Reanalysis of the ß-ν[over ¯]_{e} Angular Correlation Measurement from the aSPECT Experiment with New Constraints on Fierz Interference.

On the basis of revisions of some of the systematic errors, we reanalyzed the electron-antineutrino angular correlation (a coefficient) in free neutron decay inferred from the recoil energy spectrum of the protons which are detected in 4π by the aSPECT spectrometer. With a=-0.104 02(82) the new value differs only marginally from the one published in 2020. The experiment also has sensitivity to b, the Fierz interference term. From a correlated (b,a) fit to the proton recoil spectrum, we derive a limit of b=-0.0098(193) which translates into a somewhat improved 90% confidence interval region of -0.041≤b≤0.022 on this hypothetical term. Tighter constraints on b can be set from a combined [shown as superscript (c)] analysis of the PERKEO III (ß asymmetry) and aSPECT measurement which suggests a finite value of b with b^{(c)}=-0.0181±0.0065 deviating by 2.82σ from the standard model.

Quasiparticle Energy in a Strongly Interacting Homogeneous Bose-Einstein Condensate.

Using two-photon Bragg spectroscopy, we study the energy of particlelike excitations in a strongly interacting homogeneous Bose-Einstein condensate, and observe dramatic deviations from Bogoliubov theory. In particular, at large scattering length a the shift of the excitation resonance from the free-particle energy changes sign from positive to negative. For an excitation with wave number q, this sign change occurs at a≈4/(πq), in agreement with the Feynman energy relation and the static structure factor expressed in terms of the two-body contact. For a≳3/q we also see a breakdown of this theory, and better agreement with calculations based on the Wilson operator product expansion. Neither theory explains our observations across all interaction regimes, inviting further theoretical efforts.

Connecting Berezinskii-Kosterlitz-Thouless and BEC Phase Transitions by Tuning Interactions in a Trapped Gas.

We study the critical point for the emergence of coherence in a harmonically trapped two-dimensional Bose gas with tunable interactions. Over a wide range of interaction strengths we find excellent agreement with the classical-field predictions for the critical point of the Berezinskii-Kosterlitz-Thouless (BKT) superfluid transition. This allows us to quantitatively show, without any free parameters, that the interaction-driven BKT transition smoothly converges onto the purely quantum-statistical Bose-Einstein condensation transition in the limit of vanishing interactions.

Mountain pygmies of Western New Guinea: a morphological and molecular approach.

The presence of "pygmy" or pygmoid groups among New Guinea populations has been the object of scientific interest since the end of the nineteenth century. Morphological and molecular data are used here to study western New Guinea population variability, focusing in particular on two pygmoid groups living in the eastern fringe highlands of Papua: the Una and the Ketengban. Various kinds of anthropometric data are examined, as well as height, weight, and body mass index, to carry out comparisons with nearby ethnic groups living in the highland and lowland regions. The Ketengban data were also compared with other data recorded 20 years before. The results of previous research on the sequencing of the mitochondrial DNA hypervariable segment 1 region and nuclear DNA nonrecombining Y-chromosome polymorphisms are presented. Both morphological and molecular studies involve adult subjects of both genders, representative of the same ethnic groups and/or geographic regions. The pygmoid groups turn out to be significantly different from all other study groups, due to their small size, as confirmed by analysis of variance, although significant height and weight increments are observed with respect to those previously recorded. However, putative neutral genetic variation estimated from mitochondrial DNA and Y-chromosome markers support a recent shared common history between these pygmoid populations and the other central Papua groups (except for the Dani-Lani). These findings suggest that the short-stature phenotype is an independent secondary adaptation, possibly driven by an iodine-deficient environment, which leaves the potential for further investigations.

Operative versus non-operative treatment for two-part surgical neck fractures of the proximal humerus.

