Background: Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen. Methods: Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1) and 35 patients with a gram-negative pathogen (Group 2). Results: Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors. Conclusions: Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.

Atrophic nonunion of femoral shaft fracture after intramedullary (IM) nailing is uncommon. The treatment for femoral shaft aseptic atrophic non-union remained controversial. The aim of this study was to compare the surgical results between exchanging reamed nailing (ERN) and augmentative antirotational plating (AAP) for femoral shaft aseptic atrophic nonunion. We retrospectively reviewed the patients with femoral shaft nonunion between the year of 2014 and 2015. The patients with nonunion after plate osteosynthesis, septic nonunion, hypertrophic nonunion, additional surgery during revision surgery were excluded. All the patients were followed up at least 12 months. Overall, the union rate after revision surgery was 70.8%. The union rate was significantly higher in the AAP group than in the ERN group. Operating time was also significantly shorter in the AAP group. Regarding the location of nonunion, the union rate was comparable between groups for isthmic nonunions. However, for non-isthmic nonunions, the union rate was significantly higher and operating time was significantly shorter in the AAP group. AAP showed an overall higher union rate for management of femoral shaft aseptic atrophic nonunion compared with ERN. Especially for non-isthmic femoral shaft atrophic nonunions, AAP provided a significantly higher union rate and significantly shorter operating time.

Polycaprolactone/nano-hydroxylapatite (PCL/nHA) nanocomposites have found use in tissue engineering and drug delivery owing to their good biocompatibility with these types of applications in addition to their mechanical characteristics. Three-dimensional (3D) printing of PCL/nHA nanocomposites persists as a defiance mostly because of the lack of commercial filaments for the conventional fused deposition modeling (FDM) method. In addition, as the composites are prepared using FDM for the purpose of delivering pharmaceuticals, thermal energy can destroy the embedded drugs and biomolecules. In this report, we investigated 3D printing of PCL/nHA using a lab-developed solution-extrusion printer, which consists of an extrusion feeder, a syringe with a dispensing nozzle, a collection table, and a command port. The effects of distinct printing variables on the mechanical properties of nanocomposites were investigated. Drug-eluting nanocomposite screws were also prepared using solution-extrusion 3D printing. The empirical outcomes suggest that the tensile properties of the 3D-printed PCL/nHA nanocomposites increased with the PCL/nHA-to-dichloromethane (DCM) ratio, fill density, and print orientation but decreased with an increase in the moving speed of the dispensing tip. Furthermore, printed drug-eluting PCL/nHA screws eluted high levels of antimicrobial vancomycin and ceftazidime over a 14-day period. Solution-extrusion 3D printing demonstrated excellent capabilities for fabricating drug-loaded implants for various medical applications.