A systematic review and meta-analysis of functional outcomes and complications following external fixation or open reduction internal fixation for distal intra-articular tibial fractures: an update.

PURPOSE: To conduct a systematic review and meta-analysis comparing physical function and complications following DIATF surgery with external fixation (EF) or open reduction internal fixation (ORIF). METHOD: A search was conducted using PubMed, Embase, Cochrane CENTRAL, Open Grey and Orthopaedic Proceedings. Studies with a level of evidence of I-III on patients (≥ 18 years) with DIATFs operated on with either EF or ORIF were included. A total of 3814 studies were identified. The Cochrane Risk of Bias Tool for randomised controlled trials and the ROBINS-I tool for nonrandomised studies were used to assess risk of bias. RESULTS: Nine studies with 478 patients, 271 ORIF and 197 EF met the inclusion criteria. The mean follow-up ranged from 12 to 38 months. The meta-analysis showed a higher incidence of superficial wound infections (RR = 2.94, 95% CI 1.62-5.34, p = 0.0004) and malunions (RR = 2.62, 95% CI 1.27-5.43, p = 0.009) in the EF group compared to the ORIF group. Also worse physical function was associated with the EF group. However, the overall evidence was low. CONCLUSION: This systematic review is the first to report on physical function following DIATF surgery. In general, decreased physical function was reported. The meta-analysis showed lower incidence of superficial wound infection and malunion rates in the ORIF group. Heterogeneity was low. In conclusion, this review reports lower complication rates following ORIF for DIATF. The overall evidence was limited, and therefore, the authors cannot recommend ORIF to be superior to EF treatment for DIATF. More multi-centre studies with larger sample sizes are needed to assess long-term physical function and complications following DIATF surgery. LEVEL OF EVIDENCE: Level 1.

Evaluation of strategies for the treatment of type B and C pelvic fractures: results from the German Pelvic Injury Register.

Aims: The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization. Patients and Methods: The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality. Results: Operative stabilization reduced mortality by 36% (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42 to 0.98) but the incidence of complications was twice as high (OR 2.04, 95% CI 1.57 to 2.64). Mortality and the incidence of neurological deficits at discharge were no different after isolated posterior or combined anteroposterior fixation. However, the odds of both surgical (98%, OR 1.98, 95%CI 1.22 to 3.22) and general complications (43%, OR 1.43, 95% CI 1.02 to 2.00) were higher in the group with the more extensive surgery. Conclusion: Operative stabilization is recommended for non-complex unstable pelvic fractures. The need for anterior fixation of obturator ring fractures should, however, be considered critically. Cite this article: Bone Joint J 2018;100-B:973-83.

The electrical and structural properties of n-type InAs nanowires grown from metal-organic precursors.

The electrical and structural properties of 111B-oriented InAs nanowires grown using metal-organic precursors have been studied. On the basis of electrical measurements it was found that the trends in carbon incorporation are similar to those observed in the layer growth, where an increased As/In precursor ratio and growth temperature result in a decrease in carbon-related impurities. Our results also show that the effect of non-intentional carbon doping is weaker in InAs nanowires compared to bulk, which may be explained by lower carbon incorporation in the nanowire core. We determine that differences in crystal quality, here quantified as the stacking fault density, are not the primary cause for variations in resistivity of the material studied. The effects of some n-dopant precursors (S, Se, Si, Sn) on InAs nanowire morphology, crystal structure and resistivity were also investigated. All precursors result in n-doped nanowires, but high precursor flows of Si and Sn also lead to enhanced radial overgrowth. Use of the Se precursor increases the stacking fault density in wurtzite nanowires, ultimately at high flows leading to a zinc blende crystal structure with strong overgrowth and very low resistivity.

The fabrication of dense and uniform InAs nanowire arrays.

Nanowires are important candidates for use in future electronics, photonics and thermoelectrics applications. We focus here in particular on nanowires for use in thermoelectric power generation and present a method of fabricating dense uniform InAs nanowire arrays amenable to future incorporation of advanced heterostructures that could further increase the thermoelectric performance of these nanowires. In these applications it will be important to have the nanowires densely packed in order to give an appreciable amount of power output. Here we present the fabrication of such dense arrays, using metal-particle seeded growth and chemical beam epitaxy, where the metal particles are defined by electron beam lithography, metal evaporation and lift-off. We evaluate the potential of chemical beam epitaxy for the growth of dense, freestanding InAs nanowire arrays and describe the process that enabled us to achieve areal packing densities of up to 19% with a variation of only a few per cent in nanowire diameter and height. We close by discussing how even higher areal packing densities can be achieved.

