Antegrade versus retrograde nailing techniques and trochanteric versus piriformis intramedullary nailing entry points for femoral shaft fractures: A systematic review and meta-Analysis

© 2017 Joule Inc. or its licensors. Background: There are several different techniques commonly used to perform intramedullary (IM) nailing of the femur to fix femoral fractures. We sought to identify significant differences in outcomes of studies comparing 1) trochanteric and piriformis entry and 2) antegrade and retrograde entry in IM nailing of the femur. Methods: We searched MEDLINE, Cochrane and Embase databases and the Orthopaedic Trauma Association and American Academy of Orthopaedic Surgeons websites for comparative studies published from inception to November 2015. Criteria used to select articles for detailed review included use of antegrade and retrograde entry point or use of trochanteric and piriformis entry point for IM nailing of the femur in adult patients. Functional and technical outcomes were extracted from accepted studies. Results: We identified 483 potential studies, of which 52 were eligible. Of these, we included 13 publications and 2 abstracts (2 level I, 7 level II and 6 level III studies). Trochanteric entry significantly reduced operative duration by 14 min compared with piriformis entry (p = 0.030). Retrograde nailing had a greater risk of postoperative knee pain than antegrade nailing (p = 0.05). On the other hand, antegrade nailing had significantly more postoperative hip pain (p = 0.003) and heterotopic ossification (p \u3c 0.001) than retrograde nailing. No significant differences in functional outcomes were observed. Conclusion: Although some significant differences were found, the varying quality of studies made recommendation difficult. Our meta-Analysis did not confirm superiority of either antegrade over retrograde or trochanteric over piriformis entry for IM nailing of the femur. Level of evidence: Level III therapeutic

Placement and orientation of individual DNA shapes on lithographically patterned surfaces

Artificial DNA nanostructures show promise for the organization of functional materials to create nanoelectronic or nano-optical devices. DNA origami, in which a long single strand of DNA is folded into a shape using shorter 'staple strands', can display 6-nm-resolution patterns of binding sites, in principle allowing complex arrangements of carbon nanotubes, silicon nanowires, or quantum dots. However, DNA origami are synthesized in solution and uncontrolled deposition results in random arrangements; this makes it difficult to measure the properties of attached nanodevices or to integrate them with conventionally fabricated microcircuitry. Here we describe the use of electron-beam lithography and dry oxidative etching to create DNA origami-shaped binding sites on technologically useful materials, such as SiO_2 and diamond-like carbon. In buffer with ~ 100 mM MgCl_2, DNA origami bind with high selectivity and good orientation: 70–95% of sites have individual origami aligned with an angular dispersion (±1 s.d.) as low as ±10° (on diamond-like carbon) or ±20° (on SiO_2)

The science of electrical stimulation therapy for fracture healing

This article is a brief review of the basic science research conducted in the field of electrical stimulation for fracture healing. Direct electrical current, capacitive coupling, and inductive coupling have been studied as potential techniques to enhance fracture healing through the proliferation and differentiation of osteogenic cells. These techniques are particularly appealing as they offer a potential minimally invasive solution to the difficult clinical problem of delayed fracture healing and nonunion. Basic science studies have shown conclusively that electrical stimulation techniques lead to bone cell proliferation and have attempted to elucidate the intracellular processes by which this bone cell proliferation occurs. Further basic science and clinical research is required to enhance the effectiveness of this therapy for the treatment of fracture nonunions

Wastewater Purification from Excess Phosphates Using Bentonite Activated by Microwave Radiation

This article examines the possibilities of improving the ecological condition of small rivers on the example of the upper part of the Prut River in the vicinity of Yaremche (Ivano-Frankivsk region, Ukraine). The previously published data of the article authors and other researchers that the amount of pollutants in river water in this area has increased, in particular, phosphorus compounds, has been confirmed. It was shown that the incompletely purified wastewaters of Yaremche, which contains an excess of phosphate ions, has a significant impact on this fact. On the basis of their own previous research and current work, the authors propose removing these ions using a natural sorbent based on bentonite, activated by microwaves in various ways. Experiments have shown that microwave activation of this sorbent increases the coefficient of phosphate ions extraction from wastewater significantly higher compared to natural bentonite. An approximate technological scheme of wastewater purification from excess phosphates after the main standard purifying cycle was suggested

Prognostic Factors for Reoperation After Plate Fixation of the Midshaft Clavicle

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Objectives: To determine which prognostic factors were associated with an increased risk for all-cause reoperation in a heterogeneous population of patients treated with primary plate fixation of a midshaft clavicular fracture. Design: Retrospective observational study. Setting: Single university-affiliated tertiary care Level 1 trauma center. Patients: Of 235 consecutive patients with primary plate fixation for a midshaft clavicular fracture. A reviewer extracted data through a retrospective chart review regarding 20 possible prognostic variables and documented reoperations (defined as any surgical procedure after the initial surgery, including implant removal, bone grafts, implant exchanges, or debridement for infection). Intervention: Open reduction and internal fixation of the clavicle using straight and precontoured clavicle plates. Main Outcome Measurements: Complete 2-year follow-up information was available for 153 of 235 patients (65%). Of these 153 patients included in the analysis, 58 (38%) had reoperations. The preoperative risk factors for 3 specific reoperation outcomes were examined: (1) reoperation for implant removal alone; (2) reoperation for nonunion, infection, or fixation failure; and (3) multiple reoperations. Results: There was a significant reoperation rate in this patient series (58 of 153 patients, 38%). Although most were for isolated plate removal (42 of 153 patients, 27%), there were a minority of patients who required more complex (16 of 153 patients, 10%) or multiple (8 of 153 patients, 5%) procedures. For these 3 possible outcomes (reoperation for implant removal alone, reoperation for nonunion, infection, or fixation failure, and the need for multiple reoperations), significant risk factors were identified that can assist surgeons in patient selection and predicting reoperation after plate fixation of midshaft clavicle fractures. The significant risk factors for implant removal alone (42 of 153, 27%) were the use of a plate that was not precontoured and patient height nonunion, infection, or fixation failure (16 of 153, 10%) were illicit drug use, diabetes, and previous surgery of the shoulder. The significant risk factors for multiple reoperations (8 of 153, 5%) were age \u3e55 years and alcohol use \u3e15 drinks per week. Conclusions: The use of precontoured plates can decrease the rate of hardware removal after primary fixation of displaced fractures of the midshaft clavicle. Also, specific preoperative prognostic factors may be used to counsel patients, maximize outcomes, minimize serious complications, and limit revision surgery. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence