Talonavicular-cuneiform arthrodesis in the management of Mueller-Weiss Syndrome: a retrospective case series.

Mueller-Weiss Syndrome (MWS), characterized by spontaneous adult-onset tarsal navicular osteonecrosis, is an uncommon cause of chronic midfoot pain that can lead to functional impairment and progressive deformities. This study aimed to present clinical and radiological outcomes of talonavicular-cuneiform (TNC) arthrodesis in the treatment of patients with MWS. A retrospective study was performed on 8 consecutive patients (6 female, 2 male; mean age = 50 years; range = 33-64) who underwent TNC arthrodesis using plate fixation with autologous bone grafting for the treatment of MWS. To evaluate clinical status, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Midfoot Score was performed immediately preoperatively and at the final follow-up. In radiographic evaluation, talus-first metatarsal angle (Meary's angle) was measured preoperatively and at the final follow-up. Solid fusion was also examined on postoperative radiographs and computerised tomography. The mean follow-up was 35 months (range = 24-52). The mean AOFAS improved from 37 (range = 24-53) preoperatively to 85 (range = 80-93) at the final follow-up (p < 0.001). No major intra- operative complications were observed in any of the patients. According to the Maceira and Rochera radiological staging system, 5 feet was stage 3, and 3 feet was stage 4. The mean union time was 10 months (range = 5-15). Radiographic solid fusion was achieved in all but one foot that developed talonavicular non-union. TNC arthrodesis using plate fixation with autologous bone grafting seems to be an effective surgical method for reconstruction of MWS.

Comparison of High Hip Center versus Anatomical Reconstruction Technique in Crowe Types II and III Developmental Dysplasia of the Hip: a Retrospective Clinical Study.

PURPOSE OF THE STUDY The literature is conflicting as to whether the high hip center (HHC) reconstruction in total hip arthroplasty (THA) is an ideal option for patients with severe developmental dysplasia of the hip (DDH). This study aimed to compare the mid-term functional and radiographic outcomes of THA using HHC versus anatomical hip center (AHC) technique in Crowe types II and III DDH. Our hypothesis was that there may be no differences in terms of functional and radiographic outcomes between patients who underwent THA using HHC or AHC. MATERIAL AND METHODS Fifty-seven patients who underwent a primary THA due to Crowe type-II or type-III DDH were retrospectively reviewed and included. Patients were divided into two groups as per the hip center reconstruction: Group A (AHC technique) and group H (HHC technique). A cementless cup was inserted in 25 hips (19 female, 6 male; mean age = 51 years, age range = 28-67)) at near-AHC in group A and 32 hips (22 female, 10 male; mean age = 53 years, age range = 29-68) at HHC position in group H. To assess clinical status, the Harris Hip Score (HHS) was used at the final follow-up. In radiographical assessment, component loosening and osseointegration of the acetabular cup were examined on follow-up radiographs. Complications were also recorded. RESULTS The mean follow-up was 41 months (range, 25-84) in group A and 40 months (range, 24-86) in group H. The mean HHS was 83 (range, 74-91) in group A and 83.6 (range, 73-94) in group H (p = 0.741). Osteolysis was determined in three patients from each group. The other 51 cups demonstrated a minimum of one radiographic sign of osseointegration. Although the overall complication rate was higher in group A (64%) than in group H (46%), this difference reached no statistical significance (p = 0.11). CONCLUSIONS The HHC technique using cementless acetabular fixation seems to be a valuable alternative option to AHC technique in cases of Crowe types II and III DDH. Key words: High hip center; anatomical hip center; center of rotation; total hip arthroplasty; dysplastic hip; developmental dysplasia of the hip; Crowe type II; Crowe Type III.

Influence of age, gender, and educational background on tooth color.

