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Supplemental Material, FAO890861-ICMJE for Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures by Sohail Yousaf, Alan Saleh, Aashish Ahluwalia, Shahnawaz Haleem, Zara Hayat and Palanisamy Ramesh in Foot & Ankle Orthopaedics

Stress fractures commonly occur in athletes and military cadets due to repetitive stress on the bony cortex. Stress fractures of the tibia are commonly localized proximally and occur during aerobic weightbearing exercises. This is an unusual case of bilateral simultaneous distal tibial stress fracture in a young homemaker.

Background: Isolated distal fibular fractures resulting from supination external rotation (SER) injuries without evidence of obvious talar shift on standard radiographs present a diagnostic dilemma for clinicians. The status of the deep deltoid ligament, the main stabilizer of the ankle joint, is assessed by an increase in medial clear space (MCS) on radiographs. Therefore, these injuries can be either stable or unstable. In recent years, considerable clinical and research efforts have been made to determine ankle stability following SER fracture. The purpose of this systematic review was to evaluate and compare the role of different stress radiograph modalities in assessing stability of the ankle with SER fractures with no obvious talar subluxation on standard radiographs. Methods: The electronic databases MEDLINE, EMBASE, Ovid, Cochrane Central, CINAHL, and Google Scholar were searched from January 2000 to January 2018 to identify literature relating to radiologic assessment of stability of SER ankle fractures. Results: Our literature search revealed 10 peer-reviewed articles that fulfilled inclusion criteria. This yielded a total of 698 patients. The systematic review found 3 broad categories of radiographic investigations in the assessment of ankle joint stability: external rotation (ER) stress radiographs, gravity stress views (GSV), and weightbearing (WB) radiographs. Proponents of WB radiographs have demonstrated how axial load can normalize ankle joint alignment in cases of proven instability. There was a consistently high grade of evidence for using a medial clear space (MCS) value of more than 4 to 5 mm to indicate an unstable ankle following SER fracture. Conclusion: In conclusion, the results of this systematic review support an MCS value of less than 4 to 5 mm as a good indicator of stability, regardless of choice of stress imaging modality. These patients can be allowed early weightbearing with expected good functional outcomes. Recent published literature favors WB stress radiographs as a reliable and safe technique for assessing stability in SER ankle fractures. However, it should be kept in mind that this is based on studies with relatively low grades of evidence. Level of Evidence: Level II, systematic review of variable quality studies.

A high energy density supercapacitor device is reported that utilizes hybrid carbon electrodes and the ionic liquid, 1-butyl-3-methylimidazolium tetrafluoroborate (BMIMBF4) as an electrolyte. The hybrid electrodes are prepared from reduced graphite oxide (rGO) and purified single-walled carbon nanotubes (SWCNTs). A simple casting technique gives the hybrid structure with optimum porosity and functionality that provides high energy and power densities. The combination of SWCNTs and rGO in a weight ratio of 1:1 is found to afford a specific capacitance of 222 F g−1 and an energy density of 94 Wh kg−1 at room temperature.

International audience; Graphene displays unprecedented electronic properties including room-temperature ballistic transport and quantum conductance, and because of its small spin-orbit interaction, graphene has the potential to function as the building block of future spintronic devices. Theoretical calculations indicate that a defective graphene sheet will be simultaneously semiconducting and magnetic; thus it would act as a room-temperature magnetic semiconductor. Recently, ferromagnetic ordering at room temperature has been observed by magnetometry measurements on bulk samples of reduced graphene oxide.

The authors present a previously unreported case of an open fracture of the distal tibia and fibula with associated Achilles tendon rupture in a 27-year-old motorcyclist. Management followed established trauma principles of wound exploration, debridement, and stabilization of the fracture with reamed locked intramedullary nailing of the tibia. The injury to the Achilles tendon was not identified until surgical exploration for fixation of the fracture. This required a 2-stage operative approach, involving initial debridement and fracture fixation followed by Achilles tendon repair during the second-look wound review procedure. The authors believe this to be the first reported case of Achilles tendon rupture in association with an open transverse distal tibia fracture. Prior to surgical exploration of the wound, Achilles tendon rupture was not suspected, emphasizing the need for clinical suspicion, thorough examination, and adequate wound exploration at operation for fracture fixation.

