The majority of patients sustaining Jones fractures have evidence of varus hindfoot alignment. This may be a predisposing factor to developing the fracture or refracture after fixation. Postoperative varus unloading (lateral hindfoot and forefoot posting) orthotic insert appears to be helpful in preventing reinjury or refracture of Jones fractures.

Fatty acid methyl esters (FAME) were produced from cow's milk (Bostaurus) butter by esterification/transesterification in the presence of methanol. The product was assayed according to the Standard Specification for Biodiesel Fuel Blend Stock (B100) for Middle Distillate Fuels (ASTM D 6751). The preparation failed to meet the specifications for flash point, free and total glycerin contents, total sulfur, and oxidation stability. Failures to meet the flash point and free/total glycerin specifications were determined to be due to interference with standard assays for these parameters by short-chain-length fatty acid esters. The oxidation stability of the butterfat FAME was improved by supplementation with a commercial antioxidant formulation. Approximately 725 ppm of antioxidant was required to meet the ASTM-specified stability value for biodiesel. This work indicates that, without further purification to reduce a slightly excessive sulfur content, fatty acid ester preparations produced from butter are unacceptable as sole components of a biodiesel fuel. However, it is possible that even without further purification a butter-based ester preparation could be mixed with biodiesel from other feedstocks to produce a blend that meets the current quality standards for biodiesel. The results presented here also illustrate some potential weaknesses in the accepted methods for biodiesel characterization when employed in the analysis of FAME preparations containing mid- and short-chain fatty acid esters.

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Introduction Pathologic fracture of the femur due to Streptococcus anginosus osteomyelitis has rarely been described. With limited evidence for treating S. anginosus osteomyelitis, the orthopaedic surgeon is presented with a difficult treatment decision at index presentation. Presented here is a case of failed conservative management, diagnostic dilemma, failed hardware stabilization, and definitive surgical treatment resulting in good clinical outcome. Case presentation A 69-year-old male experienced acute right thigh pain, edema, and erythema after dental treatment 17 days prior. He was diagnosed with right femoral diaphyseal osteomyelitis and Brodie's abscess. Blood cultures grew S. anginosus , but all site-specific tissue cultures resulted negative. Initial management consisted of intravenous antibiotic therapy and percutaneous abscess drainage. Months later, the patient sustained a displaced pathologic fracture of the diaphyseal femur and there was concern for neoplasm, but biopsies were negative. Stabilization was attempted with a lateral plate and screws. This hardware catastrophically failed in the setting of an oligotrophic femoral nonunion. Ultimately, the patient was successfully treated with an intramedullary nail coated with antibiotic-impregnated cement. Twelve months later, the patient achieved clinical and radiographic healing with no evidence of relapse of his osteomyelitis. Clinical discussion Conservative management of S. anginosus femoral osteomyelitis was inadequate and corroborates the existing literature. S. anginosus osteomyelitis and pyomyositis may be most optimally treated aggressively with early surgical intervention. Conclusion Early surgical debridement and stabilization of the compromised bone with an antibiotic coated intramedullary nail following medullary reaming may prevent pathologic fracture, eradicate infection, and achieve predictable outcomes.