INTRODUCTION: The purpose of this study was to determine the effect of age, gender, and educational background on the color coordinates of the maxillary central incisor. MATERIALS AND METHODS: The color of the maxillary central incisor teeth of 302 individuals was measured using a spectrophotometer. The L*, a*, and b* parameters were recorded. T-tests, analysis of variance (ANOVA), and the Scheffe's post-hoc tests were used to describe the relation of the L*, a*, and b* values between color with age, gender, and educational background. RESULTS: The results of this study showed that a significant difference among all three parameters of color and age was observed. There was a significant difference for the a* and b* parameters for gender, but no difference was found for the L* parameter. Finally, there was a significant difference in the L* and a* parameters, but no difference in the b* parameter in terms of educational background. CONCLUSIONS: As individuals age, their tooth color darkens. Women have lighter teeth than men. The tooth color of high school graduates was found to be lighter than that of the other groups.

Influence of micro- and nano-hydroxyapatite coatings on the osteointegration of metallic (Ti6Al4 V) and bioabsorbable interference screws: an in vivo study.

The purpose of this study is to show and compare the fixation and osteointegration capability of metallic and bioabsorbable interference screws. For this, 8×20-mm interference screws were implanted into the bone tunnel in the proximal tibial metaphysis of sheep. The nano- (25 nm±0.8) and microscale (25 µm±0.5) hydroxyapatite were both dip-coated on Ti6Al4 V interference screws via an in vivo study. After the initial 12 weeks of postoperative, the pullout test, histopathology, X-ray diffraction and scanning electron microscopy examinations were performed. This multidisiplined work showed that the coated screws particularly those with nano-sized-HA coating and the bioabsorbable screws enhanced fixation and provided better stabilization, bone ingrowth and osteointegration than that of uncoated and microscale HA-coated screws. The bioabsorbable screws showed better histopathologic results.

Fabrication of hydroxyapatite-based nano-gold and nano-silver-doped bioceramic bone grafts: Enhanced mechanostructure, cell viability, and nuclear abnormality properties.

In this study, nano-gold (nAu) and nano-silver (nAg) were doped at the molar ratios of Molar5-Molar30 to the Hydroxyapatite (HAp)-based bioceramic bone graft synthesized by the sol-gel method. The effects of nAu and nAg on structural, mechanical, cell viability, and nuclear abnormality of the synthesized bioceramic grafts were evaluated. The chemical and morphological properties of the bone grafts after production were examined through XRD and SEM-EDX analyses and mechanical tests. To determine the biocompatibility of the bone grafts, cell viability tests were performed using human fibroblast cells. In the cytotoxicity analyses, only HAp and HAp-nAu5 grafts did not show toxicological properties at any concentration, while HAp-nAg5 among the nAg-containing grafts gave the best results at the 200-100 µg/mL concentrations and showed significant cytotoxicity in human fibroblast cells. The other nAu-containing grafts showed toxicological properties in the concentration range of 200-50 µg/mL and nAg-containing grafts in the concentration range of 200-100 µg/mL against the negative control. The micronucleus (MN) analyses showed that the lowest total MN and L (lobbed) amounts, while the lowest total N (notched) amount, was obtained from the only HAp graft. It was found that the nAg-doped bone grafts gave higher total MN, L, and N amounts compared to the nAu-doped bone grafts. Furthermore, while the mean nuclear abnormality (NA) values of all grafts gave close results, the highest values were again obtained from the nAg-doped bone grafts.

Acute monoarthritis in children: clinical and laboratory factors distinguishing septic arthritis from noninfectious inflammatory arthritis.

