Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept.

METHODS: Between 2005 and 2012, 50 patients (23 female, 27 male) with nonunion of the humeral shaft were included in this retrospective study. The mean age was 51.3 years (14 to 88). The patients had a mean of 1.5 prior operations (sd 1.2;1 to 8). All patients were assessed according to a specific risk score in order to devise an optimal and individual therapy plan consistent with the Diamond Concept. In 32 cases (64%), a change in the osteosynthesis to an angular stable locking compression plate was performed. According to the individual risk an additional bone graft and/or bone morphogenetic protein-7 (BMP-7) were applied. RESULTS: A successful consolidation of the nonunion was observed in 37 cases (80.4%) with a median healing time of six months (IQR 6). Younger patients showed significantly better consolidation. Four patients were lost to follow-up. Revision was necessary in a total of eight (16%) cases. In the initial treatment, intramedullary nailing was most common. DISCUSSION: The use of locking compression plates in combination with autologous cancellous bone graft has been shown to be a safe and effective treatment. In more complex cases, the use of the Masquelet technique and BMP-7 may be indicated at the first revision operation. TAKE HOME MESSAGE: Our results suggest the Diamond Concept is a successful treatment strategy for nonunions of the humeral shaft.

Optical studies on free-standing films of an achiral smectic liquid crystal.

Employing null transmission ellipsometry and depolarized reflected light microscopy, we have studied two smectic phases, Sm-C1 and Sm-C2, of one achiral mesogen. Our results show that Sm-C1 and Sm-C2 are the synclinic Sm-C and anticlinic Sm-C(A) phases, respectively. We find no evidence to support recent claims that the Sm-C1 is chiral and ferroelectric [R. Stannarius et al., Phys. Rev. Lett. 90, 025502 (2003)].