A thin film of single-wall carbon nanotubes (SWNTs) and SWNT−multiwall carbon nanotube (MWNT) hybrids loaded with Pt have been evaluated as the cathode catalyst layer in proton exchange membrane fuel cells. The optimum Pt loading and thickness for SWNT films is found to be in the range of 20−100 µg Pt/cm2 and 0.3−1.4 µm, respectively. In this optimum range, Pt-SWNT thin films show excellent proton conductivity and are able to reach peak performance without additional nafion in the catalyst layer. Cathode-specific mass activity of Pt on a SWNT support is found to decrease as the Pt loading and thickness increase due to mass transfer limitations. Addition of Pt-MWNTs to Pt-SWNT thin films is found to increase the mass transport characteristics and cathode-specific mass activity. A SWNT−MWNT hybrid support shows three times higher mass activity than a SWNT support at about the same power output, and the optimum hybrid is found for a blend composed of 20−30 µgPt/cm2 on SWNTs and 5−10 µgPt/cm2 on MWNTs.

Soluble graphene layers were formed by reacting graphite fluoride with alkyl lithium reagents. IR spectral studies confirmed the covalent attachment of alkyl chains to the graphene layers. Raman scattering and XRD studies of the starting materials and products revealed that the chemical process partially restores the sp2 carbon network. The solubility and extinction coefficient were determined by UV–vis-near infrared spectroscopy. Annealing of bulk samples further extends the sp2 lattice due to dealkylation as followed by Raman, XRD and mid-infrared spectroscopy. The present study demonstrates a one-step chemical treatment of graphite fluoride that allows the manipulation of a soluble form of graphene.

Fuel cell membrane electrode assemblies with Pt loading of 0.2 mg Pt/cm2 at the anode and ultralow Pt loadings of 6 μg Pt/cm2 and 12 μg Pt/cm2 at the cathode have been fabricated using thin films of multiwalled carbon nanotube supported Pt catalysts (Pt/MWNTs) at the cathode. The Pt/MWNTs have a Pt weight loading of 26.8 wt % and a uniform and small Pt particle size of 2.1 nm. The MWNTs used are 360 μm long. This thin film cathode catalyst layer with a loading of 6 μg Pt/cm2 is about 1.3 μm thick, contains no ionomer, and exhibits surprisingly high performance in a hydrogen proton exchange membrane fuel cell. The peak power density for a membrane electrode assembly with a cathode loading of 12 μg Pt/cm2 when tested at 70 °C with hydrogen and oxygen is 613 mW/cm2. A mass activity (ampere per milligram of Pt) based on the cathode Pt loading greater than 250 A/mg Pt is achieved with 6 μg Pt/cm2, and this is among the highest reported to date.

Natural graphite was intercalated, thermally exfoliated, and dispersed in acetone to prepare graphite nanoplatelets (GNPs, Gn) of controlled aspect ratio. Thermal conductivity measurements indicate that few graphene layer Gn, where n ∼ 4, with a thickness of ∼2 nm function as a very efficient filler for epoxy composites. When embedded in an epoxy matrix, the G4 GNPs provide a thermal conductivity enhancement of more than 3000% (loading of ∼25 vol %), and a thermal conductivity κ = 6.44 W/mK, which surpasses the performance of conventional fillers that require a loading of ∼70 vol % to achieve these values. We attribute the outstanding thermal properties of this material to a favorable combination of the high aspect ratio, two-dimensional geometry, stiffness, and low thermal interface resistance of the GNPs.

A highly efficient enrichment of thin double-wall carbon nanotubes (DWNTs) having an average outer diameter of ca. 1.4 nm by thermal oxidative purification has been reported. Thin DWNTs of ca. 1% with respect to single-wall carbon nanotubes (SWNTs), which are synthesized by catalyst-supported chemical vapor deposition (CCVD) on zeolite supports, are enriched up to ca. 90% (vs SWNTs) by thermal oxidation in air. The present thin DWNTs grown on zeolite are several hundreds of times as resistant as SWNTs toward the oxidation at 700 °C. When oxidative purification is applied for DWNTs with larger diameters, the amount of DWNTs lost during the purification process is large compared to thinner DWNTs lost. The present oxidative purification is much more effective for thin DWNTs with diameters smaller than 2 nm.

