attributed between individuals within the group. A general linear model (GLM) was used to identify marker-trait associations, which detected a total of 23 and 27 significant new marker-trait associations (MTAs) at the p < 0.01 significance level during the 2018-19 and 2019-20 crop seasons, respectively. The findings of this study have important implications for the identification of molecular markers associated with CLA resistance. These markers can increase the accuracy and efficiency of aphid-resistant germplasm selection, ultimately facilitating the transfer of resistance traits to desirable wheat genotypes.

Deciphering the genetic diversity and population structure of wild barley germplasm against corn leaf aphid, Rhopalosiphum maidis (Fitch).

Corn-leaf aphid (CLA-Rhopalosiphum maidis) is a major insect pest of barley (Hordeum vulgare) causing yield loss upto 30% under severe infestation. Keeping in view of the availability of very few sources of CLA resistance in barley, the present investigation was framed to assess the genetic diversity and population structure of 43 wild barley (H. vulgare subsp. spontaneum) genotypes using eight microsatellite markers against R. maidis. Three statistical methods viz. multivariate-hierarchical clustering, Bayesian clustering and PCoA, unanimously grouped genotypes into three subpopulations (K = 3) with 25.58% (SubPop1-Red), 39.53% (SubPop2-Green) and 34.88% (SubPop3-Blue) genotypes including admixtures. Based on Q ≥ 66.66%, 37.20% genotypes formed a superficial "Mixed/Admixture" subpopulation. All polymorphic SSR markers generated 36 alleles, averaging to 4.5 alleles/locus (2-7 range). The PIC and H were highest in MS31 and lowest in MS28, with averages of 0.66 and 0.71. MAF and mean genetic diversity were 0.16 and 89.28%, respectively. All these parameters indicated the presence of predominant genetic diversity and population structure amongst the studied genotypes. Based on AII, only 6 genotypes were found to be R. maidis resistant. SubPop3 had 91.66% (11) of the resistant or moderately resistant genotypes. SubPop3 also had the most pure genotypes (11), the least aphid infestation (8.78), and the highest GS (0.88), indicating its suitability for future R. maidis resistance breeding initiatives.

Genetic diversity and population structure analyses in barley (Hordeum vulgare) against corn-leaf aphid, Rhopalosiphum maidis (Fitch).

Corn-leaf aphid (CLA), Rhopalosiphum maidis (Fitch) (Hemiptera: Aphididae) is a serious economic pest of barley worldwide. Breeding for aphid resistance in plants is considered a cost-effective and environmentally safe approach for aphid control, compared to the use of chemical pesticides. One of the challenges in breeding for aphid resistance is the identification of resistant plant genotypes, which can be achieved through the use of molecular markers. In the present study, a set of aphid specific 10 simple-sequence repeats (SSR) markers were used to investigate genetic diversity and population structure analyses in 109 barley genotypes against R. maidis. Three statistical methods viz., multivariate hierarchical clustering based on Jaccard's similarity coefficient, principal coordinate analysis (PCoA) and the Bayesian approach were utilized to classify the 109 barley genotypes. The analyses revealed four subpopulations i.e., SubPop1, SubPop2, SubPop3 and SubPop4 with 19, 46, 20 and 24 genotypes including admixtures, respectively and represented 17.43%, 42.2%, 18.34% and 22.01% genotypes of the total population size, respectively. The studied SSR markers produced 67 polymorphic bands, with an average of 6.7 and ranging from 3 to 12 bands. Heterozygosity (H) was found to be highest in SSR28 (0.64) and lowest in SSR27 (0.89). The observed genetic diversity index varied from 0.10 to 0.34 (with an average of 0.19). Major allele frequency varied from 74.08% to 94.80%. On an average, 87.52% of the 109 barley genotypes shared a common major allele at any locus. Based on the Aphid Infestation Index (AII), only 2 genotypes were found to be resistant against CLA. SubPop2 also had lowest mean aphid population (28.83), widest genetic similarity index (0.60-1.00) and highest genetic similarity coefficient (0.82), which highlighted its potential for inclusion in future CLA resistance breeding programs.

"A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management".