INTRODUCTION: Aim of this study was to evaluate outcomes of operative as compared to conserveative treatment for two-part humerus fractures at the surgical neck. METHODS: Data from a prospective multi-centre cohort study on four treatment options (conservative treatment and three implants, i.e. LPHP, PHILOS and PHN) for proximal humerus fractures were evaluated in this post hoc analysis. All patients with two-part fractures of the surgical neck (AO types A2, n = 54 and A3, n = 110) were identified and included for the analysis. All operatively treated patients were gathered and compared to those receiving conservative treatment. Primary outcome parameters were pain, range of motion and absolute and relative Constant scores at 3, 6 and 12 months following injury and coronal plane alignment at 12 months. RESULTS: Operative (n = 133) and non-operative (n = 31) groups were comparable with regard to all parameters assessed including mean age (62.9 vs. 65.6, P = 0.479), gender (27 vs. 29 % male, P = 0.826) and fracture distribution (65 vs. 77 % A3 type, P = 0.207). 26 of the 31 conservatively treated and 103 of the 133 operatively treated patients (84 and 77 %, respectively) were available for final follow-up. There was a continuous improvement for all outcome parameters in both treatment groups (P < 0.001). Operative treatment resulted in a more effective reduction of pain at 3 months (51 vs. 76 % reporting pain at fracture site, P = 0.03) and a reduction of coronal plane malalignment. Both range of motion and Constant scores were, however, comparable in both groups at all follow-up visits. Relative and absolute Constant scores were generally excellent at final follow-up (74 vs. 74, P = 0.528 and 89 vs. 91, P = 0.494, respectively). CONCLUSIONS: Both non-operative treatment and operative treatment using modern implants (LPHP, PHILOS and PHN) can be considered safe and effective treatment options for two-part fractures of the proximal humerus. Operative treatment may result in better range of motion and reduced pain in the early postoperative course of treatment.

R×B drift momentum spectrometer with high resolution and large phase space acceptance.

We propose a new type of momentum spectrometer, which uses the R×B drift effect to disperse the charged particles in a uniformly curved magnetic field, and measures the particles with large phase space acceptance and high resolution. This kind of R×B spectrometer is designed for the momentum analyses of the decay electrons and protons in the PERC (Proton and Electron Radiation Channel) beam station, which provides a strong magnetic field to guide the charged particles in the instrument. Instead of eliminating the guiding field, the R×B spectrometer evolves the field gradually to the analysing field, and the charged particles can be adiabatically transported during the dispersion and detection. The drifts of the particles have similar properties as their dispersion in the normal magnetic spectrometer. Besides, the R×B spectrometer is especially ideal for the measurements of particles with low momenta and large incident angles. We present a design of the R×B spectrometer, which can be used in PERC. For the particles with solid angle smaller than 88 msr, the maximum aberration is below 10-4. The resolution of the momentum spectra can reach 14.4 keV/c, if the particle position measurements have a resolution of 1 mm.

4-(4,6-di[2,2,2-trifluoroethoxy]-1,3,5-triazin-2-yl)-4-methylomorpholinium tetrafluoroborate. Triazine-based coupling reagents designed for coupling sterically hindered substrates.

4-(4,6-Di[2,2,2-trifluoroethoxy]-1,3,5-triazin-2-yl)-4-methylomorpholinium tetrafluoroborate (DFET/NMM/BF(4)) was prepared and used as a reagent for coupling sterically hindered substrates. The formation of the appropriate triazine "superactive" ester in a reaction of DFET/NMM/BF(4) with carboxylic acids was confirmed. The efficiency of the reagent has been studied in the synthesis of Leu-enkephaline pentapeptide carried out on a Fmoc-RinkAmide-AM-PS resin, by systematically modifying the -Gly-Gly- fragment for N-methyl or α,α-disubstituted residues and compared with the efficiency of classic aminium salt 2-(1H-benzotriazole-1-yl)-1,1,3,3-tetramethyluronium tetrafluoroborate (TBTU) under a variety of reaction conditions. In syntheses of Aib-Aib (Aib: α-aminoisobutyric acid), MeVal-MeVal, and MeLeu-MeLeu, the considerably superior performance of enkephaline analogues was obtained for DFET/NMM/BF(4) relative to TBTU, regardless of reaction conditions. Analysis of the couplings involving triazine reagent suggests that factors controlling efficiency of coupling sterically hindered substrates are the structure of the leaving group permitting formation of the cyclic intermediate or cyclic transition state and the absence of strongly solvating solvents. It has to be considered as highly probable that the absence of strongly solvating milieu favors cyclic intermediates or the cyclic transition state. Arrangement of both components into the cyclic intermediate or cyclic transition state by accumulation of the geminal (vicinal) substituents effect (known as the Thorpe-Ingold effect) would compensate retardation of the coupling process caused by steric hindrance.

