BackgroundNovel bone substitutes have challenged the notion of autologous bone grafting as the ‘gold standard’ for the surgical treatment of fracture nonunions. The present study was designed to test the hypothesis that autologous bone grafting is equivalent to other bone grafting modalities in the management of fracture nonunions of the long bones.MethodsA retrospective review of patients with fracture nonunions included in two prospective databases was performed at two US level 1 trauma centers from January 1, 1998 (center 1) or January 1, 2004 (center 2), respectively, until December 31, 2010 (n = 574). Of these, 182 patients required adjunctive bone grafting and were stratified into the following cohorts: autograft (n = 105), allograft (n = 38), allograft and autograft combined (n = 16), and recombinant human bone morphogenetic protein-2 (rhBMP-2) with or without adjunctive bone grafting (n = 23). The primary outcome parameter was time to union. Secondary outcome parameters consisted of complication rates and the rate of revision procedures and revision bone grafting.ResultsThe autograft cohort had a statistically significant shorter time to union (198 ± 172–225 days) compared to allograft (416 ± 290–543 days) and exhibited a trend towards earlier union when compared to allograft/autograft combined (389 ± 159–619 days) or rhBMP-2 (217 ± 158–277 days). Furthermore, the autograft cohort had the lowest rate of surgical revisions (17%) and revision bone grafting (9%), compared to allograft (47% and 32%), allograft/autograft combined (25% and 31%), or rhBMP-2 (27% and 17%). The overall new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) (P < 0.05).ConclusionAutologous bone grafting appears to represent the bone grafting modality of choice with regard to safety and efficiency in the surgical management of long bone fracture nonunions.

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The Clouded leopard (Neofelis nebulosa) is a medium-sized highly arboreal cat. This study compares the structure of the digital, metacarpal and metatarsal pads of the manus and pes in N. nebulosa to that of the domestic cat (Felis catus). Covered by a stratified squamous cornified epithelium, the pads have a supple deposit of subepidermal fat that is partitioned by collagen fibers and extensively anchored to the muscle tendon sheaths. In both animals, a pes metatarsal pad suspensory ligament originates from the Mm. flexores digitorum profundi tendon and forms 3-4 small branches that project through the dermal fat layer and attach to the pad epidermis. In the cat manus, four tendons of equal size extend from the M. flexor digitorum superficialis (FDS) to form the manica flexoria in digits 2-4 from which extends a metacarpal pad suspensory ligament (MPSL) on digits 2 and 5 that extends into the tela subcutanea and epidermis. On digits 3 and 4 MPSL extends directly from the FDS tendon itself. In contrast, manus FDS tendons 1 and 5 in N. nebulosa were thin and either project directly to the tela subcutanea (tendon 1) or connect with the manica flexoria forming a metacarpal pad suspensory ligament (tendon 5). Tendons 2-4 connect with the manica flexoria from which MPSL project into the tela subcutanea and epidermis. In both species, the suspensory ligaments may serve to contract the pad to conform to the under lying substrate, thus enhancing the animal's ability to grip branches while climbing.

Staphylococcus aureus nasal colonization in trauma patients with open fractures is similar to that of the general community. In this pilot study, the addition of vancomycin to standard antibiotic prophylaxis was found safe, but its efficacy should be evaluated in a larger multiinstitutional trial.

A system for NMCT patient dose audit has been developed, but there are non-trivial challenges which make the process labour intensive. These include limited information provided by CRIS downloads, dependence on paper records and limited number of examinations available owing to the need to subdivide data. Advances in knowledge: This article demonstrates that a system can be developed for NMCT patient dose audit, but also highlights the challenges associated with such audit, which may not be encountered with more routine audit of radiology CT.

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Backgrounds/Aims Middle hepatic vein (MHV) is usually preserved as a part of the right or left hepatectomy in order preserve the venous outflow of remnant liver. The aim of this study was to evaluate if resection of MHV could influence post-resection outcomes of standard right or left hepatectomy. Methods Patients who underwent standard right or left hepatectomy between January 2015 and December 2019 were included. Anatomical remnant liver volumes were measured retrospectively using the Hermes workstation (Hermes Medical Solutions AB, Stockholm, Sweden). Uni- and multi-variate analyses were performed to assess the difference in outcomes of those with preservation of MHV and those without preservation. Results A total of 144 patients were included. Right hepatectomy was performed for 114 (79.2%) and left hepatectomy was performed for 30 (20.8%) patients. MHV was resected for 13 (9.0%) in addition to the standard right or left hepatectomy. Median remnant liver volume was significantly higher in the MHV resected group ( p < 0.01). There was no significant difference in serum level of bilirubin, international normalized ratio, alanine aminotransferase, creatinine on postoperative day 1, 3, 5, or 10, ≥ grade IIIa complications ( p = 0.44), or 90-day mortality ( p = 0.41). On multivariable analysis, resection of the MHV did not influence the incidence of post hepatectomy liver failure ( p = 0.52). Conclusions Resection of the MHV at standard right or left hepatectomy did not have a negative impact on postoperative outcomes of patients with adequate remnant liver volume.