Background: The management of the GCT continues to be controversial. The most accepted treatment reported is extended curettage with various adjuvants. However, the rate of recurrence has been very high (10-66%). For better understanding of the lesion and its management, it has become necessary to revise the existing grading system. Materials and Methods: The recommendation of the proposed grading is based on 480 cases of GCT along with the analysis of other major reports published. Out of these, 279 were grade-II and 109 grade-III which were subjected to en bloc excision and reconstruction with non-vascularized fibular graft. Depending on the site, the grafts were stabilized with a suitable plate or extra long Kirschner wires. Results: The observations made in 480 cases over a period of 5 decades revealed that for Campanacci grade-II and grade-III lesions, en bloc excision and suitable reconstruction resulted in minimum recurrence rate of 1.2%. The fibular reconstruction after excision has proved advantageous to our patients as it provides a stable joint in the form of an arthrodesis of the neighboring joint. Conclusion: GCT of bone has been a challenging lesion. Extended curettage has been recommended as the choice of treatment but the reported rate of recurrence has been high. En bloc excision and suitable reconstruction with fibular strut graft have resulted in 1.2% recurrence. It is, therefore, suggested the existing grading system should be revised mainly for grade-II and grade-III lesions which can bring down the high rate of recurrence in this unpredictable tumor. Level of Evidence: Level-IV.

Trees outside forests as climate change mitigation champions: evaluating their carbon sequestration potential and monetary value in Maharshi Dayanand University, Rohtak (Haryana), India.

The annual average increase in carbon dioxide (CO2) concentration is touching new heights every year. Global climate change and warming are twin outcomes of record-breaking CO2 levels. The trees outside forests (TOF) are the most promising and suitable components in the ecosystem for combating global warming via carbon (C) sequestration. Urban university campuses are the hotspot regions of TOF. We have attempted to quantify the C stock, C sequestration potential, and C credit value of dominant tree species at Maharshi Dayanand University (MDU), Rohtak. Different volumetric and biomass equations were used for biomass computation. We assessed a total of 29,442 trees (top 10) for measuring phytosociological parameters like total tree count, age, height (H), and diameter at breast height (DBH) to quantify the amount of C stored. The total C stock, C sequestration rate, and monetary value were 78.67 (Mg C ha-1), 19.05 (Mg CO2 ha-1 year-1), and 23,101.59 $ year-1, respectively. Eucalyptus globulus is the most dominant tree species on the campus and topped almost all the quantitative characteristics like total tree count (~40 %), age (25 years), density (D) (55.35 trees ha-1), and total C stock (16.06 ± 9.90 ï»¿Mg C ha-1). Tree basal area (BA), D, diversity, and H positively affected the total C stocks. When the C market becomes operational, these C credits can be traded while generating additional income for the university. The results from this study can also help calculate the total C footprint of the campus.

Advance methodological approaches for carbon stock estimation in forest ecosystems.

The forests are a key player in maintaining ecological balance on the earth. They not only conserve biodiversity, reduce soil erosion, and protect watersheds but also promote the above and below-ground ecosystem services. Forests are known as air cleaners on the planet and play a significant role in mitigating greenhouse gas (GHG) emissions into the atmosphere. As per programs launched in the Conference of Parties (COP) 26, there is a need to promote policies and programs to reduce the atmospheric carbon (C) through the forest ecosystem; it is because forests can capture the atmospheric CO2 for a long time and help to achieve the goals of net-zero emission CO2 on the earth. Therefore, there is an urgent need to know the advanced technological approaches for estimating C stock in forest ecosystems. Hence, the present article is aimed at providing a comprehensive protocol for the four C stock estimation approaches. An effort has also been made to compare these methods. This review suggests that tree allometry is the most common method used for the quantification of C stock, but this method has certain limitations. However, the review shows that accurate results can be produced by a combination of two or more methods. We have also analyzed the results of 42 research studies conducted for C stock assessment along with the factors determining the amount of C in different types of forests. The C stock in vegetation is affected by temporal and spatial variation, plantation age, land use, cropping pattern, management practices and elevation, etc. Nevertheless, the available results have a large degree of uncertainty mainly due to the limitations of the methods used. The review supports the conclusion that the uncertainty in C stock measurements can be addressed by the integration of the above-mentioned methods.

Ethnomedicinal uses of Indian spices used for cancer treatment: A treatise on structure-activity relationship and signaling pathways.

Cancer is among the major cause of demise worldwide. Though the array of anticancer chemical medications is available but unfortunately, they are also associated with negative health effects. The invaluable therapeutic potential of spices makes them an integral part of our daily diet. Therefore, the present work focuses on the traditional uses of 46 spices and the phytochemical analysis of 31 spices. Out of them, only 29 spices are explored for their cytotoxicity against different cancer cell lines. The pre-clinical and clinical anticancer studies of spices along with their toxicity, mechanism of actions like Wnt/ß-catenin, phosphatidylinositol-3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR), JAK/STAT, mitogen-activated protein kinase (MAPK), Notch-mediated pathways and Quantitative structure-activity relationship (QSAR) studies were also focused. Curcumin was found as one of the most explored bioactive in every aspect such as in-vitro, in-vivo, clinical as well as SAR anticancer studies while some other bioactive such as 1,8-Cineole, trans-Anethole, Diosgenin, Trigonelline are either unexplored or least explored for their clinical and SAR studies. In fact, traditional medicinal uses of spices also provide solid shreds of evidence for the new leads towards the invention of novel anticancer agents. Therefore, further research can be designed for the anticancer marketed formulation from spices after having their placebo and related toxicological data.

