A safe, cost-effective, and high-throughput SARS-CoV-2 antigen capture ELISA suitable for large-scale screening in low-resource settings.

Diagnostics employing multiple modalities have been essential for controlling and managing COVID-19, caused by SARS-CoV-2. However, scaling up Reverse Transcription-Quantitative Polymerase Chain Reaction (RT-qPCR), the gold standard for SARS-CoV-2 detection, remains challenging in low and middle-income countries. Cost-effective and high-throughput alternatives like enzyme-linked immunosorbent assay (ELISA) could address this issue. We developed an in-house SARS-CoV-2 nucleocapsid capture ELISA, and validated on 271 nasopharyngeal swab samples from humans (n = 252), bovines (n = 10), and dogs (n = 9). This ELISA has a detection limit of 195 pg/100 µL of nucleocapsid protein and does not cross-react with related coronaviruses, ensuring high specificity to SARS-CoV-2. Diagnostic performance was evaluated using receiver operating characteristic curve analysis, showing a diagnostic sensitivity of 67.78 % and specificity of 100 %. Sensitivity improved to 74.32 % when excluding positive clinical samples with RT-qPCR Ct values > 25. Furthermore, inter-rater reliability analysis demonstrated substantial agreement (κ values = 0.73-0.80) with the VIRALDTECT II Multiplex RT-qPCR kit and perfect agreement with the CoVeasy™ COVID-19 rapid antigen self-test (κ values = 0.89-0.93). Our findings demonstrated that the in-house nucleocapsid capture ELISA is suitable for SARS-CoV-2 testing in humans and animals, meeting the necessary sensitivity and specificity thresholds for cost-effective, large-scale screening.

Fabrication of a wearable and foldable photodetector based on a WSe2-MXene 2D-2D heterostructure using a scalable handprint technique.

Several studies on semiconductor material-based single-band, high-performance photosensitive, and chemically stable photodetectors are available; however, the lack of broad spectral response, device flexibility, and biodegradability prevents them from being used in wearable and flexible electronics. Apart from that, the selection of the device fabrication technique is a very crucial factor nowadays in terms of equipment utilization and environmental friendliness. This report presents a study demonstrating a straightforward solvent- and equipment-free handprint technique for the fabrication of WSe2-Ti3C2TX flexible, biodegradable, robust, and broadband (Vis-NIR) photodetectors. X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), energy dispersive X-ray spectroscopy (EDX), UV-visible spectroscopy, and X-ray photoelectron spectroscopy (XPS) confirm the formation of a WSe2-Ti3C2TX film. The WSe2-Ti3C2TX van der Waals heterostructure plays a key role in enhancing the optoelectrical properties. The as-prepared photodetector exhibits efficient broadband response with a photoresponsivity and a detectivity of 0.3 mA W-1 and 6.8 × 1010 Jones, respectively, under NIR (780 nm) irradiation (1.0 V bias). Under various pressure and temperature conditions, the device's flexibility and durability were tested. The biodegradable photodetector prepared through the solvent- and equipment-free handprint technique has the potential to attract significant interest in wearable and flexible electronics in the future.

In-process quality control in foot-and-mouth disease vaccine production by detection of viral non-structural proteins using chemiluminescence dot blot assay.

Foot-and-mouth disease (FMD) is a contagious viral disease of cloven-footed animals. Immunization with inactivated virus vaccine is effective to control the disease. Six-monthly vaccination regimen in endemic regions has proven to be effective. To enable the differentiation of infected animals from those vaccinated, non-structural proteins (NSPs) are excluded during vaccine production. While the antibodies to structural proteins (SPs) could be observed both in vaccinated and infected animals, NSP antibodies are detectable only in natural infection. Quality control assays that detect NSPs in vaccine antigen preparations, are thus vital in the FMD vaccine manufacturing process. In this study, we designed a chemiluminescence dot blot assay to detect the 3A and 3B NSPs of FMDV. It is sensitive enough to detect up to 20 ng of the NSP, and exhibited specificity as it does not react with the viral SPs. This cost-effective assay holds promise in quality control assessment in FMD vaccine manufacturing.

