Healing of 56 segmental femoral shaft fractures after locked nailing: Poor results of dynamization

We treated 56 consecutive acute segmental femoral shaft fractures with closed static locked nailing. 12 nails were dynamized after 6 (5-10) months due to slow fracture healing and 5 united after another 5 (3-8) months. The other 7 required cancellous bone grafting and all healed uneventfully 6 (5-8) months after grafting. Since dynamization did not promote healing in most of our cases we suggest early cancellous bone grafting in cases of delayed union.     

Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis

Methods for the treatment of tuberculous spondylitis still are controversial. The authors treated 32 consecutive patients with a two-stage surgical technique combined with antituberculous chemotherapy for 1 year. After anterior debridement, fusion with autogenous anterior iliac tricortical strut bone graft was done, and in a second stage, posterior instrumentation and fusion with autogenous posterior iliac corticocancellous bone graft was done 11 days (range, 4-22 days) later. Postoperatively, patients were encouraged to ambulate with brace protection as early as possible. Twenty-nine patients were followed up for a minimum of 2 years (median, 4.7 years; range, 2-10 years) of whom 28 patients achieved solid fusion (97%). All patients had improvement of back pain including the only patient with pseudarthrosis. Neurologic deficits completely recovered in 84% (16 of 19) of patients after 3 months. Kyphotic deformity improved in all 29 patients (34.6 degrees versus 17.3 degrees ) with the average correction angle of 17.3 degrees. Clinically, 27 patients had achieved a satisfactory outcome (93%). There were no evident surgical complications. The authors, therefore, recommend a two-stage surgical technique combined with antituberculous chemotherapy to treat patients with severe vertebral body destruction attributable to tuberculosis because of its high success rate and a low complication rate.     

A revised protocol for more clearly classifying a nonunion

Classifying a nonunion solely on the extent of callus formation on a radiograph is insufficient. We have conducted a study with a revised protocol to classify a nonunion more clearly, which uses both radiographic observation and fixation stability. 47 consecutive femoral shaft nonunions were studied using this protocol and 42 nonunions were followed up for at least one year after discovery (range, 1-3 years). 40 nonunions healed after treatment with a union rate of 95.2% (40/42) and a union period of 4.7 plus or minus 0.9 months. The 2 cases of failure were due to implant failure and both healed after reoperation. We recommend this revised protocol as a pretreatment assessment for all nonunions because of its integrity and effectiveness.     

Using in situ hybridization to detect endosymbiont Wolbachia in dissected tissues of mosquito host

The endosymbiont Wolbachia, extensively occurring in arthropods, usually causes reproductive distortions of the host, such as mosquitoes. In past years, detection of Wolbachia in host tissues has highly relied on transmission electron microscopy (TEM) that is tedious and usually unable to gain satisfactory results without experienced techniques and expensive instruments. Polymerase chain reaction (PCR) recently has become popular in Wolbachia identification. However, necessity of DNA extraction from host individuals or dissected tissues has limited its application in extensiveness and versatility. At present, in situ hybridization has increased its role in examination of various microbes. This report provides a technique for rapid detection and localization of Wolbachia in tissues dissected from mosquitoes and possibly other infected organisms. To detect Wolbachia and to localize them in host tissues more precisely, in situ hybridization by using digoxigenin (DIG)-labeled probes was invented and applied to Wolbachia detection in this study. The results showed that Wolbachia preferentially aggregate in ovarioles, which is consistent with previous observations by TEM. The endobacteria also were detected in salivary glands, mostly in lateral lobes. Ultrastructurally, Wolbachia has been shown to occur in the cytoplasma of salivary gland cells.