A review on health benefits of phenolics derived from dietary spices.

Spices are an affluentpool of polyphenolcompounds that possessgigantic medicinal peculiarities such as remedying microbial infections, oxidative stress, inflammation, diabetes, cancers, neurodegenerative disorders, cardiac disorders, etc. On that account, thepresent review illustrates the therapeutic potential, mechanism of action, and different procedures for conscious extraction of polyphenols. The various ethnopharmacological properties; reasons for their diverse pharmacological actions and the mechanism of action of spices-derived phenolics have also been discussed. The findings of this review may be utilized by the food and pharmaceutical industries for developing suitable alternatives to synthetic antioxidants and can be developed into effective food supplements. Further in-depth scientific studies are needed to find out their actual and exact relevance as natural health boosters. Moreover, clinical and toxicological studies are also required for harnessing the full therapeutic potential of polyphenols derived from dietary spices.

Natural products: Potential therapeutic agents to prevent skeletal muscle atrophy.

The skeletal muscle (SkM) is the largest organ, which plays a vital role in controlling musculature, locomotion, body heat regulation, physical strength, and metabolism of the body. A sedentary lifestyle, aging, cachexia, denervation, immobilization, etc. Can lead to an imbalance between protein synthesis and degradation, which is further responsible for SkM atrophy (SmA). To date, the understanding of the mechanism of SkM mass loss is limited which also restricted the number of drugs to treat SmA. Thus, there is an urgent need to develop novel approaches to regulate muscle homeostasis. Presently, some natural products attained immense attraction to regulate SkM homeostasis. The natural products, i.e., polyphenols (resveratrol, curcumin), terpenoids (ursolic acid, tanshinone IIA, celastrol), flavonoids, alkaloids (tomatidine, magnoflorine), vitamin D, etc. exhibit strong potential against SmA. Some of these natural products have been reported to have equivalent potential to standard treatments to prevent body lean mass loss. Indeed, owing to the large complexity, diversity, and slow absorption rate of bioactive compounds made their usage quite challenging. Moreover, the use of natural products is controversial due to their partially known or elusive mechanism of action. Therefore, the present review summarizes various experimental and clinical evidence of some important bioactive compounds that shall help in the development of novel strategies to counteract SmA elicited by various causes.

A review on traditional uses, phytochemistry, pharmacology, and clinical research of dietary spice Cuminum cyminum L.

Cuminum cyminum L. is a versatile spice belonging to family Apiaceae. Though the plant has pan-tropical distribution but it is indigenous to Egypt, the Mediterranean, and South Asian countries. It exhibits numerous culinary, traditional, and pharmacological attributes. Its traditional uses also validate its immense pharmacological potential. Cuminum cyminum is the hub of numerous bioactives such as alkaloids, flavonoids, terpenoids, and so forth. Cuminaldehyde is the major bioactive, rendered to most of its pharmacological as well as clinical significance. The present study comprised of current knowledge on its taxonomy, nutritional, traditional, phytochemistry, pharmacology (antimicrobial, antioxidant, anti-inflammation, antidiabetic, wound healing, anticancer, etc.), toxicology, and clinical attributes. Besides, the mechanism of action is also well explained. The present study provides a rationale for further bioprospection of this wonder plant. Future studies are needed to fill the research gaps, particularly on relevant phytocompound isolation, their pre-clinical and clinical characterization, evaluation, and structure-activity relationship. Moreover, well-designed and highly appropriate clinical and placebo trials are still needed to demonstrate the trustworthy role of cumin on human health.

An overview of nanomaterial based biosensors for detection of Aflatoxin B1 toxicity in foods.