Self-Supported Mn-Ni3Se2 Electrocatalysts for Water and Urea Electrolysis for Energy-Saving Hydrogen Production.

Recently, there has been a huge research interest in developing robust, efficient, low-cost, and earth-abundant materials for water and urea electrolysis for hydrogen (H2) generation. Herein, we demonstrate the facile hydrothermal synthesis of self-supported Mn-Ni3Se2 on Ni foam for overall water splitting under wide pH conditions. With the optimized concentration of Mn in Ni3Se2, the overpotential for hydrogen evolution, oxygen evolution, and urea oxidation is significantly reduced by an enhanced electrochemical active surface area. Different electronic states of metal elements also produce a synergistic effect, which accelerates the rate of electrochemical reaction for water and urea electrolysis. Owing to the chemical robustness, Mn-doped Ni3Se2 shows excellent stability for long time duration, which is important for its practical applications. A two-electrode electrolyzer exhibits low cell voltages of 2.02 and 1.77 V for water and urea electrolysis, respectively, to generate a current density of 100 mA/cm2. Finally, the prepared nanostructured Mn-Ni3Se2@NF acts as an electrocatalyst for overall water splitting under wide pH conditions and urea electrolysis for energy-saving hydrogen production and wastewater treatment.

2D Monolayer Catalysts: Towards Efficient Water Splitting and Green Hydrogen Production.

A viable alternative to non-renewable hydrocarbon fuels is hydrogen gas, created using a safe, environmentally friendly process like water splitting. An important role in water-splitting applications is played by the development of two-dimensional (2D) layered transition metal chalcogenides (TMDCs), transition metal carbides (MXenes), graphene-derived 2D layered nanomaterials, phosphorene, and hexagonal boron nitride. Advanced synthesis methods and characterization instruments enabled an effective application for improved electrocatalytic water splitting and sustainable hydrogen production. Enhancing active sites, modifying the phase and electronic structure, adding conductive elements like transition metals, forming heterostructures, altering the defect state, etc., can improve the catalytic activity of 2D stacked hybrid monolayer nanomaterials. The majority of global research and development is focused on finding safer substitutes for petrochemical fuels, and this review summarizes recent advancements in the field of 2D monolayer nanomaterials in water splitting for industrial-scale green hydrogen production and fuel cell applications.

Transition to period-3 synchronized state in coupled gauss maps.

We study coupled Gauss maps in one dimension with nearest-neighbor interactions. We observe transitions from spatiotemporal chaos to period-3 states in a coarse-grained sense and synchronized period-3 states. Synchronized fixed points are frequently observed in one dimension. However, synchronized periodic states are rare. The obvious reason is that it is very easy to create defects in one dimension. We characterize all transitions using the following order parameter. Let x∗ be the fixed point of the map. The values above (below) x∗ are classified as +1 (-1) spins. We expect all sites to return to the same band after three time steps for a coarse-grained periodic or three-period state. We define the flip rate F(t) as the fraction of sites i such that si(3t-3)≠si(t). It is zero in the coarse-grained periodic state. This state may or may not be synchronized. We observe three different transitions. (a) If different sites reach different bands, the transition is in the directed-percolation universality class. (b) If all sites reach the same band, we find an Ising-type transition. (c) A synchronized period-3 state where a new exponent is observed. We also study the finite-size scaling at critical points. The exponents obtained indicate that the synchronized period-3 transition is in a new universality class.

Diagnosis of Intrauterine Pregnancy Despite the Presence of Etonogestrel Implant.

While contraception is an important method to avoid pregnancy, it is not always effective. Our case details a 33-year-old-female with an etonogestrel implant who presented to the emergency department (ED) with a two-week history of vomiting and abdominal pain. Pelvic and transvaginal ultrasound confirmed a single, live intrauterine pregnancy. Our case serves as a reminder that ED providers should have a high index of suspicion for pregnancy in clinically relevant scenarios, despite contraceptive methods, until the appropriate confirmatory diagnostic evaluation for pregnancy is completed.

Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis.

Background: Management of neck of femur fractures depend upon the age of presentation and it ranges from internal fixation to arthroplasty. In a relatively young population, anatomical reduction with stable internal fixation is the preferred treatment modality; the choice of implants available are multiple cannulated cancellous screws, dynamic hip screws, and the newly devised femoral neck system. The fracture configuration and pattern dictate the ideal implant to be utilized, with the femoral neck system documented to be apt for all the fracture types, while the cannulated screws are deemed better for stable fractures. Methods: A primary electronic search was conducted on databases of Medline, Scopus, Scopus, Cochrane Library, and Embase, to look for articles published between 1st January 2010 to 22nd November 2021. Studies including adults with femoral neck fractures treated with internal fixation with femoral neck system and comparing them with internal fixation with cannulated cancellous screws in terms of variables like mean surgical duration, loss of blood, length of incision, fluoroscopy time, duration of hospital stay and outcomes like union time, complications, functional outcomes, Visual Analogue Score, and femoral neck shortening, were included. Results: 6 retrospective studies with 371 patients (224 males,147 females) (164: FNS; 207: CCS) were included. Our analysis demonstrated no statistically significant difference in terms of duration of surgery, incision length, and length of hospital stay, there was more blood loss in FNS, but less fluoroscopy time. The fracture union time was lesser for the FNS group and also the femoral shortening was lesser in it. There was no difference in terms of complications, pain relief, and functional outcomes. Conclusion: Femoral neck system is a new and effective implant for femoral neck fractures in the young with faster union rates and lesser neck shortening through an incision similar to the conventional multiple cancellous screws. It has additional advantages of lesser fluoroscopy exposure to the patient and the OT personnel. However, the rates of complications like implant failure, non-unions, and avascular necrosis are similar to the cannulated screws and either of the implants do not offer any advantage in the final functional status and pain relief to the patient over each other.

Association of Specific Genetic Polymorphisms with Atraumatic Osteonecrosis of the Femoral Head: A Narrative Review.

Introduction: Atraumatic ONFH is one of the leading cause of hip morbidity in the working-age group. It is a multi-factorial disease whose root cause can be attributed to single-nucleotide polymorphism. Identifying such polymorphisms could pave the way for new modalities of treatment for ONFH. Methodology: Two databases were electronically searched for relevant articles. The articles were screened through titles, abstract and full texts to include the relevant studies. A secondary search was done through the reference list of selected articles. Results: A total of 52 studies were included among the 181 hits. All 181 were case-control studies. Summary of these studies identifies multiple SNPs which can cause ONFH. There were 117 SNPs in all 181 studies, of which 92 were associated with the causation of ONFH and 25 were protective against ONFH. Conclusion: SNPs play an essential role in causing atraumatic ONFH. Identification of SNP that contribute to causing ONFH may help reduce the disease burden by early identification, diagnosis and treatment, including targeted gene therapy.

Capnocytophaga canimorsus meningitis in a 38-year-old immunocompetent woman from household pet exposure.

A 38-year-old otherwise healthy woman with no history of immunocompromise, recent travel, or concerning exposures presented to the ED with several days of nonspecific cold-like symptoms with associated generalized headache. After the patient was symptomatically treated and discharged, she returned several hours later with worsening of symptoms and new vomiting, confusion, and sensorineural hearing loss. Blood and cerebrospinal fluid cultures eventually returned positive for a Capnocytophaga canimorsus infection, a bacterial pathogen found in the saliva of dogs and cats. Only after that, the patient recalled being scratched and licked by her pets, two dogs and a cat. She was treated with a course of systemic steroids, antibiotics and discharged home.

The Clinical Significance of Perineural Invasion by Prostate Cancer on Needle Core Biopsy: Involvement of Single Versus Multiple Sextant Sites.