Carbon nanotubes with 1–6 walls have been grown on cobalt-loaded mesoporous silica (i.e., MCM41) by using acetylene catalytic chemical vapor deposition. It is found that titanium grafting on the MCM41 pore walls prior to cobalt loading promotes the growth of nanotubes with 1–6 walls. As-grown nanotube material is found to be a mixture of single-wall carbon nanotubes (SWNTs), double-wall carbon nanotubes (DWNTs) and thin-multiwall carbon nanotubes (t-MWNTs) with 3–6 walls. Annealing of the as-grown nanotubes has reduced the amount of SWNTs in the nanotube mixture. Several structural deformations of the t-MWNTs are observed during transmission electron microscopy (TEM) analysis. Complete or partial collapse of the t-MWNTs is also found due to these structural deformations. Graphite-like domains developed at the collapsed regions stabilize these structural deformations.

Experimental conditions that govern the double-wall carbon nanotube (DWNT) growth during alcohol catalytic chemical vapor deposition (CCVD) have been optimized for mesoporous silica (MCM41) support materials. Catalyst pretreatment and preparation methods influence the quality of as-grown carbon nanotubes (CNTs). Catalyst pretreatment at low pressure leads to high-quality CNTs concomitant with an increase in the DWNT yield. Impregnation of metal precursors using methanol as the solvent is found to be more suitable than the aqueous solution. Influence of the precursor anion/metal ion on the DWNT yield is also studied under these optimized conditions. Thermogravimetric analysis (TGA), transmission electron microscopy (TEM) and Raman spectroscopic methods have been employed to estimate the quality of the CNTs. It is observed that the present optimized method yields high-quality DWNTs with low amounts of side-wall defects and other carbon impurities.

Double-wall carbon nanotubes (DWNTs) have been selectively synthesized by catalytic chemical vapor deposition of alcohol over Fe/Co loaded mesoporous silica. The as-grown carbon nanotubes are purified using a multi-step process involving heat treatment in air followed by alkali and acid treatments. The nanotubes are characterized as-grown and after each step of the purification stage by thermo-gravimetric analysis (TGA), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and Raman spectroscopy. It is observed that most of the mesoporous silica and metal particles have been removed from the as-grown nanotubes by these treatments. The carbon content of the nanotube material obtained after the purification is found to be more than 90 wt%.

High-quality single-wall carbon nanotubes (SWNTs) with narrow diameter distribution have been grown on Fe/Co-loaded MCM41 by using acetylene as the carbon source within a short reaction period, typically 10 min or less. The optimum temperature for SWNTs synthesis is 850 degrees C. Longer reaction time (i.e., 30 min) favors the formation of multiwall carbon nanotubes (MWNTs) and graphitic carbon. When the reaction time is reduced to less than 10 min, formation of MWNTs and graphitic carbon is greatly suppressed, and high-quality SWNTs dominates the yield. The surface of the as-grown SWNTs is found to be free from amorphous carbon, as observed from high-resolution transmission electron microscope (HRTEM) analysis. Raman spectral data show a G/D ratio above 10, indicating that the as-grown SWNTs have very few defects. Furthermore, radial breathing mode (RBM) analysis reveals that the diameter distribution of the current SWNTs is narrow and ranges from 0.64 to 1.36 nm.

PurposeTo analyse the implementation of fast‐tracking pathway of hip fractures from accident and emergency to the orthopaedic wards.Design/methodology/approachA retrospective audit analysing 100 case notes of fast‐tracked hip fractures selected at random for the period of one year was undertaken.FindingsSeveral deficiencies were identified in the implementation of the pathway.Practical implicationsRecommendations have been made for correction of the inadequacies identified.Originality/valueThis paper aims to increase the efficiency and safety of fast‐tracking system for hip fractures, which is being deployed by many hospitals throughout the UK.