OBJECTIVE: Distinguishing septic arthritis from specific inflammatory arthritis in children with acute monoarthritis can be a clinical challenge. This study aimed to assess the diagnostic performance of presenting clinical and laboratory findings for distinguishing septic arthritis from common forms of noninfectious inflammatory arthritis in children with acute monoarthritis. PATIENTS AND METHODS: Children presented for the first episode of monoarthritis were retrospectively reviewed and then divided into two groups: (1) the septic group, 57 children with true septic arthritis, and (2) the non-septic group, 60 children with several types of noninfectious inflammatory arthritis. Several clinical findings and serum inflammatory markers on admission were documented. RESULTS: Univariate analyses demonstrated that body temperature, weight-bearing status, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WCC), absolute neutrophil count (ANC), and neutrophil percentage (NP) levels were significantly higher in the septic group than in the non-septic group (p<0.001 for each variable). Based on the ROC analysis, optimum diagnostic cut-off values were 63 mg/L for CRP, 6,300/mm3 for ANC, 53 mm/h for ESR, 65% for NP, 37.1°C for body temperature, and 12,100/mm3 for WCC. While children with no presenting factor had a 4.3% risk of having septic arthritis, those with six predictors had a risk of 96.2%. CONCLUSIONS: A CRP level of ≥63 mg/L is the best independent predictor of septic arthritis among the commonly used serum inflammatory markers (ESR, WCC, ANP, NP). It should be borne in mind that a child with zero predictors may still have a 4.3% risk of septic arthritis. Thus, clinical assessment is still imperative in managing children presenting with acute mono-arthritis.

Long-term outcomes of conventional core decompression for osteonecrosis of the femoral head in systemic lupus erythematosus: a single-center retrospective study.

OBJECTIVE: Although the therapeutic efficacy of conventional core decompression (CD) for the early-stage osteonecrosis (ON) has been widely investigated in the literature, no study to date has specifically focused on its therapeutic effect on the long-term outcome of ON of the femoral head (ONFH) in systemic lupus erythematosus (SLE). This study aimed to provide a long-term survival analysis of all hips that underwent conventional CD for the management of ONFH in a consecutive case series of patients with SLE. PATIENTS AND METHODS: Sixteen hips of 10 consecutive SLE patients that underwent conventional CD for the management of ONFH in a single tertiary referral center were retrospectively identified and included in the study. After a retrospective chart review, several clinical and radiological data were recorded. RESULTS: All the hips treated with CD were stage I or IIA sclerotic and/or cystic based on the classification system of Ficat. Only the 2 hips of 1 patient (12.5%) survived both clinically and radiographically. The median overall survival for all hips after CD was 80 months (95% CI, 60-100). The 5-, 10-, and 15- year survival rates of hip joints following CD were 63%, 31%, and 12.5%, respectively (CI 95% 63.567 to 133.058 months). CONCLUSIONS: Conventional CD may not be effective in preventing the progression of pre-collapse ONFH to collapse and eventually end-stage osteoarthritis requiring arthroplasty in patients with SLE.

Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection.

PURPOSE: The aim of this study is to report the outcomes of the treatment of talar osteochondral lesions with arthroscopic microfracture technique and postoperative intra-articular hyaluronan injection. METHOD: Fifty-seven patients (29 men, 28 women) with osteochondral lesions of the talus were included in this prospective randomized clinical study between the years 2003 and 2009. The patients were treated with arthroscopic debridement and microfracture technique. Randomly selected 41 patients were injected intra-articular hyaluronan (injection group). The remaining 16 patients did not receive postoperative injection (non-injection group). Assessment of the pain and functional outcomes was performed using the Freiburg and AOFAS ankle/hindfoot scoring systems. RESULTS: In the injection group, the mean postoperative Freiburg functional and pain scores were significantly higher compared to preoperative functional and pain scores (P < 0.001). Similarly, for the patients in non-injection group, the mean postoperative Freiburg functional and pain scores were significantly higher compared to preoperative functional and pain scores (P < 0.001). The AOFAS functional and pain scores of the patients in the injection group were significantly higher (P < 0.001) postoperatively compared to preoperative scores. Scoring the patients in the non-injection group according to AOFAS system also revealed significantly higher (P < 0.001) postoperative functional and pain scores over preoperative scores. The increase in the postoperative scores was found to be significantly higher in the injection group compared to non-injection group in both Freiburg and AOFAS systems (P < 0.001). CONCLUSION: Treatment of osteochondral lesions of the talus using microfracture technique significantly improved functional and pain scores postoperatively. Additional treatment with intra-articular hyaluronan injection as an adjunct to microfracture technique may offer better clinical outcomes over microfracture technique alone. LEVEL OF EVIDENCE: Randomized, controlled trial, Level I.