Quantum-confinement effects in InAs-InP core-shell nanowires.

We report the detection of quantum confinement in single InAs-InP core-shell nanowires. The wires, having an InAs core with ∼25 nm diameter, are characterized by emission spectra in which two peaks are identified under high excitation intensity conditions. The peaks are caused by emission from the ground and excited quantized levels, due to quantum confinement in the plane perpendicular to the nanowire axis. We have identified different energy contributions in the emission spectra, related to the wurtzite structure of the wires, the strain between the wurtzite core and the shell, and the confinement energy of the InAs core. Calculations based on six-band strain-dependent [Formula: see text] theory allow the theoretical estimation of the confined energy states in such materials, and we found these results to be in good agreement with those from the photoluminescence studies.

[Establishment of routines for elective laparoscopic surgery]. / Etablering av rutiner for elektiv laparoskopisk kirurgi.

BACKGROUND: During the autumn of 1999, elective laparoscopic cholecystectomy was introduced as a new surgical procedure in the Central Hospital Østfold, Askim. A prospective evaluation of perioperative patient logistics and patient satisfaction was performed. MATERIAL AND METHODS: 214 patients were evaluated in the ambulatory; 116 of them were scheduled for operation. The operations were performed in general anaesthesia with continuous infusion of propofol and short acting opioides. Analgetics and anti-emetics were given pre- and perioperatively as prophylaxis against postoperative pain and nausea. RESULTS: There were three unexpected cancellations. Two patients had serious postoperative bleedings and two had symptoms indicating residual bile duct stones. Twenty-eight patients (24%) were discharged on the same day. 114 patients (98%) were satisfied with their stay in hospital. INTERPRETATION: The established patient logistics proved efficient and rational.

Optimal felodipine dose when combined with metoprolol in arterial hypertension: a Swedish multicenter study within primary health care. Swedish General Practitioner Felodipine Study Group.

In a multicenter study comprising 23 Swedish primary health care centers, felodipine extended-release (ER) tablets in doses of 5, 10, and 20 mg were compared double-blind with placebo when given in addition to metoprolol controlled-release (CR) tablets 100 mg. All medication was given once daily in the morning. Altogether, 251 hypertensive patients with a diastolic blood pressure greater than 95 mm Hg after 4 weeks of treatment with placebo in combination with metoprolol CR 100 mg were randomized to four parallel groups. After 4 weeks of treatment, there were significantly greater reductions in blood pressure with all doses of felodipine ER than with placebo, both 2 and 24 h after intake of the tablets. Twelve patients were withdrawn because of adverse reactions. Of these, one patient was taking placebo, one 5 mg of felodipine ER, four 10 mg of felodipine ER, and six patients 20 mg of felodipine ER. When combined with metoprolol, 5 mg of felodipine ER seemed to be less effective than higher doses, but was very well tolerated. Adding 10 mg of felodipine ER to the basal metoprolol appeared to be optimal if both the effect and adverse reactions were taken into consideration.

Pseudohypoaldosteronism due to sweat gland dysfunction.

Pseudohypoaldosteronism is an uncommon disorder characterized by urinary sodium wasting and is attributed to a defect in distal renal tubular sodium handling with failure to respond to endogenous aldosterone. Sweat electrolyte values in other reported patients, when measured, have been normal. A 3.5-year-old girl developed repeated episodes of dehydration, hyponatremia, and hyperkalemia during the first 19 months of life. Serum sodium was as low as 113 mEq/liter and potassium as high as 11.1 mEq/liter. Her plasma and urinary aldosterone levels were persistently elevated (Figs. 1-4). Unlike patients with classic pseudohypoaldosteronism she demonstrated no urinary sodium wasting (Figs. 2 and 3). During episodes of hyponatremia and reduced sodium intake her urinary sodium was less than 5 mEq/liter. In addition, her sweat sodium concentration was consistently above 125 mEq/liter and salivary sodium concentration above 58 mEq/liter. Her chest x-ray, 72-hr fecal fat excretion, serum and urinary pancreatic amylase (amy-2) were normal, providing no evidence for cystic fibrosis. It is proposed that this patient represents a new variant of pseudohypoaldosteronism with excessive loss of sodium from the sweat and salivary glands instead of the kidneys.