Transcalcaneal talonavicular dislocation is a rare injury, with very few reported cases. Of these, most have been the result of high-energy mechanisms such as road traffic collisions or falls from a height. The management of this injury is challenging, and treatment is fraught with a high rate of disability, infection, and amputation. We describe the successful management of the first reported case of a low-energy transcalcaneal talonavicular dislocation in a 71-year-old female. Combined external and internal fixation was used to reduce and maintain the injury, with a resultant good functional and complication-free outcome at 1 year after the injury. Our experience highlights the prevalence of these devastating injuries caused by relatively benign mechanisms in an increasingly older population with osteoporotic bone. It also indicates that operative stabilization of a low-energy injury can be more successful than that with the traditional high-velocity trauma.

Stress fractures commonly occur in athletes and military cadets due to repetitive stress on the bony cortex. Stress fractures of the tibia are commonly localized proximally and occur during aerobic weightbearing exercises. This is an unusual case of bilateral simultaneous distal tibial stress fracture in a young homemaker.

Osteoarticular tuberculosis, especially in the foot is uncommon.1 It makes up less than 3% of cases of extra-pulmonary tuberculosis. As such, it has remained a diagnostic enigma despite improvements in investigative technology.1–4 It is an aggressive disease. Any significant delay in diagnosis may lead to spread of the infection from bone into adjacent joints and surrounding soft tissue. This leads to significant functional disability.1,4 A 36-year-old South Indian priest attended the orthopaedic department with a 1-year history of spontaneous onset right foot pain. There was no history of trauma or any systemic symptoms that may indicate infection. By the time of presentation he had been living in the UK for over 5 years. His symptoms were affecting his work as a priest as footwear was not permitted in his temple. On examination there was …

Ruthenium oxide (RuO2) nanoparticles were supported on the outer surface of single walled carbon nanotubes (SWNTs) using chemical reduction technique. The nanocomposite was employed as an electrode material for charge storage capacitor using ionic liquid, 1-ethyl-3-methylimidazolium tetrafluoroborate electrolyte solution. The electrochemical charge storage properties of the composite were investigated using two electrode cyclic voltammetry and galvanostatic charge-discharge techniques. The specific capacitance and energy density of the RuO2-SWNT nanocomposite electrode material based on the fabricated coin cell supercapacitor were measured to be as high as 174 F/g and 74 Wh/kg at current density of 1 A/g.

Background: Although many treatment modalities are available for Morton’s neuroma (MN), studies looking at the long-term effectiveness of most forms of treatment are scarce. The injection of MN with alcohol has gained popularity over the past 10 years with widespread media coverage. Many surgeons have anecdotally questioned the long-term effectiveness of this treatment. We reviewed a cohort of patients at an average 5-year follow-up to assess the medium-term results of alcohol injection. Methods: We used the modified Johnson score and visual analogue scales to assess 45 of the original cohort of patients with an average follow-up of 61 months (range, 33-73 months). Any complications from the procedure were also noted. Results: Our results indicated that by 5 years, 16 of 45 patients had undergone surgical treatment and a further 13 patients had return of symptoms. Only 29% (13/45) remained symptom free. The visual analog scale and modified Johnson scores showed statistically significant deterioration in patients’ symptoms at 5 years following alcohol injection. Conclusion: Injection with alcohol sclerosant for MN has been marketed as a definitive management option comparable to surgical excision. Our investigation illustrated that although short-term results are encouraging, alcohol injection does not offer permanent resolution of symptoms for most patients and can be associated with considerable morbidity. Our investigation provides the only long-term data for alcohol injection treatment of MN. Level of Evidence: Level II, prospective case series.

Chemically modified single-walled carbon nanotubes (SWNTs) with varying degrees of functionalization were utilized for the fabrication of SWNT thin film catalyst support layers (CSLs) in polymer electrolyte membrane fuel cells (PEMFCs), which were suitable for benchmarking against the US DOE 2017 targets. Use of the optimum level of SWNT -COOH functionality allowed the construction of a prototype SWNT-based PEMFC with total Pt loading of 0.06 mg(Pt)/cm²--well below the value of 0.125 mg(Pt)/cm² set as the US DOE 2017 technical target for total Pt group metals (PGM) loading. This prototype PEMFC also approaches the technical target for the total Pt content per kW of power (0.125 g(PGM)/kW) at cell potential 0.65 V: a value of 0.15 g(Pt)/kW was achieved at 80°C/22 psig testing conditions, which was further reduced to 0.12 g(Pt)/kW at 35 psig back pressure.

