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Nonunion of distal femur is a complex problem with the added burden of poor bone stock, osteopenia, and joint contracture. Various procedures are described ranging from osteosynthesis using auto/allograft, to use of mega prosthesis. Use of vascularized corticoperiosteal flap based on descending genicular artery and superomedial genicular artery is a new technique to provide living vascular graft for the nonunion site. Although few free corticoperiosteal flap reconstructions have been reported in the past for these distal femur nonunions, this flap has seldom been used as a pedicled variety. Through this article, we aimed at highlighting the main obstacles faced while using pedicled corticoperiosteal flap for these patients given its dearth in literature. Five patients of at least two previously failed osteosynthesis for distal femur fracture non-union were selected for performing corticoperiosteal flaps. The intraoperative findings that were both favourable and unfavourable were documented along with the outcome of procedure in the form of callus formation or fracture healing. Dissection of the flap was more tedious in these cases than when performed for a different indication in a virgin territory. However, despite the previous trauma resulting in decreased pliability of their vessels, all flaps were viable at the end of procedure with favourable cosmetic and functional outcomes. Despite the complexities in flap harvest, use of the less morbid and technically easier "Pedicled corticoperiosteal flap" and osteosynthesis along with the auto technique is a worthwhile option for retaining the native joint with favourable outcome in non-unions of distal femur. [ABSTRACT FROM AUTHOR]

Abstract: Large quantities of rice husk ash (RHA), bagasse ash (BA) and coal fly ash (FA) are available in many Asian countries as waste materials, which create a serious disposal problem. Recycling of these ashes on agricultural land can help to improve physical and chemical fertility of soil. The present field experiment was conducted for three and half years to explore the possibilities to utilize these waste materials as soil amendments to improve productivity of rice–wheat system (RWS). The treatments consisted of application of RHA and BA at 10Mgha−1 to either wheat or to rice or to both wheat and rice and 20Mgha−1 to rice alone. The rates used for FA were 15 and 30Mgha−1. Addition of RHA and BA significantly increased the grain yield of wheat and rice but FA caused small increases in crop yields. Direct application of RHA and BA to wheat was significantly superior than their application to rice in the RWS. Direct application of RHA and BA to wheat resulted in 25 and 24% increase in mean grain yield of wheat and 10 and 11% increase in subsequent rice crop, respectively. However, direct application to rice resulted in 8 and 11% yield increase in rice and 10 and 14% increase in subsequent wheat for RHA and BA, respectively. Application of RHA and BA at 20Mgha−1 to rice resulted in lower RWS productivity than that applied at 10Mgha−1 to wheat. There was no significant effect of these ashes on heavy metal contents in grain and straw of the 7th crop of wheat. Application of three types of ashes generally resulted in positive P balance in RWS, however, K balance remained negative. These results suggest that RHA and BA can be recycled successfully in rice–wheat system to improve its productivity with no adverse effect on soil health. [Copyright &y& Elsevier]