CONTEXT.­: Perineural invasion (PNI) by prostate cancer has been associated with adverse pathology, including extraprostatic extension. However, the significance of PNI quantification on prostate biopsy (PBx) remains unclear. OBJECTIVE.­: To compare radical prostatectomy (RP) findings and long-term outcomes in patients whose PBx had exhibited PNI. DESIGN.­: We assessed 497 consecutive patients undergoing sextant (6-site/≥12-core) PBx showing conventional adenocarcinoma followed by RP. RESULTS.­: PNI was found in 1 (n = 290)/2 (n = 132)/3 (n = 47)/4 (n = 19)/5 (n = 5)/6 (n = 4) of the sites/regions of PBx. Compared with a single PNI site, multiple PNIs were significantly associated with higher preoperative prostate-specific antigen, higher Grade Group (GG) on PBx or RP, higher pT or pN category, positive surgical margin, and larger estimated tumor volume. When compared in subgroups of patients based on PBx GG, significant differences in RP GG (GG1-3), pT (GG1-2/GG1-3/GG2/GG3), surgical margin status (GG1-3/GG3/GG5), or tumor volume (GG1-2/GG1-3/GG2/GG3) between 1 versus multiple PNIs were observed. Moreover, there were significant differences in prostate-specific antigen (PNI sites: 1-2 versus 3-6/1-3 versus 4-6/1-4 versus 5-6), RP GG (1-3 versus 4-6/1-4 versus 5-6), pT (1-2 versus 3-6/1-3 versus 4-6), pN (1-3 versus 4-6), or tumor volume (1-2 versus 3-6/1-4 versus 5-6). Outcome analysis revealed significantly higher risks of disease progression in the entire cohort or PBx GG1-2/GG1-3/GG2/GG3/GG5 cases showing 2 to 6 PNIs, compared with respective controls with 1-site PNI. In multivariate analysis, multisite PNI was an independent predictor for progression (hazard ratio = 1.556, P = .03). CONCLUSIONS.­: Multiple sites of PNI on PBx were associated with worse histopathologic features in RP specimens and poorer prognosis. PNI may thus need to be specified, if present, in every sextant site on PBx, especially those showing GG1-3 cancer.

Limited Adenocarcinoma of the Prostate on Needle Core Biopsy.

CONTEXT.­: Grading small foci of prostate cancer on a needle biopsy is often difficult, yet the clinical significance of accurate grading remains uncertain. OBJECTIVE.­: To assess if grading of limited adenocarcinoma on prostate biopsy specimen is critical. DESIGN.­: We studied 295 consecutive patients undergoing extended-sextant biopsy with only 1-core involvement of adenocarcinoma, followed by radical prostatectomy. RESULTS.­: The linear tumor lengths on these biopsy specimens were: less than 1 mm (n = 114); 1 mm or more or less than 2 mm (n = 82); 2 mm or more or less than 3 mm (n = 35); and 3 mm or more (n = 64). Longer length was strongly associated with higher Grade Group (GG) on biopsy or prostatectomy specimen, higher risk of extraprostatic extension/seminal vesicle invasion and positive surgical margin, and larger estimated tumor volume. When cases were compared based on biopsy specimen GG, higher grade was strongly associated with higher prostatectomy specimen GG, higher incidence of pT3/pT3b disease, and larger tumor volume. Outcome analysis further showed significantly higher risks for biochemical recurrence after radical prostatectomy in patients with 1 mm or more, 2 mm or more, 3 mm or more, GG2-4, GG3-4, GG4, less than 1 mm/GG2-4, less than 1 mm/GG3-4, less than 2 mm/GG3-4, 3 mm or more/GG2-4, or 3 mm or more/GG3-4 tumor on biopsy specimens, compared with respective control subgroups. In particular, 3 mm or more, GG3, and GG4 on biopsy specimens showed significance as independent prognosticators by multivariate analysis. Meanwhile, there were no significant differences in the rate of upgrading or downgrading after radical prostatectomy among those subgrouped by biopsy specimen tumor length (eg, <1 mm [44.7%] versus ≥1/<2 mm [41.5%] versus ≥2/<3 mm [45.7%] versus ≥3 mm [46.9%]). CONCLUSIONS.­: These results indicate that pathologists still need to make maximum efforts to grade relatively small prostate cancer on biopsy specimens.