The authors present a case of an incidental finding of a metallic foreign body located within the calcaneus of a 17-year-old girl. Although the presence of foreign material is a common occurrence in the foot, intraosseous metallic bodies are rare, especially so when they present as an incidental finding. A literature review of PubMed using keywords metallic, foreign body, and calcaneus revealed only a single case report, which did not present as an incidental finding. The presentation described here is rare and provides a platform for discussion about possible management options. Levels of Evidence: Therapeutic, Level IV: Case study

International audience; The authors report the effects of radical functionalization on the electrostatic force microscopy (EFM), the scanning tunneling spectra (STS), and Raman spectroscopy of epitaxial graphene. The EFM studies show the existence of layer dependent trapped charges in the pristine graphene. The uniform enhancement of energy gap is observed through STS. Raman spectra show nonuniformly distributed D-band intensities throughout the functionalized sample as a result of the inhomogeneous distribution of covalent bonds to the graphene sheets. The functionalization chemistry has a marked effect on the homogeneity of the electrostatic charge and leads to an increase of the energy of the band gap.

We report a 40% improvement of the thermal conductivity of graphite nanoplatelets–epoxy composites by chemical functionalization of graphite nanoplatelets utilizing nitric acid treatment, which also serves to enhance the spreadability of the material. FTIR and Raman spectroscopy confirmed the presence of a variety of oxygen functional groups at the edges and basal plane of the functionalized graphite nanoplatelets, which contributed to improved interaction with the polymer matrix. A comparative statistical analysis of the particle size distributions in pristine and functionalized graphite nanoplatelets based on scanning electron microscopy showed an increasing degree of exfoliation of the functionalized material. We compare the performance of the functionalized graphite nanoplatelets and carbon nanotubes as fillers in the polymer matrix and discuss the prospects for utilization of graphite nanoplatelets-based thermal interface materials in electronic packaging.

International audience; We report the enhanced photosensitivity of epitaxial graphene (EG) after electrochemical oxidation in nitric acid. The onset of photoconductivity appears at a photon energy of ~1.7 eV while the responsivity reaches 2.5 A/W at a wavelength of 470 nm (blue light, energy 2.64 eV) and further increases to 200 A/W in the UV spectral range (3.5 eV, 350 nm). The observed photoresponse is attributed to the formation of deep traps at the electro-oxidized EG interface, which release charge carriers under illumination and prolong the life time of the photocarriers. Potential applications of electro-oxidized EG in ultraviolet photodetection are discussed

International audience; We report the effect of electrochemical oxidation in nitric acid on the electronic properties of epitaxial graphene (EG) grown on silicon carbide substrates; we demonstrate the availability of an additional reaction channel in EG, which is not present in graphite but which facilitates the introduction of the reaction medium into the graphene galleries during electro-oxidation. The device performance of the chemically processed graphene was studied by patterning the EG wafers with two geometrically identical macroscopic channels; the electro-oxidized channel showed a logarithmic increase of resistance with decreasing temperature, which is ascribed to the scattering of charge carriers in a two-dimensional electronic gas, rather than the presence of an energy gap at the Fermi level. Field-effect transistors were fabricated on the electro-oxidized and pristine graphene channels using single-walled carbon nanotube thin film top gate electrodes, thereby allowing the study of the effect of oxidative chemistry on the transistor performance of EG. The electro-oxidized channel showed higher values for the on-off ratio and the mobility of the graphene field-effect transistor, which we ascribe to the availability of high-quality internal graphene layers after electro-oxidation of the more defective top layers. Thus, the present oxidative process provides a clear contrast with previously demonstrated covalent chemistry in which sp3 hybridized carbon atoms are introduced into the graphitic transport layer of the lattice by carbon-carbon bond formation, thereby opening an energy gap.