Scaphoid fracture is the most common carpal fracture. Nonunion rate has been reported around 10 to 15% of scaphoid fractures. Risk factors for scaphoid nonunion are known as location, displacement, poor vascularity, time to treatment etc. The goals of surgical treatment for scaphoid nonunion are to achieve bony union, to correct carpal deformities and also to prevent progressive carpal instability and arthritis. Scaphoid nonunion can cause scaphoid nonunion advanced collapse (SNAC) which is a pattern of progressive degenerative radiocarpal and midcarpal arthritis secondary to posttraumatic pathomechanics of the scapholunate joint. Achieving bony union is essential to prevent carpal collapse or arthritis. To improve bony union, many surgical procedures including various forms of bone grafting have been developed and attempted. However, there is a controversy about which procedure is the most effective. In this review, we provide an overview of surgical treatment methods for scaphoid nonunion and discuss proper surgical strategies for scaphoid nonunion which requires surgical management.

Non healing chronic wounds are difficult to treat in patients with diabetes and can result in severe medical problems for these patients and for society. Negative-pressure wound therapy (NPWT) has been adopted to treat intractable chronic wounds and has been reported to be effective. However, the mechanisms underlying the effects of this treatment have not been elucidated. To assess the vasculogenic effect of NPWT, we evaluated the systemic mobilization of endothelial progenitor cells (EPCs) during NPWT. Twenty-two of 29 consecutive patients who presented at the clinic of Seoul National Universty Hospital between December 2009 and November 2010 who underwent NPWT for diabetic foot infections or skin ulcers were included in this study. Peripheral blood samples were taken before NPWT (pre-NPWT) and 7–14 days after the initiation of NPWT (during-NPWT). Fluorescence-activated cell sorting (FACS) analysis showed that the number of cells in EPC-enriched fractions increased after NPWT, and the numbers of EPC colony forming units (CFUs) significantly increased during NPWT. We believe that NPWT is useful for treating patients with diabetic foot infections and skin ulcers, especially when these conditions are accompanied by peripheral arterial insufficiency. The systemic mobilization of EPCs during NPWT may be a mechanism for healing intractable wounds in diabetic patients with foot infections or skin defects via the formation of increased granulation tissue with numerous small blood vessels.

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Original ArticleClinics in Orthopedic Surgery 2014;6:62-71 • http://dx

This study aimed to develop a highly efficient nanofilter for capturing fine particles using electrostatic forces. Poly(vinyl alcohol) (PVA), a water-soluble synthetic polymer, was selected as the main component of the filter because it can be easily fabricated by electrospinning. Titanium dioxide (TiO 2 ) nanopowder with an anatase structure was applied to the nanofilters as it has the highest photocatalytic activity among the existing photocatalysts. PVA nanofilters fabricated by electrospinning could still be dissolved in water by hydrolysis. Therefore, heat treatment was performed to make the nanofilters stable, thereby forming CO bonds by keto−enol tautomerization. Structural changes in the PVA nanofilter before and after heat treatment were investigated by X-ray diffraction (XRD) and Fourier transform infrared (FT-IR) analysis. As the TiO 2 concentration increased, the fiber diameter of the PVA nanofilter decreased and a homogeneous fiber was obtained. The filtration efficiency and pressure drop also improved significantly, compared to those of the PVA-only nanofilter. Moreover, we observed eco-friendly decomposition of the PVA/TiO 2 nanofilter into water and carbon dioxide by a photocatalytic reaction under UV irradiation.