A retrospective comparison of total versus partial cross-bone resection in surgical management of congenital cleft hand.

This study aimed to compare clinical and radiographical results of total or partial resection of the cross-bone in the management of children with cleft hand. Nine children with 10 cleft hands who underwent resection of the cross-bone were retrospectively identified and divided into two groups based on type of resection: Group T (total resection) including 5 children (5 affected hands; 3 boys; mean age = 3.5 (range, 2-5) years), and Group P (partial resection) including 4 children (5 affected hands; 3 boys; mean age = 3.2 (range, 2-5) years). Mean follow-up was 68 (range, 60-85) months in group T and 47 (range, 40-60) months in group P. To assess clinical status, postoperative cosmetic satisfaction was evaluated by asking the parents, and cosmetic appearance was rated using a visual analogue scale (VAS) at the follow-up. In the radiographical evaluation, change in cleft divergence following reconstruction was assessed as the metacarpal divergence angle between the index and the ring finger metacarpals. Overall, cosmetic satisfaction was rated "very satisfied" or "satisfied" in 7 of the 10 hands, and functional satisfaction as "very satisfied" or "satisfied" in all. Mean postoperative cosmetic aspect on VAS was 6.4 (range, 5-8) in group T, and 6.2 (range, 4-8) in group P (p = 0.99). Mean metacarpal divergence angle significantly decreased from 42.2° (range, 35-52°) and 40.2° (range, 36-46°) preoperatively to 21.2° (range, 15-35°) and 19.8° (range = 12-31°) at 3-year follow-up in groups T and P, respectively (p < 0.001 for each group). Both total and partial cross-bone resection provided satisfactory clinical and radiographical medium-term results for of children with cleft hand.

Aneurysmal Bone Cyst after Femoral Derotational Osteotomy: A Case Report.

Aneurysmal bone cysts rather than local aggressive lesions of the bone which may arise in any part of the axial or appendicular skeleton. Although several theories are available in the literature, the pathogenesis is still conflicting. We report an exceptional case of an aneurysmal bone cyst in the distal femur of a female cerebral palsy patient who underwent bilateral distal femoral derotational osteotomy and plate-screw fixation operations when she was 11 years old. Twenty-four months after the operation, radiographs showed a cystic lesion in the distal portion of the right femur around the osteotomy site. The diagnosis of Aneurysmal Bone Cyst (ABC) was made and the lesion was treated by curettage with cement application. After 36 months of follow-up, there was no recurrence. This is the first case reported in literature which raises the possibility that an osteotomy could be a cause in the development of an aneurysmal bone cyst.

In vitro study of antimicrobial and cell viability on newly synthesized bioglass-based bone grafts: Effects of selenium and silver additions.

Selenium (Se)- and Silver (Ag)-doped Bioglass®-based biografts were synthesized using the sol-gel method. Fourier-transform infrared spectroscopy, inductively coupled plasma mass spectrometry, scanning electron microscopy and energy-dispersive X-ray analyses were carried out in order to examine mechanostructure of synthesized bioglass-based bioceramics. The effects of Se and Ag additions on cell viability were investigated via cytotoxicity and antibacterial activity analysis, respectively. The bacteria of Escherichia coli ( E. coli, JM103) and Gram-positive Staphylococcus aureus ( S. aureus, ATCC29293) were used to perform the antibacterial tests. Moreover, cell viability studies were conducted using the Saos-2 osteoblast cells by performing dimethylthiazol diphenyltetrazolium bromide assay. It was observed that while (PO4)3- and (CO3)2- peaks were observed in Fourier-transform infrared spectroscopy analyses, crystallinity also increased with increasing amount of AgNO3 addition into the Bioglass®. In addition, it was determined from scanning electron microscopy images that small irregular thin lamellar grain distribution was formed in synthesized B45Ag5Se20 and B30Ag10Se15 biografts. From antibacterial activity tests, it was determined that while some grafts was affected by E. coli, which is a Gram-negative, however, some did not affect the Gram-positive S. aureus and had antimicrobial activity on E. coli and S. aureus. According to the cell viability tests, it was found that the synthesized grafts did not have toxic effect on living cells. While the cell growth was greater for some grafts, however, some others had lower growth.

