Seventy-two patients with 76 fracture-dislocations of the Lisfranc tarsometatarsal joint complex were evaluated. Fifty-eight (81%) were polytrauma patients and the remainder suffered isolated injuries. Sixty of the original 72 patients were available for long-term study. Eight of these had an amputation at or shortly after the original admission, leaving 52 patients with 55 Lisfranc injuries for analysis. The average length of follow-up was 4.2 years (range, 20 months to 11 years). According to the Painful Foot Center scoring system, 27 feet (49%) achieved an excellent or good result and 28 (51%), a fair or poor result. Direct crush injuries did poorly with only one of eight scoring good or excellent. Of the various treatment modalities, open reduction and internal fixation with Kirschner wires yielded the best results. The major determinant of unacceptable results was identified as the quality of the initial reduction. Tarsal instability and late degenerative joint disease caused most of the symptoms. Twenty-three of the 52 patients (44%) have had or should have further mid-foot surgery to improve function and comfort. Because our results were often poor, our present protocol includes closed or open reduction and Kirschner wire internal fixation. Displacement greater than 2 mm or a talometatarsal angle greater than 15 degrees on radiographs following a closed reduction mandates open reduction.

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We present a collection of eight data sets from state-of-the-art experiments and numerical simulations on turbulent velocity statistics along particle trajectories obtained in different flows with Reynolds numbers in the range R 2 120:740. Lagrangian structure functions from all data sets are found to collapse onto each other on a wide range of time lags, pointing towards the existence of a universal behavior, within present statistical convergence, and calling for a unified theoretical description. ParisiFrisch multifractal theory, suitably extended to the dissipative scales and to the Lagrangian domain, is found to capture the intermittency of velocity statistics over the whole three decades of temporal scales investigated here.

We report the results of a series of three-dimensional (3D) simulations of the deflagration phase of the gravitationally confined detonation mechanism for Type Ia supernovae. In this mechanism, ignition occurs at one or several off-center points, resulting in a burning bubble of hot ash that rises rapidly, breaks through the surface of the star, and collides at a point opposite the breakout on the stellar surface. We find that detonation conditions are robustly reached in our 3D simulations for a range of initial conditions and resolutions. Detonation conditions are achieved as the result of an inwardly directed jet that is produced by the compression of unburnt surface material when the surface flow collides with itself. A high-velocity outwardly directed jet is also produced. The initial conditions explored in this paper lead to conditions at detonation that can be expected to produce large amounts of 56 Ni and small amounts of intermediate-mass elements. These particular simulations are therefore relevant only to high-luminosity Type Ia supernovae. Recent observations of Type Ia supernovae imply a compositional structure that is qualitatively consistent with that expected from these simulations.