The Clinical Impact of pT3a Lesions in Patients With pT3b Prostate Cancer Undergoing Radical Prostatectomy.

CONTEXT.­: Seminal vesicle invasion (SVI) by prostate cancer (pT3b disease) has been considered as a key prognostic factor. OBJECTIVE.­: To assess the clinical impact of T3a lesions (ie, extraprostatic extension other than bladder neck invasion [BNI] or SVI [EPE], microscopic bladder neck invasion [mBNI]) in pT3b disease. DESIGN.­: We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients with pT3b disease, with versus without EPE/mBNI. RESULTS.­: Extraprostatic extension/mBNI was found in 219 (88.3%)/48 (19.4%) cases, respectively. Extraprostatic extension was significantly associated with higher preoperative prostate-specific antigen (PSA) level, higher rates of positive surgical margin (pSM) and lymphovascular invasion (LVI), and larger tumor volume. Similarly, mBNI was significantly associated with higher PSA level, higher rates of Grade Group(s) 4-5 or 5, pSM, LVI, and pN1, and larger tumor volume. Significant differences in all of these clinicopathologic features (except lymph node metastasis) between EPE-/mBNI+ or EPE+/mBNI- and EPE+/mBNI+ cases were also observed. Outcome analysis revealed that patients with EPE (P < .001) or mBNI (P < .001) had a significantly higher risk of disease progression than respective controls. Notably, there were significant differences in progression-free survival between EPE-/mBNI+ or EPE+/mBNI- cases and EPE-/mBNI- (P = .001) or EPE+/mBNI+ (P < .001) cases. In multivariate analysis, EPE (hazard ratio [HR] = 6.53, P = .009) and mBNI (HR = 2.33, P = .003), as well as EPE-/mBNI+ or EPE+/mBNI- (HR = 11.7, P = .01) and EPE+/mBNI+ (HR = 25.9, P = .002) versus EPE-/mBNI-, showed significance for progression. CONCLUSIONS.­: From these significant findings, we propose a novel pT3b subclassification: pT3b1 (SVI alone without EPE or mBNI), pT3b2 (SVI with either EPE or mBNI), and pT3b3 (SVI with both EPE and mBNI).

The Clinical Impact of Unilateral Versus Bilateral Invasion Into the Seminal Vesicle in Patients With Prostate Cancer Undergoing Radical Prostatectomy.

CONTEXT.­: Seminal vesicle involvement by prostate cancer has generally been considered as a key prognosticator. OBJECTIVE.­: To assess the clinical significance of unilateral (Uni) versus bilateral (Bil) seminal vesicle invasion (SVI). DESIGN.­: We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients showing Uni-SVI (n = 139) versus Bil-SVI (n = 109). RESULTS.­: Tumor grade was significantly higher in Bil-SVI cases than in Uni-SVI cases. Additionally, Bil-SVI was significantly associated with a higher incidence of lymphovascular invasion, lymph node metastasis, or positive surgical margin, and larger estimated tumor volume. When the histopathologic features at SVI foci were compared, Grade Group (GG) 3-5/4-5/5 and cribriform morphology were significantly more often seen in Bil-SVI. Outcome analysis revealed that patients with Bil-SVI had a significantly higher risk of disease progression (P < .001) than patients with Uni-SVI. Significantly worse progression-free survival in patients with Bil-SVI was also observed in all subgroups examined, including those with no immediate adjuvant therapy (IAT) (n = 139; P = .01), IAT (n = 109; P = .001), pN0 disease (n = 153; P = .002), or pN1 disease (n = 93; P = .006). In multivariate analysis, Bil-SVI (versus Uni-SVI) showed significance for progression in the entire (hazard ratio [HR] = 1.83, P = .01), IAT (HR = 2.90, P = .006), and pN0 (HR = 2.05, P = .01) cohorts. Meanwhile, tumor grade at SVI (eg, GG4, GG5), as an independent predictor, was significantly associated with patient outcomes. CONCLUSIONS.­: Bil-SVI was found to be strongly associated with worse histopathologic features on radical prostatectomy and poorer prognosis. Pathologists may thus need to report Uni-SVI versus Bil-SVI, along with other histopathologic findings, such as Gleason score, at SVI in prostatectomy specimens.