Long-term results of scapulothoracic arthrodesis with multiple cable method for facioscapulohumeral dystrophy: do the results deteriorate over time?

Aims: The present study aimed to investigate the long-term functional results of scapulothoracic fusion using multifilament cables in patients with facioscapulohumeral dystrophy (FSHD) to identify if the early improvement from this intervention is maintained. Patients and Methods: We retrospectively investigated the long-term outcomes of 13 patients with FSHD (18 shoulders) in whom scapulothoracic fusion using multifilament cables was performed between 2004 and 2007. These patients have previously been reported at a mean of 35.5 months (24 to 87). There were eight men and five women with a mean age of 26 years. Their mean length of follow-up of our current study was 128 months (94 to 185). To evaluate long-term functional results, the range of shoulder flexion and abduction, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with a comparison of preoperatively, interim and at the final outcomes. The fusion was examined radiographically in all. Results: The complication rate was 33% (six of 18 scapulothoracic fusions) in 13 patients, which comprised failure of fusion in four shoulders (four patients) all occurring within the first year postoperatively. In two shoulders (one patient) wound problems arose due to attribution from the cables which required shortening but the fusion developed satisfactorily. At the final examination, the mean QuickDASH score and range of movement significantly improved in all but one patient (p < 0.001, p < 0.001 and p < 0.001). In the comparison of 13 patients' mid- and long-term results, the mean QuickDASH score decreased from 9.8 (sd 6.7; 3 to 26) in the third year to 9.1 (sd 5.6; 3 to 22) in the tenth year (p = 0.7); the mean range of shoulder flexion and abduction decreased from 129° (sd 22°; 90° to 160°) and 124° (sd 12; 100° to 150°) at the mid-term to 103° (sd 12°; 80° to 120°) and 101° (sd 8°; 80° to 120°) at the long-term, respectively (p = 0.78 and p = 0.65). Conclusion: Scapulothoracic fusion using a multiple cabling method can confer a considerable improvement in clinical and functional outcomes for most patients with FSHD after a long follow-up period. The technique requires careful execution to avoid complications. Cite this article: Bone Joint J 2018;100-B:953-6.

Effects of thymoquinone on liver miRNAs and oxidative stress in Ehrlich acid mouse solid tumor model.

We investigated the effects of thymoquinone (TQ) on the expression of liver microRNAs (miRNAs), liver histopathology and oxidative stress in Ehrlich acid solid tumor model induced mice. We used 24 male BALB/c mice divided randomly into three groups. Control (C) group mice were injected intraperitoneally (i.p.) with 0.5 ml saline for four weeks. Tumor (T) group mice were injected i.p. with 0.5 ml saline for four weeks, then Ehrlich acid tumor cells were injected subcutaneously into the neck to induce solid tumor formation. TQ (T + Tq) group mice injected i.p. with 10 mg/kg TQ for four weeks, then Ehrlich acid tumor cells were injected subcutaneously into the neck of the mice in this group to induce solid tumor formation. At the end of the study, liver from all groups were removed for histopathological and miRNAs analysis, and oxidative stress measurement. We found that the expression of miR-206b-3p was up-regulated and the oxidative stress and necrosis increased in the liver tissue of mice with Ehrlich acid solid tumor. TQ application decreased the oxidative stress, prevented necrosis, increased regeneration and down-regulated the expression of miR-206b-3p in the liver tissue.

Fibroblast cell attachment and growth on nanoengineered sculptured thin films.