Percutaneous iliosacral screw insertion: malpositioning and revision rate of screws with regards to application technique (navigated vs. Conventional).

BACKGROUND: Conventional percutaneous iliosacral screw placement in pelvic surgery is considered to be a highly demanding operative technique with a high rate of screw malpositions, which may be associated with the risk of neurologic damage or inefficient stability. In the conventional technique, the correct entry point for the screw and the small target corridor for the iliosacral screw may be difficult to visualize using an image intensifier. We tried to find out in this study whether the positioning of percutaneous screw implantations could be optimized by evaluating the rate and grade of malpositions and whether the needed revisions could be reduced by using computer navigation and three-dimensional (3D) image intensifier. METHODS: A group of 54 patients with 63 screws implanted using computer navigation was compared with 87 patients with 131 screws implanted using the conventional fluoroscopic technique. The exact screw position was controlled in a postoperative computed tomography scan, and the grade of malposition of every screw was investigated and compared. RESULTS: A complete intraosseous screw position was found in 42% of cases using the conventional technique and was significantly less compared with 81% using a 3D image intensifier in combination with a navigation system. Moreover, the revision rate of 1.6% was significantly less in the navigated group compared with 19% in the conventional group. CONCLUSIONS: The results indicate that 3D-computer navigation of the percutaneous iliosacral screw insertion can facilitate surgical performance in respect to reducing screw malposition and revision rates.

Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique.

BACKGROUND: The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate. METHODS: One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six month,and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up. RESULTS: Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture. CONCLUSIONS: Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.

[Variability of the screw position after 3D-navigated sacroiliac screw fixation. Influence of the surgeon's experience with the navigation technique]. / Variabilität der Schraubenlage bei 3D-navigierter Sakrumverschraubung. Einfluss der operateurspezifischen Navigationserfahrung.

BACKGROUND: The precision of sacroiliac screw placement can be improved with the use of navigation techniques. The purpose of this study was to evaluate the accuracy of 3D-navigated sacroiliac screw positioning in relation to the surgeon's experience with the navigation technique. PATIENTS AND METHODS: A consecutive series of 3D-navigated sacroiliac screw placements were prospectively evaluated between December 2005 and February 2008. Postoperatively the precision of screw placement was analyzed in relation to the surgeon's navigation experience with a CT-scan using the criteria of Smith. RESULTS: A total of 37 screws were implanted by 7 surgeons in 33 patients. In the group of surgeons with less experience in navigation techniques two cases of malpositioning led to revision of the screws. No screws which were implanted or assisted by surgeons experienced in navigation needed to be revised. There was no significant difference in the malposition rate. CONCLUSION: In the clinical setup a malpositioning of sacroiliac screws is possible even with the use of 3D navigation. One reason may be a low level of navigation experience of the surgeon in combination with low experience in the conventional technique. Therefore even in navigation-based placement of sacroiliac screws the malpositioning rate is dependent on the surgeon's experience with the navigation technique. The correct placement of the screws should be controlled intraoperatively using the 3D image intensifier.

The impact of nasal surgery on air-conditioning of the nasal airways.