Aflatoxin B1 (AFB1) is one of the most potent mycotoxin contaminating several foods and feeds. It suppresses immunity and consequently increases mutagenicity, carcinogenicity, teratogenicity, hepatotoxicity, embryonic toxicity and increasing morbidity and mortality. Continuous exposure of AFB1 causes liver damage and thus increases the prevalence of cirrhosis and hepatic cancer. This article was planned to provide understanding of AFB1 toxicity and provides future directions for fabrication of cost effective and user-friendly nanomaterials based analytical devices. In the present article various conventional (chromatographic & spectroscopic), modern (PCR & immunoassays) and nanomaterials based biosensing techniques (electrochemical, optical, piezoelectrical and microfluidic) are discussed alongwith their merits and demerits. Nanomaterials based amperometric biosensors are found to be more stable, selective and cost-effective analytical devices in comparison to other biosensors. But many unresolved issues about their stability, toxicity and metabolic fate needs further studies. In-depth studies are needed for development of advanced nanomaterials integrated biosensors for specific, sensitive and fast monitoring of AFB1 toxicity in foods. Integration of biosensing system with micro array technology for simultaneous and automated detection of multiple AFs in real samples is also needed. Concerted efforts are also required to reduce their possible hazardous consequences of nanomaterials based biosensors.

Phytochemical and pharmacological review of Cinnamomum verum J. Presl-a versatile spice used in food and nutrition.

Cinnamomum verum is the widely used spice for its medicinal and culinary uses since ages. It is native to Sri Lanka and southern India but also distributed in many Asian, Caribbean, Australian and African countries. It is widely used in food preparations and industrial products like candies, chewing gums, mouthwash and toothpaste. It is also used to treat asthma, bronchitis, diarrhea, headache, inflammation and cardiac disorders. Cinnamaldehyde, eugenol, caryophyllene, cinnamyl acetate and cinnamic acid are the major compounds found in its essential oil. These compounds exhibit a wide range of pharmacological activities including antioxidant, antimicrobial, anti-inflammatory, anticancer, antidiabetic, wound healing, anti-HIV, anti-anxiety and antidepressant, etc. This review highlights its comprehensive and up-to-date information on taxonomy, ethnomedicinal uses, phytochemical composition, pharmacological and toxicity activities. Structure-activity relationship, mechanism of action and some research gaps has also been provided. Owing to its immense medicinal importance, more well-designed in-vivo and clinical studies are required.

Chemical characterization, phytotoxic, and cytotoxic activities of essential oil of Mentha longifolia.

The present study assessed the phytotoxic and cytotoxic potential of the essential oil (EO) extracted from aboveground parts of Mentha longifolia (L.) Huds. Gas chromatography-mass spectrometry revealed 39 compounds constituting 99.67% of the EO. The EO was rich in monoterpenoids (mostly oxygenated monoterpenes), which accounted for 89.28% of the oil. The major components in EO were monoterpene ketones such as piperitone oxide (53.83%) and piperitenone oxide (11.52%), followed by thymol (5.80%), and (E)-caryophyllene (4.88%). The phytotoxic activities of EO were estimated against Cyperus rotundus, Echinochloa crus-galli, and Oryza sativa (rice) through pre- and post-emergence assays at concentrations ranging from 10 to 250 µg/ml and 0.5-5%, respectively. In pre-emergence assay, the phytotoxic effect of EO was most pronounced on C. rotundus, thereby significantly affecting percent germination, plantlet growth, and chlorophyll content. On the contrary, the impact was comparatively lesser on rice, with ~ 40% germination in response to 250 µg/ml of EO treatment. In the post-emergence assay, the spray treatment of EO caused a loss of chlorophyll and wilting in test plants, and subsequently affected the growth of plants, even leading to death in some cases. The cytotoxic activity of EO (at 2.5-50 µg/ml) was studied in meristem cells in onion (Allium cepa L.) root tips. EO exposure to the onion roots induced various chromosomal aberrations such as chromosomal bridges, c-mitosis, stickiness, vagrant chromosomes, etc., and negatively affected the mitotic index. At 50 µg/ml, EO treatment triggered the complete death of roots. The study concludes that M. longifolia EO has phytotoxic activities due to the mito-depressive effect, along with other physiological effects on target plants. Therefore, EO of M. longifolia could be developed into a novel bioherbicide for sustainable management of weeds in agricultural systems.

Dissipation and decontamination behavior of pre-mix formulation of tebuconazole and rifloxystrobin fungicides in okra.

The present study was done to assess the dissipation behavior, decontamination, and half-life time of ready-mix formulation of trifloxystrobin (25% w/w) and tebuconazole (50% w/w) in okra and soil under the crop after foliar spray at fruiting stage. Samples of okra and soil were collected periodically, i.e., zero (2 h after spray), 1, 3, 5, 7, 10, 15, 20, and 25 days after third application at a 7-day interval. Residues of these fungicides were determined by gas liquid chromatography (GLC) equipped with electron capture detector (ECD) and gas chromatography-tandem mass spectrometry (GCMS-triple quadruple). The limits of quantification (LOQ) and detection (LOD) for both the fungicides were 0.01 and 0.003 mg kg-1, respectively. Washing alone with faucet water was found successful in minimizing the residues. Soil was free from residual contamination at fifth day after spraying in case of both the fungicides and at both the doses.