Nanoengineered parylene-C sculptured thin films (STFs) are deposited on glass and silicon substrates using a direct one-step growth technique. The deposited STFs support fibroblast cell attachment and proliferation in vitro, which is an early indication of biocompatibility and bioactivity of this emerging class of biomaterials. Surface modification of endoprostheses of the small joints of the hand, which heal with fibrous stabilization, may be greatly enhanced by such nanoengineered biomaterials.

A case of spontaneous abortion related to ovarian endometriosis in a Golden Retriever dog.

This report describes a case of spontaneous abortion in a 4-year-old Golden Retriever dog with ovarian endometriosis. Clinical findings indicated that there was not any senstivity in the abdomen and the viability parameters were within the reference values. On vaginal examination, serosanguineous discharge was determined. Ultrasonographic examination revealed that no fetus was observed in cornu uteri and an hypoechoic cystic structure, measuring 3.2 × 3.4 cm was found behind the left kidney. Ovarian cyst was suspected, and then ovariohysterectomy was performed. On laparotomy, the presence of a cystic structure was confirmed in the left ovary similar to ultrasonographic findings. Cyst was smooth, flat, hemorrhagic and thick-walled structure. Histopathologic examination of the ovarian stroma revealed covered luteinizing cells and midline hemorrhagic cyst. However, the internal surface of the cyst wall was covered by an endometrial lining. Interestingly, the endometriotic tissue had a maximal penetration into the cyst wall. It was thought that the ovarian endometriosis caused a failure in the luteinizing hormone action which is responsible for luteal function and spontaneous abortion was observed in this case. Although ovarian endometriosis is quite usual in human, this case could be the first report to describe ovarian endometriosis in a dog, and thus it has been reported to cause spontaneous abortion.

Synthesis and characterization of Bioglass-based bone grafts with Gelatine substitution for biomedical applications.

BACKGROUND: Syntesizing alternative bone graft materials are important in biomedical applications. Their morphology, mechanical properties and cell viability plays an important role in tissue engineering. OBJECTIVE: Bioglass (B) based bone grafts with Gelatin (G) substitution were syntesized via the sol-gel method and were compared with various Gelatin and Bioglass concentrations (wt%). METHODS: Syntesized bone grafts were characterized by Scanning Electron Microscopy (SEM) and X-ray diffraction (XRD) to show the structural and morphological changes of the fabricated B-based bone grafts. RESULTS: It was demonstrated that the concentration of pore size increased with increasing amounts of Gelatin in wt%. The biograft-B40G20 produced the highest flexture strength and hardness. Increasing the pore size caused a decrease in hardness and flexture stress of B-based biografts. CONCLUSIONS: Cell viability tests were conducted on the fabricated biografts and it was shown that the cell viability increased in fabricated B-based bone grafts.

Incarceration of umbilical hernia during pregnancy due to a sessile fibroid.

The incidence of both umbilical hernias and fibroids during pregnancy is reported to be rare. Another rare entity is the incarceration of fibroids in pregnancy. We report here the case of a 30-year-old woman in her 32nd gestational week with an incarcerated umbilical hernia. She was operated on an emergency basis, the sessile fibroid was mobilized and the hernia defect was repaired with the Mayo technique. No complications were observed during the post-operative period. She gave birth to a baby girl during the 38th gestational week by means of a cesarean section. The possibility of a fibroid entrapped in the hernial sac should always be taken into consideration at the evaluation of incarcerated hernias during pregnancy. If the contents of the hernial sac cannot be pushed into the abdominal cavity easily, an emergency operation should be considered as a means to prevent further complications related to pregnancy.

Viburnum opulus L.: A remedy for the treatment of endometriosis demonstrated by rat model of surgically-induced endometriosis.

