ABSTRACT
OBJECTIVES: This multicenter study was designed to evaluate whether tibia fracture nonunions treated with exchange nailing proceed to union faster with dynamically- versus statically-locked nails, or with fibular osteotomy versus no fibular osteotomy. DESIGN: Retrospective, chart-review, multicenter study. SETTING: Multicenter review of 6 level 1 trauma centers. PATIENTS/PARTICIPANTS: Patients who had a tibia fracture treated with an intramedullary nail that progressed to nonunion, and were subsequently treated with exchange nailing, were identified. All patients that met inclusion criteria and subsequently progressed to union were included in the study. INTERVENTION: Patients underwent tibial exchange nailing to repair nonunions, with screws in either a dynamically- or statically-locked configuration with or without fibular osteotomy. MAIN OUTCOME MEASURES: The primary outcome measure was a comparison of time to healing of tibial nonunion comparing different screw configurations and fibular osteotomy. RESULTS: Fifty-two patients underwent an exchange nail procedure and their outcomes were used for the primary analysis. Patients with dynamically-locked nails proceeded to union 7.9 months after revision surgery compared with 7.3 months for those with statically-locked nails, but this was not statistically significant (P = 0.68). Patients with fibular osteotomy proceeded to union 2.9 months faster than those without fibular osteotomy, and this trended toward significance (P = 0.067). Obese patients healed on average 8.8 months after surgery compared with 6.8 months for nonobese patients (P = 0.27). Closed fractures healed after 6.4 months compared with 7.7 months for open fractures (P = 0.40). CONCLUSIONS: There was no significant difference in time to union between patients who had a dynamic screw configuration compared with a static screw configuration for their exchange nail. Patients who underwent fibular osteotomy proceeded to union faster than those without an osteotomy. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Subject(s)
Bone Screws , Fibula/surgery , Fracture Fixation, Intramedullary/statistics & numerical data , Fracture Healing , Osteotomy/statistics & numerical data , Tibial Fractures/epidemiology , Tibial Fractures/surgery , Adult , Aged , Female , Fracture Fixation, Intramedullary/instrumentation , Fracture Fixation, Intramedullary/methods , Fractures, Malunited/diagnosis , Fractures, Malunited/epidemiology , Fractures, Malunited/surgery , Humans , Male , Middle Aged , Osteotomy/instrumentation , Osteotomy/methods , Prevalence , Risk Factors , Tibial Fractures/diagnosis , Treatment Outcome , United States/epidemiologyABSTRACT
Superhydrophobic nanotextured surfaces have gained increased usage in various applications due to their non-wetting and self-cleaning abilities. The aim of this study was to investigate nanotextured surfaces with respect to their resistance to the inception of freshwater biofouling at transitional flow conditions. Several coatings were tested including industry standard polyurethane (PUR), polytetrafluoroethylene (PTFE), capstone mixed polyurethane (PUR + CAP) and nanocomposite infused polyurethane (PUR + NC). Each surface was exposed to freshwater conditions in a lake at 4 m s(-1) for a duration of 45 min. The polyurethane exhibited the greatest fouling elements, in terms of both height and number of elements, with the superhydrophobic nanocomposite based polyurethane (PUR + NC) showing very little to no fouling. A correlation between the surface characteristics and the degree of fouling inception was observed.
