Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients.

PURPOSE: The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups. METHODS: Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12-120 months). RESULTS: Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18-99) and 70.1 (18-100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6-48, SD 7.3) versus 28.4 (3-48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01. CONCLUSION: While the rate of non-union was higher in the LP group and the functional results were superior in the plating group.

Effects of fiber laxatives and calcium docusate on regional water content and viscosity of digesta in the large intestine of the pig.

The aim of this study was to determine how bulk fibers and calcium docusate affect regional dehydration and digesta viscosity throughout the large intestine. Fifty-two pigs were fed a chow diet supplemented with a bulk laxative, placebo, or calcium docusate for three days, after which the pigs were sacrificed and the contents of the large bowel were analyzed. Digesta occurred as a continuum from liquid (cecum, 91.2% water content) to solid (rectum, 70.5% water content). The observed 20.7% difference in water content resulted in a 240-fold increase in viscosity. Half of this water is reabsorbed in the first 18% of the large bowel length where viscosity remains relatively low. Compared to placebo, calcium docusate and calcium polycarbophil had no significant effect on digesta water content or viscosity, polycarbophil exhibited significantly (P < 0.05) lower digesta viscosity in three bowel segments, and psyllium exhibited significantly (P < 0.01) lower viscosity in six bowel segments and higher water content in nine bowel segments. In conclusion, the majority of digesta dehydration occurs early in the proximal large bowel, while the greatest increases in viscosity occur in the distal bowel. Relatively small decreases in digesta water content result in large increases in digesta viscosity. Psyllium, and to a lesser extent polycarbophil, are able to resist dehydration, resulting in a softer digesta.

Fatty acid-mediated gastroprotection does not correlate with prostaglandin elevation in rats exposed to various chemical insults.

This study involved a comparison of activity of several long-chain fatty acids (arachidonic acid, dihomo-[gamma]-linolenic acid, linoleic acid, and oleic acid) for protection against gastric mucosal damage elicited by taurocholic acid, acidified aspirin, and ethanol in rats. Each damaging agent induced gastric mucosal lesions in the corpus. Mucosal damage was induced by all agents, and all fatty acids protected the gastric mucosa; however, ethanol and arachidonic acid were the most potent damaging and protecting agents, respectively. Maximally protective doses for prevention of taurocholic acid-induced damage by arachidonic, dihomo-[gamma]-linolenic, linoleic, and oleic acids were 50, 200, 100, and 200 mg/kg, respectively; however, 10 mg/kg arachidonic acid reduced lesion length by > 50%, whereas minimally effective doses of the other fatty acids were > or = 50 mg/kg. Similar potency differences were observed for fatty acid protection against acidified aspirin-induced gastric damage. Although all the fatty acids reduced macroscopic damage, histologic studies showed they did not totally eliminate surface mucosal damage. Microscopic analysis showed that treatment with dihomo-[gamma]-linolenic acid or oleic acid attenuated depletion of neutral and acidic glycoproteins from the mucus neck cells of the gastric mucosa in response to exposure to taurocholic acid. Despite having similar gastroprotective activity, arachidonic, dihomo-[gamma]-linolenic, linoleic, and oleic acids had very dissimilar abilities to elevate gastric mucosal E-series prostaglandins. Both arachidonic and dihomo-[gamma]-linolenic acids elevated E-series prostaglandins, but arachidonic acid had 2-5-fold greater gastroprotective potency. Furthermore, oleic and linoleic acids, which had protective potency similar to that dihomo-[gamma]-linolenic acid, did not significantly elevate prostaglandins. These studies failed to demonstrate an absolute correlation between prostaglandin elevation and gastroprotection. The results of this investigation suggest that prostaglandin elevation, although associated with gastroprotection, does not appear to be the sole mechanism for fatty acid-mediated protection of rat gastric mucosa.

Biliary excretion products of 1-[1-14C]naphthyl-N-methylcarbamate (carbaryl) in rainbow trout (Salmo gairdneri).

Uptake and metabolism of 1-naphthyl-N-methylcarbamate (carbaryl) were studied in rainbow trout (Salmo gairdneri) exposed to 14C-carbaryl in water. A high degree of biliary concentration was indicated by a 24-hr bile to water 14C ratio of nearly 1000:1. Four 14C-labeled compounds were purified from bile and two have been identified with reasonable certainty as unchanged carbaryl and 1-naphthol glucuronide. 5,6-Dihydro-5,6-dihydroxy-1-naphthyl-N-methylcarbamate was tentatively identified by thin-layer chromatography. The results indicate that carbaryl can be metabolized in rainbow trout via pathways similar to those reported in mammals and that bile analysis may be helpful in monitoring fish for exposure to this compound.