A 72-Year-Old Patient with Bilateral Maisonneuve Fractures

Maisonneuve fractures result from a disruption of the medial ankle structures and a proximal fibular fracture. Patient complaints can be misleading and there is a significant rate of delayed diagnosed injuries. We present a case of bilateral Maisonneuve fractures after a fall due to a syncopal collapse. A precise clinical examination led to this rare diagnosis. The injuries were treated with syndesmotic screw fixation, removal of hardware followed after 6 weeks. The patient was asymptomatic at threemonths follow up. Patients with bilateral injuries undergoing standard surgical treatment can gain full recovery, but high suspicion in clinical examination is needed to detect this uncommon bilateral injury

Collagen Type I Conduits for the Regeneration of Nerve Defects

To date, reliable data to support the general use of biodegradable materials for bridging nerve defects are still scarce. We present the outcome of nerve regeneration following type I collagen conduit nerve repair in patients with large-diameter nerve gaps. Ten patients underwent nerve repair using a type I collagen nerve conduit. Patients were re-examined at a minimal follow-up of 14.0 months and a mean follow-up of 19.9 months. Regeneration of nerve tissue within the conduits was assessed by nerve conduction velocity (NCV), a static two-point discrimination (S2PD) test, and as disability of arm shoulder and hand (DASH) outcome measure scoring. Quality of life measures including patients’ perceived satisfaction and residual pain were evaluated using a visual analog scale (VAS). No implant-related complications were observed. Seven out of 10 patients reported being free of pain, and the mean VAS was 1.1. The mean DASH score was 17.0. The S2PD was below 6 mm in 40%, between 6 and 10 mm in another 40% and above 10 mm in 20% of the patients. Eight out of 10 patients were satisfied with the procedure and would undergo surgery again. Early treatment correlated with lower DASH score levels. The use of type I collagen in large-diameter gaps in young patients and early treatment presented superior functional outcomes

Total hip arthroplasty through the mini-incision (Micro-hip) approach versus the standard transgluteal (Bauer) approach : a prospective, randomised study

Purpose To compare outcome after total hip arthroplasty (THA) through the mini-incision approach versus the standard transgluteal approach. Methods 80 women and 63 men aged 33 to 89 (mean, 62) years with primary osteoarthritis of the hip were randomised to undergo unilateral THA through a mini-incision approach (Micro-hip, n=55) or standard, lateral, transgluteal approach (Bauer, n=88). Levels of haemoglobin, haematocrit, serum creatine kinase, and C-reactive protein, length of hospital stay, mobilisation, and any complication were recorded. Visual analogue scale (VAS) for pain was assessed. Hip function was assessed using the Harris Hip Score and the Oxford Hip Score, whereas general health was assessed using the EQ-5D general health questionnaire. The cup inclination and varus/ valgus of the stem position were measured using a goniometer. Results The Micro-hip group achieved a significantly lower mean incision length (9.3 vs. 13.4 cm, p<0.001), mean surgical time (60 vs. 68 minutes, p=0.021), mean reduction in haemoglobin level (2.1 vs. 2.8 g/dl, p<0.001), and mean VAS for pain from hour 6 to day 6 (all p<0.05). One patient in the Micro-hip group developed early aseptic loosening of the cup and underwent revision surgery at month 4. Three patients in the Bauer group and one patient in the Micro-hip group sustained intra-operative non-displaced fractures of the proximal femur, which were fixed with cerclages. Two patients in the Micro-hip group developed deep vein thrombosis during week 1. Conclusion THA through the Micro-hip approach achieved faster pain relief

Selective decomposition of hydrogen peroxide in the epoxidation effluent of the HPPO process

This work describes the selective H2O2 decomposition in the exit stream of the epoxidation reactor employed in the Hydrogen Peroxide-Propylene Oxide (HPPO) process. Pd/Al2O3 and Pt/Al2O3 catalysts were tested. The effects of the reaction temperature and the pH of the solution on catalyst performance were investigated. It was found that the Pt catalyst is much more active than its Pd counterpart. An increase in the temperature and the pH of the solution resulted in an increase in the H2O2 decomposition rate; however a parallel increase of by-products from PO was also observed. Working with a Pt/Al2O3 catalyst under optimized reaction conditions (333 K, pH = 7), hydrogen peroxide can be completely decomposed at reaction times of 120 minutes with no by-products produced from propylene oxide.Repsol (Spain) and the MICINN (Spain) through the PSE-310200-2006-2, FIT-320100-2006-88 and ENE2007-07345-C03-01/ALTPeer reviewe