Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures

We evaluated the results of patients with Gustilo types II, IIIA and IIIB open tibial fractures managed early with the Ilizarov external fixator (IEF). Sixty patients (51 males, nine females; age range 20–62 years; mean age 32.8 years) with type II (11 patients), type IIIA (13) and type IIIB (36) tibial diaphyseal fractures underwent emergency debridement and minimal bone fixation (with external fixator), followed by definite fixation with the IEF after three to five days. Average duration of the hospital stay was 8.6 days. All fractures united with an average union time of 21.1 weeks (standard deviation [SD] 3.18) in type II, 21.7 weeks (SD 3.57) in IIIA and 24. 9 weeks (SD 5.14) in IIIB fractures. The difference between union time in type II and IIIA was not significant (p > 0.05), but that between IIIA (and also type II) and IIIB was significant (p < 0.05). The healing index in patients who underwent lengthening was 1.5 months/cm. The wounds in 27 patients were managed by delayed primary closure, in 19 patients with second intent (all IIIB), in 11 patients with skin grafting (mostly type IIIB fractures) and in three patients with musculocutaneous flaps. The most common complications of the procedure were pin tract infection and pain at the fracture site. Most of the patients were able to achieve good knee and ankle range of motion. Early application of the Ilizarov fixator constitutes an excellent management of open tibial fractures, especially types II, IIIA and IIIB, due to good functional and radiological results. Despite the technical difficulties and some complications (which are mostly minor) IEF may be the preferred method in open tibial fractures, especially types II and III

Employee engagement and internal branding:two sides of the same coin?

Abstract This study examines the link between employee engagement and internal branding. It seeks to understand which antecedent factors healthcare professionals consider important for employee engagement and what kinds of implications this engagement-related information may have for internal branding. The study reviews the literature on employee engagement and internal branding and presents a conceptualisation of the linkage between the two concepts. The empirical portion content analyses more than 1200 answers to open questions to examine employee engagement in the case organisation, a large private healthcare organisation in Finland. The findings suggest the following eight antecedent factors to be particularly important for healthcare professionals’ employee engagement: organisational culture, reward, working environment, training, HR practices, reputation and values, communication, and physical environment. Based on the empirical and theoretical analyses, it can be said that the antecedent factors of employee engagement and elements of internal branding can be considered two sides of the same coin