Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study

Background. Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods. The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results. 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 \ub1 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions. This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings

A tropological theory of institutionalization

We address the co-evolution of language and material practices during institutionalization by proposing a tropological model of institutionalization that integrates linguistic and practice-oriented approaches into a four-stage sequence: Metaphor enables members to inaugurate institutional change by inspiring and energizing initial movement. Members use metonymy to operationalize the emerging institution by demonstrating how it can become expected practice. Synecdoche is used to facilitate diffusion, standardizing the institution across time and space. When material practice is noticeably contrary to linguistic claims, however, members use irony to bring about deinstitutionalization and generate another inaugurating metaphor. The model further proposes that ritualized actions dramatize each trope, highlighting its symbolic meaning and embedding distinct material practices that serve both to institutionalize the practice and to facilitate boundary crossing to the next trope. The paper goes beyond current literature by offering an integrated theory of trope and ritual as an explanation of how institutions are simultaneously symbolic-linguistic and practice-material