Air-conditioning in the nasal passageways is one of the most important functions of the upper airways. By means of in-vivo-measurements and numerical simulation, the air-conditioning function of the nose has been extensively investigated. Less well known is the effect of nasal surgery on the nasal climate. The following study presents a summary of the effect of various rhino-surgical operations, i.e. turbinoplasty, septoplasty, septorhinoplasty, repair of septal perforations, functional and radical sinus surgery, on the air-conditioning function of the nose. Nasal and sinonasal interventions have been demonstrated to be associated with increased nasal heating and humidification when the mucosal lining is preserved. Radical interventions with reduction of turbinate tissue cause reduced nasal warming and moistening within the nasal airway, with increased risk of nasal dryness and crusting. Although the impact of the nasal cycle and the airflow distribution within the nasal cavity on nasal temperature and humidity distribution is not fully understood yet, too much widening of the nasal cavity by sinunasal interventions has carefully to be avoided.

[Sports activity and proprioceptive ability after arthroscopic capsulolabral repair of post-traumatic shoulder instability]. / Sportfähigkeit und propriozeptive Fähigkeiten nach arthroskopischer Kapsel-Labrum-Rekonstruktion bei posttraumatischer Schulterinstabilität.

AIM: The aim of the study was to evaluate the clinical and functional outcome after arthroscopic transglenoid stabilisation of post-traumatic shoulder instabilities. Besides assessing the sports activity level, a special emphasis was put into evaluating the proprioceptive ability in a clinical-experimental setting as well as comparisons with a control group. METHOD: We evaluated the functional results of 35 patients after arthroscopic stabilisation of post-traumatic, unidirectional anterior shoulder instabilities at a mean of 47.4 +/- 12.8 months postoperatively. Criteria such as subjective level of contentedness, range of motion, stability and sports activity as well as the Constant and Rowe scores were recorded. Joint position sense was assessed in 30 degrees internal and external rotation with the passive angle reproduction test using an inclinometer. The difference between the discerned and the target joint position was used as a measure of proprioceptive ability. Results were compared to the contralateral shoulder as well as to a control group consisting of 31 volunteers without any history of shoulder pain or injury. The Mann-Whitney U-test was used for statistical analysis. RESULTS: The level of subjective satisfaction on a visual analogue scale was 9.3 +/- 1.1 points. ROM testing showed a mean loss of 4.8 +/- 5.1 degrees of external rotation compared to the contralateral shoulder. A mean Constant score of 88.9 +/- 7.8 and a mean Rowe score of 86.7 +/- 19.0 points were obtained. Four patients had a reluxation of the shoulder, in 3 cases due to an adequate traumatic event. 20 of 24 athletes (83 %) were able to return to their previous sports activity level without any restrictions. Passive angle reproduction testing showed no significant difference regarding the proprioceptive ability between operated shoulders in internal and external rotation (mean angle difference IRO = 2.6 +/- 1.4 degrees , ARO = 3.3 +/- 1.5 degrees ) compared to the contralateral shoulder (2.9 +/- 1.5 degrees , 3.6 +/- 1.8 degrees , p = 0.56/0.36) as well as compared to the control group (3.0 +/- 1.1 degrees , 3.4 +/- 1.1 degrees , p = 0.67/0.32). CONCLUSIONS: The results of this study indicate that arthroscopic transglenoid shoulder stabilisation is a sufficient technique for the treatment of post-traumatic shoulder instability. Arthroscopic capsulolabral reconstruction led to a complete restoration of the proprioceptive ability in internal and external rotation. 83 % of the patients were able to return to their preoperative sports activity level.

Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study.

BACKGROUND: The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate. METHODS: One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six-month, and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up. RESULTS: Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture. CONCLUSIONS: Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.

Effect of carboxymethylcellulose nasal packing on wound healing after functional endoscopic sinus surgery.

BACKGROUND: Functional endoscopic sinus surgery (FESS) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis. Nasal packing is usually placed after the surgery to support wound healing and prevent adhesions. The purpose of this study was to investigate the effect of carboxy-methylated cellulose (CMC) nasal packing on wound healing after FESS compared with no nasal packing. METHODS: Twenty-six patients underwent bilateral FESS. The patients were randomized to receive CMC mesh or gel packing on one side and no packing on the opposite side. The patients were followed at 2, 4, and 12 weeks after surgery. Endoscopically visible CMC, crusting, mucosal integrity, synechia formation, granulation tissue formation, and adverse side effects were assessed and documented. RESULTS: No adverse side effects were observed. No significant differences were found between the CMC-packed side and the unpacked side with respect to the outcome measure of wound healing. No difference was found between two different forms of CMC in terms of wound healing. Two weeks after surgery, endoscopically visible CMC was detected in four patients of the CMC mesh group, whereas none of the patients in the CMC gel group had endoscopically visible CMC (p = 0.040). CONCLUSION: As we were unable to establish an effect, we must question the efficacy of this packing material and the necessity of its use after FESS based on the technique of the Graz University Medical School. The mesh form of CMC could be potentially useful as a vehicle for extended drug delivery owing to its longer retention time in the nose.

CMC packing in functional endoscopic sinus surgery: does it affect patient comfort?

BACKGROUND: Functional endoscopic sinus surgery (FESS) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis (CRS and nasal polyposis). Nasal packing is usually placed after the surgery to minimize mucosal bleeding and support the wound healing process. Both the packing itself and its removal are often associated with pain and discomfort. OBJECTIVE: To evaluate the effect of carboxymethylcellulose (CMC) nasal packing on patient comfort following FESS. METHODS: Forty consecutive patients underwent bilateral FESS. One side of the nasal cavity was packed with CMC (mesh or gel) and the opposite side was not packed, the sides having been randomly selected. Postoperatively, patients were given visual analog scales to rate nasal airway obstruction and headache/pressure separately for the right and left sides. They also rated sleep disturbance and general well-being. RESULTS: No significant differences were found between the CMC-packed side and the unpacked side with regard to patient comfort. No significant differences were found between CMC mesh and CMC gel. CONCLUSION: Based on the presented data concerning patient comfort, CMC appears to be an ideal packing material following FESS. However, there is no other study revealing an identical study design focusing on other resorbable packing material. As a consequence, other available resorbable packing material should be investigated to find the ideal packing material following FESS, if packing is required.

Dynamic infrared thermography of the nasal vestibules: a new method.

OBJECTIVE: The surface temperature distribution within the nasal vestibule and the nasal cavity strongly depends on the exact intranasal detection site and point of time during the respiratory cycle. Therefore, conventional temperature measurements e.g. with thermocouples only provide selective measurements. The use of infrared thermography cameras could present a new contactless method with a high spatiotemporal resolution. The aim of the present study was to evaluate the use of infrared thermography camera systems for measurements of the nasal surface temperature during respiration. METHODS: The surface temperature profiles within the nasal vestibules of healthy volunteers were recorded with infrared thermography cameras during several breathing cycles. Two different types of infrared thermography standard systems were used. RESULTS: The recordings allowed a display of temperature alterations within the nasal vestibules in a high spatiotemporal resolution synchronous to the breathing cycle. During inspiration, the vestibular surface cooled down presenting a non-homogenous distribution (range, 24.7 to 30.2 degrees C). During expiration, the vestibular surface was warmed again with a non-homogenous distribution (range, 33.1 to 36.2 degrees C). The results of both camera systems were comparable. CONCLUSION: Infrared thermography cameras allow the exact mapping of nasal surface temperature within the nasal vestibules with a high spatiotemporal resolution without surface contact.

Control of bleeding following functional endoscopic sinus surgery using carboxy-methylated cellulose packing.

