Most injuries to the chest wall with residual deformity do not result in long-term respiratory dysfunction unless they are associated with pulmonary contusion. Indications for operative fixation include flail chest, reduction of pain and disability, a chest wall deformity or defect, symptomatic nonunion, thoracotomy for other indications, and open fractures. Operative indications for chest wall injuries are rare.

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Study Design-Longitudinal radiographic study of patients with progressive idiopathic scoliosis.Objective-To determine the relative contributions of vertebral and disc wedging to the increase in Cobb angle during 3 phases of adolescent skeletal growth and maturation.Summary of Background Data-Both disc wedging and vertebral body wedging are found in progressive scoliosis, but their relative contribution to curve progression over time is unknown. Which occurs first is important for understanding how scoliosis progresses and for developing methods to halt progression. Previous studies have not properly identified maturity and provide conflicting results.Methods-Eighteen girls were followed through their adolescent growth spurt with serial spine and hand skeletal age radiographs. Each Cobb angle was divided into disc wedge angles and vertebral wedge angles. The corresponding hand radiographs provided a measure of maturity level, the Digital Skeletal Age (DSA). The disc versus bone contributions to the Cobb angle were then compared during 3 growth phases: prior to the growth spurt, during the growth spurt and after the growth spurt. Significance of relative changes was assessed with the Wilcoxon two-sided mean rank test.Results-Prior to the growth spurt, there was no difference in relative contributions of the disc and the bone (3° vs 0°, p=0.38) to curve progression. During the growth spurt, the mean disc component progressed significantly more than that of the vertebrae (15° vs 0°, p=0.0002). This reversed following the growth spurt with the vertebral component progressing more than the disc (10° vs 0°, p=0.01).Conclusion-Adolescent idiopathic scoliosis initially increases through disc wedging during the rapid growth spurt with progressive vertebral wedging occurring later.

Excellent clinical outcomes with significant decrease in pain are possible with single incision technique for FHL transfer for chronic Achilles tendinopathy.

In a simulated model of segmental clavicle fracture, a LCP provided more stiffness and less deflection than a low-contact dynamic compression plate.

Introduction Tranexamic acid can decrease blood loss related to surgery and trauma. The primary objective of this study is to examine if the use of a single dose of peri-operative TXA significantly decreases the rate of allogenic blood transfusions in the setting of operative care of hip fractures. Secondary objectives included examining if total blood loss was decreased by TXA in operative hip fractures as well as examining the safety of TXA by measuring the rates venous thromboembolism (VTE). Methods Retrospective chart review of 505 patients who were operatively treated for hip fractures at a single facility was performed. In a non-randomized fashion, 307 patients received TXA and 198 patients did not. Patients received 1 gram of TXA prior to incision. Blood transfusion was the primary end point. Blood loss was calculated using the hemoglobin balance method. Chart was reviewed for VTE events during hospitalization. Results 505 patients were analyzed. The use of single perioperative dose of TXA in the surgical management of hip fracture resulted in absolute risk reduction of transfusion of 7.7% and relative risk reduction of transfusion by 29%. This was statistically significant with P =.04. Patients who received TXA on average lost 235 ml less blood compared to those who did not receive TXA ( P <.0001). No increase in VTE events were found in either group during hospitalization. Conclusion This study supports the use of TXA is decrease blood loss and transfusion rates in patients with hip fractures. TXA can be used routinely to decrease complications in this usually fragile population.

This is the first report of the survival and complication rates for delayed elevation of soft tissue flaps for tibial nonunion reconstruction. A total of 95.8% of flaps survived elevation. Flap elevation seems to be an alternative to posterolateral tibial approaches for treatment of tibial nonunions.

The three-dimensional theory of elasticity is used for a study of the stress-strain state in a hollow cylinder with varying stiffness. The corresponding problem is solved by a method that is partly analytical and partly numerical in nature: Spline approximations and collocation are used to reduce the partial differential equations of elasticity to a boundary-value problem for a system of ordinary differential equations of higher order for the radial coordinate, which is then solved using the method of stable discrete orthogonalization. Results for an inhomogeneous cylinder for various types of stiffness are presented.The increasingly stringent requirements for the estimation of strength characteristics, the tendency toward a detailed consideration of real properties of structural materials, and the discovery and study of three-dimensional effects occurring in thick-walled elements require the treatment of hollow cylindrical structures in terms of a three-dimensional model. Finding a solution for the stress-strain state in thick-walled structures within the framework of spatial linear elasticity theory goes hand-in-hand with significant difficulties related to the complexity of initial systems and partial differential equations, as well as the necessity of satisfying the boundary conditions prescribed on the surfaces of the elastic body. These difficulties arise substantially during the calculation of structural elements such as cylinders made of anisotropic and inhomogeneous materials. The facts mentioned above are consistent with the relative sparseness of the number of publications addressing such questions (Kollar, Patterson, and Springer [11], Banerjee and Henry [3], Kollar [10], Shi, Zhang, and Xiang [12], Gal and Dvorkin [5], Collin, Caillerie, and Chamlon [4], and Tsurkov and Drach [13]).Along with universal approaches used for solving boundary-value problems in mechanics and mathematical physics, such as the finite-difference technique, finite-element method, and other discrete methods, the new technique now finds wide application for this particular class of problems [2,3,14]. It allows reducing the initial problem to a system of ordinary differential equations, based on an approximation of the solution with respect to other variables by analytical methods. The exact reduction of multidimensional problems to onedimensional ones and the solution of the latter by the stable numerical method of discrete orthogonalization gives reasons to believe that the obtained results are highly accurate. Due to cylindrical geometry, the method of finite elements, if used for calculating the mechanical behavior, is time-consuming and inefficient and requires large memory and processing speed of the computer.Recently, an approach based on spline approximations has been developed in several articles [6][7][8][9] in order to study the mechanical behavior of plate and shells. Its main advantages are the following [1]:• stability against local perturbations, i.e., the local behavior of splines in the neighborhood of a point d...