ETHNOPHARMACOLOGICAL RELEVANCE: Endometriosis is a gynecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. The fruits of Viburnum opulus L. have been used to treat gynecological disorders including primary and secondary dysmenorrhea and ovarian cysts. MATERIALS AND METHODS: Air-dried and powdered fruits of V. opulus were extracted sequentially with n-hexane, ethyl acetate (EtOAc), and methanol (MeOH), respectively for four days. Endometriosis was induced by suturing 15mm piece of endometrium into abdominal wall of Sprague Dawley rats. In second laparotomy, the dimensions of endometrial implants were measured and intra-abdominal adhesions were scored. The abdomen was closed. Extracts were daily administered to the rats. At the end of the experiment, rats were sacrified and endometriotic foci areas and intra-abdominal adhesions were re-evaluated. The tissues were also histopathologically investigated. Furthermore, tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) levels of peritoneal fluid were measured. HPLC analyses were conducted on the most potent EtOAc and MeOH extracts to determine the amount of the major compound, chlorogenic acid. RESULTS: The endometriotic volumes were found to be reduced significantly in the EtOAc extract-administered group to 30.1mm3 and in the MeOH extract-administered group to 34.7mm3 as compared to the control group. No adhesion was observed in the reference and EtOAc groups. Histopathological data also supported the results. Both EtOAc and MeOH extract-administered groups displayed significant remission in the levels of TNF-α, VEGF and IL-6. When the active extracts were subjected to HPLC analysis, chlorogenic acid was found to be the major compound and the amount of this compound was calculated as 0.5112±0.0012mg and 1.7072±0.0277mg/100mg extract, repectively. CONCLUSIONS: The results of the present study indicate that the effectiveness of the fruit extract of V. opulus could be partially attributed chlorogenic acid. Other phenolic compounds could potentiate the activity due to their amount.

Interlocking nailing of humeral shaft fractures. A retrospective study of 114 patients.

BACKGROUND: Fractures of the humeral shaft are relatively common injuries. Literature suggests that humeral shaft fractures represent approximately 3 % of all fractures. There are several modalities for the management of diaphyseal humeral fractures. The latest investigations emphasize the concept of minimal exposure and rigid fixation. AIM: The aim of the study is to evaluate the results of antegrade intramedullary nailing in humeral shaft fractures. DESIGN: A retrospective review. SETTINGS: Patients were treated in private hospital settings by 3 orthopaedics surgeon. MATERIAL AND METHODS: Between 1995 and 2003, the technique of antegrade locked intramedullary nailing with UHN in humeral shaft fractures was performed on 114 patients. Forty-two (36%) patients sustained multiple traumas, and 22 (19%) fractures were open. The outcomes were evaluated with a mean follow-up of 41 months. STATISTICAL ANALYSIS USED: Ranges of results given. RESULTS: In 109 fractures primary union observed. In the other five patients union achieved after removal of the nail and fixation with DCP and bone grafting. The average time for union was 13 weeks (range, 10-36 weeks). One hundred-five patients had excellent or satisfactory recovery of shoulder and elbow function. Complications included impingement due to proximal locking screws in two patients and prominent nail in three patients, transient postoperative radial nerve palsy in four patients. CONCLUSIONS: This study shows that antegrade locked nailing in humeral shaft fractures are reliable and also effective in multiply injured patients.

Identification of kinetically hot residues in proteins.

A number of recent studies called attention to the presence of kinetically important residues underlying the formation and stabilization of folding nuclei in proteins, and to the possible existence of a correlation between conserved residues and those participating in the folding nuclei. Here, we use the Gaussian network model (GNM), which recently proved useful in describing the dynamic characteristics of proteins for identifying the kinetically hot residues in folded structures. These are the residues involved in the highest frequency fluctuations near the native state coordinates. Their high frequency is a manifestation of the steepness of the energy landscape near their native state positions. The theory is applied to a series of proteins whose kinetically important residues have been extensively explored: chymotrypsin inhibitor 2, cytochrome c, and related C2 proteins. Most of the residues previously pointed out to underlie the folding process of these proteins, and to be critically important for the stabilization of the tertiary fold, are correctly identified, indicating a correlation between the kinetic hot spots and the early forming structural elements in proteins. Additionally, a strong correlation between kinetically hot residues and loci of conserved residues is observed. Finally, residues that may be important for the stability of the tertiary structure of CheY are proposed.