Fluorescence spectroscopy method for estimation of Ivabradine in bulk and the tablet dosage form.

A simple and sensitive spectrofluorimetric method has been developed for the estimation of Ivabradine HCl in bulk and the tablet dosage form. Ivabradine HCl in methanol produces fluorescence at 325 nm (λem) with excitation at 287 nm (λex). The linearity range was found to be 100-500 ng/ml with a correlation coefficient of 0.999. The limit of detection (LOD) and limit of quantitation (LOQ) for the developed method were found to be 8.38 and 25.39 ng/ml, respectively. The developed method was found to be specific, sensitive, accurate, and precise. It was successfully used for the estimation of Ivabradine HCl in its tablet dosage form. The content of Ivabradine HCl in marketed formulations was found to be 101.25 ± 1.16 % of label claims.

Is early intramedullary interlocked nailing an effective treatment option for open grade III femoral shaft fractures: a systematic review of literature and pooled analysis of 176 cases.

BACKGROUND: Open Grade 3 femoral fractures are high-velocity injuries, often associated with other co-morbid injuries and are highly prone to infections; these fractures are commonly treated by staged procedures to minimize the complications. Early definitive fixation by intramedullary (IM) interlocking nails (ILN) has advantages like early mobility and better outcomes. STUDY QUESTION: Are early definitive fixations of grade III shaft femur fractures with debridement & IM ILN effective in union and infection rates? MATERIALS AND METHODS: Using relevant keywords, a total of 3357 articles were screened from the PubMed, Scopus and Embase database. 6 studies that evaluated at least 10 cases of grade III open femoral shaft fractures treated with early IM ILN during the index surgery were included in this review. RESULTS: Out of the 6 studies, only 1 was prospective, and the remaining 5 were retrospective in design. Out of 176 Grade III fractures, there were 8 non-unions, 3 malunions and 1 case of delayed union. Pooled analysis showed union rates of 94.8% for these fractures (4 studies). Infection was the most common complication. Pooled analysis showed that the mean rate of infection in these grade III fractures was 6.7%. Other complications included limb length discrepancy and stiff knee. CONCLUSION: Intramedullary nailing in grade 3 femoral fractures as an early method of definitive fixation is an effective option. In such cases, optimizing controllable variables like surgical expertise and adequate antibiotic prophylaxis can improve outcomes.

WSe2crystals on paper: flexible, large area and broadband photodetectors.

The paper-based photodetector has recently captivated a great deal of attention in various opto-electronics applications because of facile, cost effective and green synthesis. Two-dimensional transition metal dichalcogenides materials are promising for photodetection under the broad spectral range. In this work, we have fabricated paper-based device by rubbing the tungsten di-selenide (WSe2) crystals on paper substrate. Low-cost, facile and green synthesis technique was employed to make a high-performance paper-based WSe2photodetector. Paper-based photodetector was fabricated via non-toxic simply rubbing process of WSe2nanosheets on low-cost bio-degradable paper. The photodetector shows good responsivity of 72.5 µA W-1and detectivity at around 2.4 × 107Jones at very low bias (1.0 V) at wavelength of 780 nm, respectively. Due to good photo-absorption strength, photodetector exhibits excellent photo-response over wide wavelength range from visible to near infrared. This device also shows very good flexibility with a stable photo-response. This device shows a general and reliable study for the design of photodetectors that is eco-friendly and cost-effective. Overall studied results of the fabricated device indicate that they have the ability to be used in large-scale preparation of the device.

