A novel pyrolytic carbon implant for hallux rigidus: a cadaveric study

BACKGROUND: The aim of this cadaveric study was to assess the technical feasibility of inserting a novel interpositional pyrolytic carbon coated implant in the first MTP joint, determine the best surgical procedure for the implantation, and evaluate the dynamic behavior of the joint after surgery. METHODS: The marble implant was inserted in the first metatarsophalangeal joint of five pairs of cadaveric feet using two different surgical approaches, dorsal and medial, for each pair. The stability and mobility of the feet before and after implantation, as well as the relationship between the implant and the sesamoids, were assessed by static and dynamic fluoroscopy. RESULTS: After implantation, the stability was perfect in all positions and the mobility was conserved. There were no conflicts between the sesamoids and the implant during the movement of the first metatarsophalangeal joint. Both the dorsal and the medial surgical approaches led to similar findings. CONCLUSION: To our knowledge, this is the first anatomic evaluation of this type of implant. Whereas the results of the technique obtained on cadaveric feet were satisfactory, caution has to be applied to trying to apply this procedure to the living patient

Isolated interfragmentary compression for nonunion of humeral shaft fractures initially treated by nailing: A preliminary report of seven cases

Introduction Plating with bone grafting is considered the gold standard treatment for nonunion of humeral shaft fractures. However, this complex procedure involves multiple risks. The aim of this study is to evaluate an alternative treatment using isolated axial interfragmentary compression for the dynamisation of humeral shaft nonunion after retrograde locked nailing. Materials and methods Between January 2000 and May 2009, 124 humeral shaft fractures were treated in our trauma department with retrograde locked nailing using the unreamed humeral nail (UHN®, Synthes, Paoli, PA, USA). Nonunion occurred in seven patients (5.6%) – five females and two males, mean age 44 years (range: 17–73 years). The nonunion was treated by applying isolated secondary interfragmentary compression. Mean follow-up was 43 months (range: 8–74 months). The Rommens score and the disabilities of the arm, shoulder and hand (DASH) score were used to evaluate the global functioning of the upper limb. Results The compression procedure was successful in all seven cases. In each case, the union occurred without any complications in 3–5 months. The mean DASH score was 25/100 (range: 8.3–60.8/100). The Rommens score was judged excellent for five of the seven patients but two were rated moderate. One of these suffered from complex regional pain syndrome type II since the fracture, and another developed a stiff shoulder 6 months after trauma. Conclusion Isolated secondary interfragmentary compression appears to be a simple and successful procedure in cases of humeral nonunion

Hidden Narratives of Transnational Organised Crime in West Africa, 2022

The foundation of the project was ethically rigorous fieldwork on insider narratives of activities labelled transnational organised crime (TNOC). This was done through in-depth interviews with difficult to access market insiders and regulators in the illicit migrant transport economy in Agadez and the illicit opioid economy in Lagos. We shared/archived the core of this interview data in the form of redacted interview transcripts. Due to geographical focus of the research, the archived transcripts are in three different languages (English, Nigerian Pidgin and French).This project investigated the understandings of activities labelled transnational organised crime (TNOC) in West Africa. The project assumed that the ways illicit and state actors speak about and understand their roles, i.e. their 'narratives', provides a helpful entry point into a better understanding of the everyday reality of participating in and seeking to counter criminalised activities. The project was built on the observation that much of our understanding of TNOC in West Africa is based on official reports, statistics and other largely detached assessments. Using the cases of the illicit opioid trade and the illicit transport of migrants, the project sought to uncover the 'hidden narratives' of these activities in West Africa.</p

Hidden Narratives of Transnational Organised Crime in West Africa, 2022

The foundation of the project was ethically rigorous fieldwork on insider narratives of activities labelled transnational organised crime (TNOC). This was done through in-depth interviews with difficult to access market insiders and regulators in the illicit migrant transport economy in Agadez and the illicit opioid economy in Lagos. We shared/archived the core of this interview data in the form of redacted interview transcripts. Due to geographical focus of the research, the archived transcripts are in three different languages (English, Nigerian Pidgin and French).This project investigated the understandings of activities labelled transnational organised crime (TNOC) in West Africa. The project assumed that the ways illicit and state actors speak about and understand their roles, i.e. their 'narratives', provides a helpful entry point into a better understanding of the everyday reality of participating in and seeking to counter criminalised activities. The project was built on the observation that much of our understanding of TNOC in West Africa is based on official reports, statistics and other largely detached assessments. Using the cases of the illicit opioid trade and the illicit transport of migrants, the project sought to uncover the 'hidden narratives' of these activities in West Africa.</p

Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing

SummaryIntroductionTreatment of lower extremity segmental bone loss is difficult. Masquelet et al. proposed a two-stage technique: first, debridement and filling of bone loss with an acrylic spacer; second, bone reconstruction by filling with cancellous bone in the space left free (following cement removal) inside the so-called self-induced periosteal membrane. In the originally described technique, the fracture site is stabilized by an external fixator, which remains in place throughout the bone healing process, i.e., often longer than 9 months with all the known disadvantages of this type of assembly. Following the principle of two-stage reconstruction, we modified the technique by reconstructing around an intramedullary-locking nail placed in the first stage.HypothesisThis technique prevents the mechanical complications related to external fixator use and provides faster resumption of weight-bearing.Patients and methodsTwelve patients were operated for segmental tibial bone loss greater than 6cm resulting from injury (four cases) or aseptic necrosis (one case) or septic necrosis (seven cases). All the patients were operated on in an emergency setting and the first stage was performed before the 2nd week. A free muscle flap (ten patients) or a pediculated fasciocutaneous flap (two patients) was necessary during this first step to cover the site and provide good conditions for secondary bone growth. The follow-up was 39.5 months (range, 12–94 months).ResultsComplete weight-bearing was resumed at a mean 4 months. After the second step, all the patients except one had apparently healed (complete weight-bearing with no pain). Five septic complications occurred after the second step, in one case leading to reconstruction failure. Four other patients had infectious complications successfully treated (as of the last follow-up) either by changing the nail in two cases or by prolonged antibiotic therapy in two other cases, with no graft loss.DiscussionThe use of the intramedullary nail facilitates the Masquelet technique by allowing the patient to resume weight-bearing more quickly and avoiding secondary fractures. However, the risk of sepsis remains high but can be controlled without compromising the final bone union in four cases out of five.Level of evidence: Level IV. Retrospective study