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AIMS: The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients. METHODS: In this multicentre study, 120 patients aged ≥ 60 years with an acute unstable AO/OTA type 44-B fracture of the ankle were randomized to fixation with either a nail or a plate and followed for 24 months after surgery. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcome measures were the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, the EuroQol five-dimension questionnaire, a visual analogue score for pain, complications, the quality of reduction of the fracture, nonunion, and the development of osteoarthritis. RESULTS: At 24 months, the median AOFAS score was equivalent in the two groups (nail 90 (interquartile range (IQR) 82 to 100), plate 95 (IQR 87 to 100), p = 0.478). There were statistically more complications and secondary operations after nail than plate fixation (p = 0.024 and p = 0.028, respectively). There were no other significant differences in the outcomes between the two groups. CONCLUSION: The functional outcome after nail and plate fixation was equivalent; however, the complication rate and number of secondary operations was significantly higher after nail fixation. These results suggest that plate fixation should usually be the treatment of choice for unstable ankle fractures in the elderly.Cite this article: Bone Joint J 2023;105-B(1):72-81.

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BACKGROUND: Pulmonary torsion is a rare complication following thoracic surgery. CASE PRESENTATION: A man in his seventies was diagnosed with stage IIIA lung cancer occupying the right upper lobe, and lobectomy was performed through posterolateral thoracotomy. Postoperative chest X-rays revealed extensive, progressive middle lobe opacities on postoperative day 0 and 1, with no corresponding clinical or bronchoscopic findings. Contrast-enhanced computed tomography raised suspicion of middle lobe torsion, and exploratory surgery confirmed the finding of a necrotic middle lobe with 180 degrees of torsion. The middle lobe was resected and the patient recovered well. INTERPRETATION: Pulmonary lobar torsion is a rare but potentially life-threatening complication following thoracic surgery that should not be overlooked even in the absence of symptoms that raise concern. Bronchoscopy and radiological imaging may suggest the condition, but the final diagnosis is made surgically.

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Single-chain surfactants usually emulsify and stabilize oily substances into droplets in an aqueous solution. Here, we report a coassembly system, in which single types of anionic or non-ionic surfactants emulsify a class of water-soluble nonamphiphilic organic salts with fused aromatic rings in aqueous solutions. The nonamphiphilic organic salts are in turn promoted to form droplets of water-based liquid crystals (chromonic liquid crystals) encapsulated by single-chain surfactants. The droplets, stabilized against coalescence by encapsulated in a layer (or layers) of single chain surfactants, are of both nonspherical tactoid (elongated ellipsoid with pointy ends) and spherical shapes. The tactoids have an average long axis of ∼9 µm and a short axis of ∼3.5 µm with the liquid crystal aligning parallel to the droplet surface. The spherical droplets are 5-10 µm in diameter and have the liquid crystal aligning perpendicular to the droplet surface and a point defect in the center. Cationic and zwitterionic surfactants studied in this work did not promote the organic salt to form droplets. These results illustrate the complex interplay of self-association and thermodynamic incompatibility of molecules in water, which can cause new assembly behavior, including potential formation of vesicles or other assemblies, from surfactants that usually form only micelles. These unprecedented tactoidal shaped droplets also provide potential for the fabrication of new soft organic microcapsules.

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