Photosensitive electrocatalysts based on Ni-WS2nanohybrids for hydrogen evolution reaction.

Efficient hydrogen evolution by electrolysis plays an indispensable role for hydrogen fuel generation in green energy devices. In order to implement high-performance electrocatalytic activity, it is usually necessary to design economically viable, effective and stable electrocatalysts to reduce activation potential barriers. Herein, we report the photosensitive Ni-WS2nanohybrids for enhanced electrocatalytic hydrogen evolution reaction (HER). Optimisation of chemical composition in catalysts has resulted in the rapid water electrolysis which was further promoted by illumination of 532 nm light. Obvious HER has been achieved at over potential of as low as -210 mV versus RHE without and -190 mV versus RHE (at -10 mA cm-2) with illumination. Being a photosensitive electrocatalysts, Ni-WS2Nanohybrids have demonstrated stable time-resolved photoresponse with photocurrent of 12.7 mA cm-2at -250 mV V versus RHE as well as self-powered photodetection with current 0.68 mA cm-2. Finally, HER with improvement under visible light illumination has shown considerable development in clean energy generation by using renewable energy sources.

The effectiveness of arthroscopy assisted fixation of Schatzker types I-III tibial plateau fractures: our experience at a tertiary centre.

BACKGROUND: Tibial condyle fractures are high energy injuries which require anatomical reduction and stable fixation for early mobilisation of the knee joint. Arthroscopy assisted fixation of these fractures provide additional benefits of minimal dissection, accurate visualisation of the articular surface and faster rehabilitation. The present study describes our experience with this technique. MATERIALS & METHODS: Patients in the age group 15-65 years, presenting with closed tibial plateau fractures (Schatzker types I, II, III) at the advanced trauma centre of our institute within 3 weeks of injury, were recruited for this prospective case series. Open fractures, fractures of types IV, V and VI, fractures with associated knee dislocation, fractures presenting after 3 weeks and polytrauma patients with head injuries and/or blunt trauma to chest/abdomen, were excluded. Patients were evaluated according to Rasmussen numerical subjective evaluation chart at a minimum follow up of 6 months. RESULTS: There were 5 fractures of Schatzker type I, 8 of type II and 2 of type III, which were scoped and fixed percutaneously. The mean age of the 15 patients was 34.2 years with male to female ratio of 4:1. Diagnostic arthroscopy detected co existent lateral meniscal tears (peripheral) in 2 cases, while 1 case had a contused anterior cruciate ligament. Fixation of the fractures were done by 1 or 2 percutaneous screws in 9/15 cases; buttress plating in 4/15 cases and combination of plate and screw in 2/15 cases. The average overall Rasmussen score was 28.2/30 (range 22-30) and there were 1 patient each with postoperative stiffness and screw prominence while 3 cases had extensor lags. CONCLUSION: The aim of this combination procedure is stable fixation by minimally invasive methods; this reduces surgical insult, improves articular surface visualisation, allows management of concomitant ligament injuries, and patients can be rapidly mobilised. Case selection is extremely important for good results.

Bilateral crescent fracture-dislocation of the sacroiliac joint: a case-based discussion and review of literature.

BACKGROUND: Crescent fractures are a subset of lateral compression injuries associated with high energy trauma and are rotationally unstable. These fractures are rare bilaterally, and we present one such rare case of a bilateral crescent fracture. CASE DESCRIPTION: A 56-year-old male presented with run-over injury and was diagnosed with bilateral crescent fracture-dislocation of the Sacroiliac joint. He was stabilized hemodynamically and then operated with iliosacral screws and reconstruction plates. The fracture united, and the patient is doing his daily activities without discomfort at follow up of 1 year after fracture fixation. CONCLUSION: Bilateral pelvic crescent fractures are rare and need optimization and fixation for improved functional outcomes. It is necessary to evaluate associated injuries.