Is open bone graft always necessary when treating aseptic subtrochanteric nonunion with a reamed intramedullary nail?

Background This study aimed to compare the radiological results between closed nailing without bone graft (BG) and open nailing with BG for aseptic subtrochanteric nonunion and to determine when an open procedure with BG should be considered. Methods In this retrospective study, we investigated patients who underwent surgical intervention for subtrochanteric nonunion between January 2008 and March 2018 in two institutions. Patients with infection, large bone defect, pathologic fracture, open fracture, previous surgery using plate, and follow-up of less than 1 year were excluded. We compared the demographic details and radiological results between patients who underwent the open procedure with BG (BG group) and the closed procedure without BG (non-BG group) as a historical control, and risk factors for the failure of revision surgery were evaluated. Results Thirty-seven patients met the criteria and were divided into the following two groups: the BG group (n=19) who underwent open nailing with BG and the non-BG group (n=18) who underwent closed reamed nailing without BG. The mean degrees of correction of varus and flexion deformity were significantly different (p=0.001, respectively), 6.2° and 2.9° in the BG group and 4.1° and 0.6° in the non-BG group, respectively. Bony union was observed in 17 cases (89.5%) in an average of 7.4 months in the BG group and in 16 cases (88.9%) in 7.6 months in the non-BG group, with no significant differences. The factors that were significantly associated with failure of revision were atypical fracture, two or more previous surgeries, and varus and sagittal anterior angulation. Conclusions The radiological results of closed reamed nailing without BG for subtrochanteric nonunion were satisfactory. In the effort of percutaneous realignment, gap reduction, and intramedullary reaming, the radiological results of closed nailing without BG were not different from those of open nailing with BG; therefore, closed procedure without BG may be an acceptable option in appropriately selected patients.

Open and closed treatment of chest injuries: mortality, hospitalization, trauma indices and physiological data

Background: In more than half of cases of chest trauma, patients also have head injuries, abdominal injuries or polytrauma. Aim: The aim of the present study was to compare open and closed treatment for chest injuries according to mortality, hospitalization, trauma indices and physiological data. Method: Three hundred sixty-seven patients (293 males and 74 females) with an Anatomic Injury Scale (AIS) score of 2 or more for thoracic trauma were evaluated. The following aspects were evaluated associations between treatment (open and closed) for chest injury, discharge from hospital, hospitalization and death, Trauma indices Revised Trauma Score (RTS), Injury Severity Score (ISS) and TRISS, Blood pressure, diastolic pressure, respiratory rate and pulse. Results: No significant associations were found between the type of treatment (open or closed procedure) and discharge from hospital, hospitalization or death (p = 0.3).No significant associations were found between the type of treatment (open or closed procedure) and the trauma indices, blood pressure, pulse or respiratory rate.

The Procedure of the Court Appealing the Actions of Officials Carrying out Operative-Investigative Activity: Regulation Problems and Perspectives of Improvement of Legal Procedure

The article deals with the issues of legal regulation and the actual implementation of the procedures for appealing against the actions of officials carrying out operative-investigative activity. It is noted that there is uncertainty in the choice of the type of legal proceedings (criminal or administrative) also as a level of the court for such complaints (court of the subject of the Russian Federation or district court). Another problem is related to the actual assignment responsibility for the plaintiffs to substantiate complaints about covert operative-investigative measures which, as a rule, leads to a refusal to consider them. The authors are invited to introduce a universal appeal procedure in the framework of administrative proceedings. The secret nature of the operative-investigative activity does not allow the plaintiff to fully substantiate the essence of his claims, so this task may be performed by the court. In order to preserve information constituting a state secret, it is necessary to introduce a closed procedure for dealing with such complaints.

Preliminary results of new elastic mini-nail in the distal radius fractures. First 83 cases of the nail-o-flex nail

The distal radius fracture is a common injury in old persons. His treatment remains a critical challenge because of number of cases, the final cost of the procedure, the level of X-rays irradiation and a demanding technic of fixation in osteoporotic bone. The entire closed procedure requires a strict percutaneous nailing. This offers advantages in terms of post-operative pain, per-operative irradiation and cost. The main problem was so far the ability to insure a stable reduction in time. This point is discussed with the introduction of the “Nail-oflex®” nail. A continuous series of 83 patients is introduced.

Do Auctions Improve Public Procurement? Evidence from the Czech Republic

This paper explores the effect of various contract-awarding procedures in public procurement on the price of the contract. We provide a theoretical model that compares prices in different procedures and tests whether there is a significant price difference between the procedures using data from Czech public procurement. The model predicts that auctions are more efficient than negotiations given the same number of suppliers, and open procedures are more efficient than closed procedures if high-cost firms are selected for the closed procedure. In accordance with the first prediction, we find that open auctions are more efficient than open negotiations. Concerning the second prediction, we find that closed procedures are less efficient than open procedures, which suggests that procurers tend to select relatively more costly firms to participate in closed procedures. Comparing all four awarding procedures, we find that open auctions are the most efficient procedure used in the Czech Republic. We estimate that the inefficiencies due to the use of other contract-awarding procedures are substantial.

Anaesthetic effects of tiletamine-zolazepam-xylazine-tramadol combination in cats undergoing surgical sterilization

This study was conducted to evaluate the anaesthetic and physiological effects of tiletamine-zolazepam-xylazine-tramadol (TZXT) combination in cats undergoing surgical sterilization. A total of 20, 13.3 ± 2.5 months old, with a body weight of 2.4 ± 0.2 kg, male cats were used in the experiment. Cats were randomly assigned into the anaesthesia group (group A) or to the surgery group (group S). The tiletamine-zolazepam-xylazine-tramadol combination was administered with an intended dose of 2.4 mg·kg-1 tiletamine-zolazepam (TZ), 0.36 mg·kg-1 xylazine (X), and 0.8 mg·kg-1 tramadol (T) into the lateral femoral muscle. Physiological indicators including rectal temperature (RT), heart rate (HR), respiration rate (RR), haemoglobin saturation by oxygen (SpO2), mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) were collected after baseline values (time 0). Cats were immediately given the intramuscular injection drug combination. Physiological indicators were recorded before injection of this combination and at time 5, 10, 15, 20, 30, 40, 50, 60, 80, 100, and 120 min after administration of the tiletamine-zolazepam-xylazine-tramadol combination. In group S, castrations were performed using a closed procedure. Vomiting, excitement, apnoea, and abnormal behaviour were not observed in any cat during anaesthesia. All changes in indicators were within cardiorespiratory acceptable limits in both groups. The tiletamine-zolazepam-xylazine-tramadol combination produced satisfactory anaesthesia in cats and it will be useful not only in induction of anaesthesia but also for surgery of short duration.