The aim of this study is to evaluate the haemostatic effect of carboxy-methylated cellulose (CMC) nasal packing following functional endoscopic sinus surgery (FESS). The design includes an investigator-initiated, randomized, single-blinded, controlled, prospective clinical study. A bilateral FESS procedure was performed on 41 patients. At the end of the operation, one side was randomly filled with CMC nasal packing, the other side remained without packing. The patients were blinded to the side of nasal packing and were postoperatively examined on the 1st day, after 2 and 4 weeks and the extent of the postoperative bleeding was quantified with a clinical grading system. Even though there were slightly more postoperative bleedings reported for the non-packed sides as compared to the CMC-packed sides, these differences were at no point statistically significant within the monitored postoperative period of 4 weeks. In the examined collective, the CMC packing investigated did not statistically prove to have an effect on bleeding control in this study design.

Comparing centralised and decentralised anaerobic digestion of stillage from a large-scale bioethanol plant to animal feed production.

A comparison of stillage treatment options for large-scale bioethanol plants was based on the data of an existing plant producing approximately 200,000 t/yr of bioethanol and 1,400,000 t/yr of stillage. Animal feed production--the state-of-the-art technology at the plant--was compared to anaerobic digestion. The latter was simulated in two different scenarios: digestion in small-scale biogas plants in the surrounding area versus digestion in a large-scale biogas plant at the bioethanol production site. Emphasis was placed on a holistic simulation balancing chemical parameters and calculating logistic algorithms to compare the efficiency of the stillage treatment solutions. For central anaerobic digestion different digestate handling solutions were considered because of the large amount of digestate. For land application a minimum of 36,000 ha of available agricultural area would be needed and 600,000 m(3) of storage volume. Secondly membrane purification of the digestate was investigated consisting of decanter, microfiltration, and reverse osmosis. As a third option aerobic wastewater treatment of the digestate was discussed. The final outcome was an economic evaluation of the three mentioned stillage treatment options, as a guide to stillage management for operators of large-scale bioethanol plants.

Tibial wedge osteotomy for osteochondral transplantation in talar lesions.

Between 1999 and 2002, 16 patients with osteochondral lesions on the central and posterior talar dome underwent osteochondral autografting. A new approach with temporary removal and replacement of a tibial bone block from the anterior tibial plafond was adopted. Inclusion criteria were joint stability, an age between 18 and 50 years, and osteochondral lesions stages 3 and 4 according to the radiological classification of Loomer, for which previous arthroscopic treatment was not successful. All patients underwent clinical and MRI evaluation after 12, 35 and 59 months. The AOFAS Ankle Hindfoot score improved significantly between the preoperative period and 1 year (p < 0.001), between 1 and 3 years (p < 0.001), but not between 3 and 5 years postoperative (p = 0.37). The score was independent from patients gender (p = 0.44) and age. The Spearman coefficient of correlation between clinical outcome and defect size was - 0.79 (p = 0.01), indicating that patients with small lesions had the best results. Control radiographs and MRIs showed no reduced joint space and good integration of the tibial bone block without incongruency. Osteochondral grafting with temporary removal of a tibial bone block is a successful technique with good midterm results in osteochondral talar lesions for which arthroscopic excision, curettage and drilling has failed.

Proximal humerus fractures - current treatment options.

Proximal humerus fractures represent an increasing challenge for the health system due to epidemiological changes. As estimated by a Finnish study group the number of fractures may triple by the year 2030. The majority of patients with these fractures are older than 60 years and in this population most of the proximal humerus fractures have been related to osteoporosis. Nondisplaced fractures and fractures with minimal displacement and adequate stability are usually successfully treated non-operatively. The main challenge in the operative treatment of displaced and unstable proximal humerus fractures is to achieve effective stabilization of an adequately reduced fracture to maximize the functional patient outcome. Especially in osteoporotic bone and comminuted fractures operative stabilization is challenging and the management of displaced and unstable fractures remains controversial. The most important factor for favourable results in the treatment of complex three-part or four-part humerus fractures is anatomic reduction. Minimal exposure, high primary stability, and load transfer through the implant are important for avoiding complications such as secondary dislocation, osteonecrosis, and stiffness. Recently invented implants with angular stability provide better biomechanical properties and enhanced anchorage especially in the osteoporotic bone. These implants therefore have a potential for achieving better results in the treatment of these complex injuries.