Phytochemical constituents and ethnopharmacological properties of Ageratum conyzoides L.

Ageratum conyzoides L. (Asteraceae) is an invasive aromatic herb with immense therapeutic importance. The herb is distributed in tropical and subtropical regions. A. conyzoides has imparted numerous ethnomedicinal uses because it has been used to cure various ailments that include leprosy, skin disorders, sleeping sickness, rheumatism, headaches, dyspnea, toothache, pneumonia and many more. A number of phytoconstituents have been scrutinized such as alkaloids, flavonoids, terpenes, chromenes, and sterols from almost every part of this plant. These phytoconstituents have shown diverse pharmacological properties including antimicrobial, anti-inflammatory, analgesic, antioxidant, anticancer, antiprotozoal, antidiabetic, spasmolytic, allelopathy, and many more. The plant A. conyzoides has provided a platform for doing pharmaceutical and toxicological research in order to isolate some promising active compounds and authenticate their safety in clinical uses. A. conyzoides provides principal information for advanced studies in the field of pharmaceutical industries and agriculture. Present review article describes the cytogenetics, ethnobotany, phytochemistry, pharmacology, and toxicological aspects of A. conyzoides.

Type-I Tibial Hemimelia: A Limb-Salvage and Lengthening Technique.

BACKGROUND: Tibial hemimelia is a rare but disabling condition. Although reconstructive methods have been described, the recommended treatment typically has been amputation at various levels followed by the use of a suitable prosthesis. A new technique known as femoro-fibulo-calcaneal arthrodesis has been developed as a limb-salvage procedure for patients with type-I deficiency who refuse amputation or have no access to good prosthetic care. METHODS: Twelve children (18 extremities) with type-I tibial hemimelia were managed surgically. The ages of the patients at the time of surgery ranged from 2 to 14 years. The procedure includes 3 stages: loosening, lengthening, and stabilization. In all patients, the loosening stage involved release of soft-tissue contractures at both ends of the fibula. The lengthening stage involved either supervised lengthening at home with use with use of an external fixator (6 patients) or the use of traction in the hospital (6 patients). In all patients, the stabilization stage was subsequently performed by stabilizing the fibula to the femoral condyles proximally and the talus distally with use of crossed Kirschner wires. RESULTS: All 12 patients returned for follow-up for the first 5 years. All patients were evaluated by author. Two patients who had ipsilateral femoral focal deficiency were subsequently lost to follow-up. The remaining 10 patients were followed for a mean of 10 years (range, 5 to 32 years). All 10 patients were able to walk on their feet during follow-up. None of the patients in the present study had an amputation or needed a prosthesis. There were no major complications. CONCLUSIONS: A new procedure, femoro-fibulo-calcaneal arthrodesis, has been proposed for the treatment of type-I tibial hemimelia. The suggested procedure is simple, biological, cost-effective, and dependable. It provides a long-term stable and functional extremity that enables the patient to walk with plantigrade feet with sensation and proprioception. This limb-saving procedure should be considered as an alternative for patients who refuse to lose the limb or for whom good prosthetic care is unavailable. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Use of a Free Fibular Strut as a "Biological Intramedullary Nail" for the Treatment of Complex Nonunion of Long Bones.

BACKGROUND: Nonunion of long-bone fractures is difficult to treat, especially when the bones are osteoporotic or there is a large bone gap as a result of repeated failure of the metallic nails or implants. In such cases, the use of an autologous intramedullary fibular strut graft may be a viable treatment option. METHODS: Twenty-two patients with a complex nonunion of the shaft of the femur, humerus, or tibia were managed with a free autologous fibular strut graft for intramedullary fixation with use of closed or open methods. All patients had evidence of moderate to severe local osteoporosis and had a bone gap ranging from 4 to 20 mm. Nineteen patients had had 1 to 4 prior operations. The mean age was 51.5 years. The duration of nonunion ranged from 9 months to 4 years. RESULTS: The mean time to union was 17 weeks (range, 8 to 26 weeks), and the mean duration of follow-up was 4 years (range, 6 months to 17 years). All but 2 patients had healing at the time of the latest follow-up. CONCLUSIONS: The identification of a viable option for the treatment of difficult nonunion in osteoporotic bones has been a challenge. The insertion of a free autologous intramedullary fibular strut graft provided mechanical stability, and osteogenesis occurred inside the medullary canal of the host bone. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.