Comparison of modified Hackethal bundle nailing versus anterograde nailing for fixation of surgical neck fractures of the humerus: Retrospective study of 105 cases

AbstractIntroductionIntramedullary fixation of displaced surgical neck fractures of the humerus can be performed either by retrograde pinning or anterograde nailing. The goal of the current study was to compare the postoperative reduction and stability obtained with these two techniques.HypothesisIntramedullary nailing will provide the best reduction and stabilization of these fractures.Patients and methodsThis was a multicenter retrospective study that included patients with sub-tuberosity fractures with or without greater tuberosity fragment. These patients were treated either by retrograde Hackethal type pinning (group 1) or Telegraph anterograde nailing (group 2). To be included, patients needed to have A/P and lateral X-rays that had been taken before the surgery, immediately post-operative, between four and six weeks post-operative, and at the last follow-up. The outcomes were head angulation, translation and greater tuberosity position.ResultsOne hundred and five patients (40 retrograde pinning and 65 anterograde nailing) with an average age of 69 years (18–97 years) were included. The pre-operative fracture displacement was similar between the two groups. After the surgery, the A/P head angulation had been corrected in 72.5% of patients in group 1 and 84% in group 2 (no significant difference). Translation was still present in 17.5% of patients in group 1 and 1.5% in group 2 (P<0.05). At the last follow-up, union was achieved without residual angulation on lateral X-rays in 71% of patients in group 1 and 88% in group 2 (P<0.05). The fractures had healed with residual translation is 19.5% of patients in group 1 and 3% in group 2 (P<0.05).Discussion and conclusionIn cases of displaced surgical neck fractures with or without a greater tuberosity fragment, anterograde nailing provides better reduction and stability than retrograde pinning. However, fixation of the greater tuberosity fragment must be improved.Level of evidenceIV (retrospective comparative study)

The makeshift city: towards a global geography of squatting

This paper introduces a set of analytical frames that explore the possibilities of conceiving, researching and writing a global geography of squatting. The paper argues that it is possible to detect, in the most tenuous of urban settings, ways of thinking about and living urban life that have the potential to reanimate the city as a key site of geographical inquiry. The paper develops a modest theory of ‘urban combats’ to account for the complexity and provisionality of squatting as an informal set of practices, as a makeshift approach to housing and as a precarious form of inhabiting the city

Physiological and biochemical adaptations to training in Rana pipiens

Fifteen Rana pipiens were trained on a treadmill thrice weekly for 6.5 weeks to assess the effects of training on an animal that supports activity primarily through anaerobiosis. Endurance for activity increased 35% in these frogs as a result of training ( P =0.006, Fig. 1). This increased performance was not due to enhanced anaerobiosis. Total lactate produced during exercise did not differ significantly for the trained or untrained animals in either gastrocnemius muscle (2.77±0.21 and 2.82±0.13 mg/g, respectively) or whole body (1.32±0.10 and 1.47±0.06 mg/g, respectively). Glycogen depletion also did not differ between the two groups (Fig. 2c). The primary response to training appeared to involve augmentation of aerobic metabolism, a response similar to that reported for mammals. Gastrocnemius muscles of trained frogs underwent a 38% increase over those of untrained individuals in the maximum activity of citrate synthase (14.5±1.0 and 10.5±0.9 μmoles/(g wet wt·min); P =0.008). This enzyme was also positively correlated with the level of maximum performance for all animals tested ( r =0.61, P <0.01) and with the degree of improvement in the trained animals ( r =0.72, P <0.05). In addition to an increased aerobic capacity, the trained animals demonstrated a greater removal of lactate from the muscle 15 min after fatigue (Fig. 2b).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47124/1/360_2004_Article_BF00710002.pd

Medium-energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis

To evaluate the results of the treatment with medium-energy extracorporeal shock wave therapy (ESWT) in rotator cuff calcifying tendinitis. Fifty-four non-consecutive patients, who were referred to our institute for rotator cuff calcifying tendinitis, were managed with a standardized protocol in four sessions of medium-energy (0.11 mJ/mm2) ESWT administered with an electromagnetic lithotriptor. Pain was evaluated at the end of each session, functional state of shoulder was assessed at 1 and 6 months after the end of procedure. All patients underwent radiographs and sonography imaging. No systemic or local complications. Thirty-eight patients (70%) reported satisfactory functional results. Radiographs and sonographs showed a disappearance of calcium deposit in 29 patients (54%) and in 19 patients (35%) it appeared to be reduced more than a half. A correlation was found between residual calcium deposit and the clinical outcome, but some patients showed a reduced pain without modification of calcium deposit. These results were unmodified at 6 months follow-up. Our protocol of medium-energy ESWT provides good results overall about pain modulation