These results suggest that use of FES can significantly improve gait speed, decrease the impact of MS on walking ability, and improve QOL in people with MS-related footdrop even over a short period of time.

Proximal humerus fractures, although common, have high rates of failure after open reduction and internal fixation. The use of a fibular allograft has been explored as a means to decrease complications, particularly varus collapse and the need for revision surgery. The authors performed a retrospective review of 133 proximal humerus fractures managed surgically with locking plates (n=72) or locking plates with fibular allograft intramedullary struts (n=61). Demographic, intraoperative, and postoperative variables were collected and analyzed. The fibular allograft group was more likely to be older ( P <.01), be female ( P =.04), and have a history of osteoporosis ( P =.01). No differences were noted in the proportions of 2-, 3-, or 4-part fractures between groups. Average follow-up was 28 weeks. Medial calcar length was longer in the locking plate only group ( P =.04); however, this group demonstrated a decreased head shaft angle ( P =.01) and a trend toward increased rates of varus collapse ( P =.06). No significant differences were found regarding other radiographic complications, irrespective of fracture complexity. A notable decrease in fluoroscopy time was seen with strut use ( P =.04), but operative time and blood loss were similar between groups. A significant decrease in revision surgery rate was found with use of an allograft strut ( P =.05). Using a strut appears to preserve the radiographic head shaft angle and decrease the risk of fracture collapse in 2-, 3-, and 4-part fractures, without increasing surgical time or morbidity. Use of an intramedullary strut appears to reduce the need for revision surgery, particularly in 3- and 4-part fractures. [ Orthopedics . 2020;43(5):262–268.]

Subcutaneous emphysema is typically due to an air leak through the parietal pleura, allowing air to escape from the lung parenchyma into the adjacent soft tissue. Most cases are benign and self-limiting; however, when enough air is forced into the subcutaneous tissues allowing the air to spread into the neck, tracheal compression and respiratory distress can occur. Tube thoracotomy and endotracheal intubation are generally sufficient to overcome this respiratory compromise. However, occasionally other invasive measures are required to allow the air leak to resolve. Traditionally, this would involve placement of an incision or two into the anterior chest wall to allow decompression to the outside environment. Limited evidence exists regarding negative pressure wound therapy devices being used successfully with open incisions for the management of massive subcutaneous emphysema. We present the initial case of successful use of a loosely closed incision negative pressure therapy for massive subcutaneous emphysema. In this instance, the patient's thoracic injury was successfully stabilized and use of the negative pressure therapy device allowed the incisions to be closed with a much more cosmetically pleasing result.

Case: A 33-year-old man with recurrent intrathoracic scapular dislocation due to previous trauma-related chest wall resection successfully underwent the 2-stage induced membrane technique commonly known as the Masquelet technique; this procedure effectively created 2 new ribs that resolved his symptoms. Conclusions: Techniques for chest wall reconstruction for bone loss are quite limited, and these often consist of filling defects with a layered patch; this often cannot withstand the cyclical respiratory motion. Use of the induced membrane technique appears to carry potential when used in the chest wall, and this report describes a technique by which this procedure can be reliably performed.