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Background: Non-unions after intramedullary nailing of femoral shaft fractures are a significant problem. Treatment options such as augmenting with plates or exchange nailing have been proposed. The ideal treatment remains controversial. Methods: Augmentative plating using a 4.5 mm LCP or a 3.2 mm LCP leaving the nail in situ was tested biomechanically and compared to exchange intramedullary nailing in a SawboneTM model of a femoral shaft non-union. Results: The difference of fracture gap motion in axial testing was small. In rotational testing, the exchange nail allowed for the largest amount of motion. The 4.5 mm augmentative plate was the most stable construct in all loading conditions. Conclusions: Augmentative plating using a 4.5 mm LCP plate while leaving the nail in situ is biomechanically superior to exchange intramedullary nailing. A small fragment 3.2 mm LCP is undersized and does not reduce fracture motion sufficiently in a femoral shaft non-union. [ABSTRACT FROM AUTHOR]

Snow instability tests provide valuable information regarding the stability of the snowpack. Test results are key data used to prepare public avalanche forecasts. However, to include them into the operational procedures, a quantitative interpretation scheme is needed. Whereas the interpretation of the Rutschblock test is well established, a similar detailed classification for the Extended Column Test (ECT) is lacking. Therefore, we develop a 4-class stability interpretation scheme. Exploring a large data set of 1719 ECTs observed at 1226 sites, often performed together with a Rutschblock (RB) in the same snow pit, and corresponding slope stability information, we revisit the existing stability interpretations, explore the potential of a more detailed classification, and specifically consider the interpretation of cases when two ECTs were performed in the same snow pit. Our findings confirm previous research, namely that the crack propagation propensity is the most relevant result and that the loading step required to initiate a crack is of secondary importance for stability assessment. The comparison with the RB showed that the ECT classifies slope stability less reliably than the RB. In some situations, performing a second ECT may be helpful, when the first test did neither indicate rather unstable nor stable conditions. Finally, the data clearly show that false-unstable predictions of stability tests outnumber the correct-unstable predictions in an environment where overall unstable locations are rare. [ABSTRACT FROM AUTHOR]

Over the last two decades, there has been a growing emphasis on the publication quality in Foot & Ankle research. A level-of-evidence rating system for clinical scientific papers has been proposed by the Centre for Evidence-based medicine in Oxford, United Kingdom. As opposed to other subspecialities, foot & ankle surgery deals with a wide variety of clinical problems and surgical solutions, which in turn leads to a generally low number of patients available for study groups. However, level III and IV studies still have a valuable place in orthopaedic research, given the challenges in running high-level studies.The measurement of outcomes in medicine from the patients' perspective (PROMS:(patient reported outcome measures) has grown almost exponentially in all surgical specialties including foot & ankle surgery. There are many PROMs available to foot & ankle surgeons, but there is little consensus on which assessment is most appropriate for a given procedure or diagnosis. Their use in research and clinical practice offers many advantages in clinical practice and research, however, besides the advantages there are also some downsides. [ABSTRACT FROM AUTHOR]