Role of Anteromedial Cortical Support for Unstable Intertrochanteric Fractures Being Treated With Cephalomedullary Nails.

INTRODUCTION: Reduction quality is of paramount importance for an optimal outcome in unstable pertrochanteric fractures. The non-anatomical functional anteromedial buttress is proposed to prevent impending mechanical complications. We aimed to evaluate the role of anteromedial cortical support in preventing mechanical complications following fixation with the cephalomedullary nail. MATERIALS AND METHODS: A prospective, single-arm interventional study was conducted in the Orthopaedics Department of a Combined Military Hospital (CMH) in Rawalpindi. The duration of the study was 24 months. Patients were recruited by the purposive sampling technique as per inclusion/exclusion criteria. Preoperatively, the reduction was categorized as per Baumgartner's and Chang's criteria. Post-operatively, weight bearing as tolerated was advised. Radiographs prior to discharge for loss of reduction were evaluated. Follow-up radiographic measurements of neck length, neck shaft angle, and their loss as per protocol were done at three and six months. RESULTS: A total of 202 patients were operated on from October 21 until August 23. Mortality at six months in 39 patients (19.3%) and loss to follow-up in 31 patients (15.3%) resulted in 132 patients with complete follow-up and having developed complications in 12 patients (9.09%). The mean age was 76.3 ± 7.98 years; males were 105 (79.5%), and females were 27 (20.5%). Closed reduction was 58 (43.9%), and additional manoeuvres were required in 74 (56.1%). The mean tip apex distance (TAD) was 24.56 ± 2.76, and the Calcar gap was 5.16 ± 1.27. Cleveland zone centre-centre in 54 (40.9%), inferior-centre in 65 (49.2%), and inferior-posterior (9.9%) were statistically significant for mechanical complications (p≤0.001). There was a significant association between the grading of Chang's and Baumgartner's poor groups for the development of mechanical complications (p≤0.001). The mean time to full weight bearing without support was 21 ± 1.22 weeks. The mean Hip Harris score at six months was 69.27 ± 7.68. CONCLUSION: Results suggest that anteromedial cortical support can lead to fewer potential mechanical complications at six months. A higher Chang's grade drives surgeons to engage in additional manoeuvres. Anteromedial cortical support is worth consideration for unstable pertrochanteric fractures.

Natural resources, fiscal decentralization, and environmental quality in China: an empirical analysis from QARDL approach.

It is generally believed that fiscal decentralization is an essential way to increase the overall effectiveness and efficiency of the government through the transfer of financial autonomy to the local governments. On the same lines, this study attempts to confabulate the influence of two important economic indicators, (i) fiscal decentralization and (ii) natural resource rent in validation of the environmental Kuznets curve hypothesis. Our current analysis is grounded upon a developing economy - China - and will serve as a stepping stone for the similar economies. The time period for the empirical estimation is from 1990 to 2020. The study applied an advanced econometrics approach, called the quantile autoregressive distributed lag (QARDL), which has many advantages as compared to any conventional approach. The empirical outcomes, after estimations, illustrate that in the long run, FDE is having an unfavorable connotation with CO2 emissions. NRR is another essential factor influencing the CO2 emissions in the long run in the selected economy. The estimated outcomes are revealing the presence of the EKC. Furthermore, the present research elucidates the existence of the bi-directional causality between selected economic indicators, FDE and CO2 emissions, and GDP square and CO2 emissions. But there is a unidirectional causality between GDP and CO2 emissions. Thus, policymakers should encourage the transfer of powers to the lower tiers of government to ameliorate environmental quality in the Chinese economy.

Does ICT diffusion lead to energy efficiency and environmental sustainability in emerging Asian economies?

The role of information and communication technology (ICT) is imperative in the transformation of the world. ICT is directly affecting all the sectors of the whole economy. Thus, the present study is determined to investigate the effect of ICT on energy efficiency and environmental sustainability in emerging Asian economies from 1990 to 2019. The panel augmented autoregressive distributed lag-pooled mean group approach has been used for empirical investigation. Two separate models have been designed to attain the empirical consensus. ICT is measured through two proxies namely broadband subscriptions (internet) and mobile cellular subscriptions (mobile). Results show that internet and mobile upsurge the energy efficiency in the long run. However, internet and mobile have a reducing impact on carbon emissions in the long run. While FDI enhances energy efficiency and reduces carbon emissions inferring that environmental efficiency improves in the long run. The study suggests that policymakers must be aware of the impact of ICT on energy efficiency and environmental quality and regulate their manufacturers to enable the amalgamation of ICT into users' routines.